Procedure for changing supra-pubic catheter

If a supra-pubic catheter falls out it must be reinserted within 30- 45 minutes¹⁷ or the insertion site in the abdominal wall may close and make it difficult, if not impossible, to reintroduce. Therefore, the patient must be warned that if their catