NURSING PATIENT CARE POLICY & PROCEDURE
May 27, 2015
Nov. 24, 2017
Nursing Manual (Red)
Policy #: 3.18A
Title: Replacement and Care of a
Suprapubic Catheter (Adult)
To provide guidance for replacement and care of a suprapubic catheter.
II. POLICY STATEMENT
A. After the initial catheter change, a registered nurse (RN) may perform the subsequent
catheter changes on any inpatient unit, clinic or home health setting as ordered and/or
B. In the Emergency Department, an Emergency Medicine provider will attempt to
change or replace a catheter and if unsuccessful will page the Urology resident on
A. Sterile disposable urethral catheterization tray, without catheter
B. Catheter of appropriate size as ordered by physician and licensed as appropriate for
C. 1 sterile disposable syringe with sterile water of appropriate size for balloon inflation
D. 1 sterile disposable syringe large enough to remove volume of sterile water from
existing catheter balloon
E. 1 sterile ABD pad
F. Nonsterile Drape sheet, e.g., bath blanket, chux pad
G. 4 x 4 (10 cm x 10 cm) sterile pre-cut drainage gauze dressing
H. Normal saline
I. Sterile drainage bag and tubing
J. Irrigation kit
A. Determine appropriate size of catheter and balloon, amount of sterile water to be
injected into the balloon, frequency of catheter change, and if a specimen(s) is to be
obtained. Also determine amount of fluid currently present in the balloon.
1. For adults, large-size indwelling catheters with a 10 mL or 30 mL balloon are
usually used for suprapubic catheters (#18 – #26 Fr.).
2. The first catheter change following a suprapubic cystostomy is performed by a
physician (or mid-level provider trained in suprapubic replacement and approved
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by physician) because the tract the catheter passes through may not yet be patent
(may take six weeks to six months to establish).
3. Existing drainage bag and tubing are discarded at the time the catheter is changed
or removed and replaced with new supplies. Indications for changing any portion
of the drainage system, including the catheter, include:
a. Contamination of any internal part of the system
b. Obstruction of tubing (sediment, stones, encrustations or clots)
c. Poor flow
d. Leakage (either around catheter and/or urethral)
B. Perform hand hygiene according to UW Health Clinical Policy 4.1.13, Hand Hygiene.
C. Place patient supine.
D. Don clean gloves.
E. Place underpad under patient’s hips, remove any dressings, and drape as necessary.
F. Place ABD pad on patient's abdomen to absorb any urine that may leak from the
G. Detach catheter from connecting tubing.
H. Remove gloves and perform hand hygiene according to UW Health Clinical Policy
4.1.13, Hand Hygiene.
I. Open catheterization tray while maintaining the sterility of the system. Supplies
should be ready before the old catheter is removed. The suprapubic opening
may close quickly and be more difficult to access with catheter changes.
J. Don clean gloves
K. Deflate balloon by inserting a sterile syringe in side arm of the catheter; withdraw all
solution. Note the amount of solution removed from balloon to assure complete
L. Remove catheter and inspect. Note any discoloration, encrustations, or sandy material
in the catheter.
M. Doff gloves, perform hand hygiene according to UW Health Clinical Policy 4.1.13,
Hand Hygiene, and put on sterile gloves.
N. Open disinfectant solution and pour over the 5 rayon balls in one compartment or
open iodophor swabs if not allergic to iodine. If allergic to iodine, substitute with 4%
CHG solution and sterile water soaked 4X4’s.
O. Place fenestrated sheet over abdomen and expose the suprapubic opening.
P. Squeeze a large amount of lubricant onto the sterile field. Do not place lubricant in
the collecting container; it may alter the findings if included in specimen.
Q. Clean the suprapubic opening and area with iodophor swabs (or with Povidine-iodine
moistened rayon balls using forceps, or with chlorhexidine solution 4% and sterile
water soaked 4 x 4s, cleansing from the opening outward. Use 1 swab, ball or 4 x 4
for each stroke.
R. Lubricate catheter well and insert into the suprapubic opening and allow for urine to
drain. The bladder may be 1-5 inches deep.
S. Insert syringe into lumen of the side arm. Inflate catheter balloon using sterile water.
Record amount of fluid used. Gentle traction may be applied until resistance is felt
from the balloon against the bladder wall.
T. Obtain urine specimen(s) if ordered, then allow urine to flow into the collection
U. If no drainage is seen, irrigate catheter with 30-60 mL of sterile saline in a Toomey
syringe to check placement.
V. Connect catheter to new drainage tubing and bag.
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W. Watch for free drainage. Note color of urine, presence of clots, mucus, blood, etc.
X. Attach drainage tubing straight from the drainage bag to the bed (bladder level) and
secure to sheet with plastic clamp (or tape and pin):
1. Position of the catheter and tubing results in downward flow of urine by the force
2. Faulty positioning of tubing (below the level of the drainage bag or convoluted)
requires greater pressure than gravity to move the urine into the collecting bag.
Pooled urine may then become a culture medium for bacteria and permit
retrograde migration of organisms.
3. Drainage bag must always be below level of bladder to prevent retrograde flow.
Y. Cleanse area around the suprapubic tube with normal saline while in the hospital or
antibacterial soap and water when at home. Place a pre-slit 4 x 4 (10 cm x 10
cm) dressing around the catheter to absorb any drainage. Make patient comfortable;
discard disposables. Suprapubic catheter site care is performed twice daily or as
ordered by physician. Empty the drainage bag every 8 hours or more frequently as
1. For patients using leg bags during the day, connect the catheter to the leg bag;
cover drainage tubing with protective cap from the leg bag.
2. Separation of the drainage tubing from the catheter is to be avoided since
contamination allows organisms to reach the bladder in a matter of hours.
Z. Record in patient's clinical record the indications for changing the catheter, size of
catheter and balloon, amount of sterile water injected into the balloon and any
V. UW HEALTH CROSS REFERENCE
UW Health Clinical Policy 4.1.13, Hand Hygiene
A. Bullman, S. (2011). Ins and outs of suprapubic catheters: A clinician’s experience.
Urologic Nursing, 31(5), 259-263.
B. Chapple, A., Prinjha, S., Mangnall, J. (2013). Changing a urethral or suprapubic
catheter: the patient’s perspective. British Journal of Community Nursing, 18(12),
C. Harrison, S. C.W., Lawrence. W.T., Morley, R., Pearce, I., & Taylor, J. (2011).
British Association of Urological Surgeons’ suprapubic catheter practice guidelines.
International Journal of Urologic Nursing, 5(3), 146-149.
D. Payne, D. (2014). How to…care for catheters. Nursing and Residential Care, 16(9),
E. Perry, A. G., & Potter, P. A. (2010). Clinical Nursing Skills and Techniques, 7
St. Louis, MO: Mosby Elsevier.
F. Rewm, N., & Smith, R. (2011). Reducing infection through the use of suprapubic
catheters. Neurogenic Bladder Supplement, 7(5), S13-S16.
G. Robinson, J. (2008). Insertion, care and management of suprapubic catheters. Nursing
Standard, 23(8), 49-56.
H. Tompkins, A.J., Travis, M., Watne, R.E., Lasser, M., & Ellsworth, P. (2014).
Decreasing Suprapubic Tube-Related Injuries: Results of Case Series and
Comprehensive Literature Review. Urologic Nursing, 34(1), 9-17.
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VII. REVIEWED BY
Clinical Nurse Manager, Gynecology, Urology, Otolaryngology, Plastics
Clinical Nurse Specialist, Inpatient Psychiatry & Gynecology, Urology, Otolaryngology,
Nurse Clinician, Urology Clinic
Nurse Clinician, Urology Unit Staff
Sr. Clinical Infection Control Practitioner, Infection Control
Nursing Patient Care Policy and Procedure Committee, May 2015
Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive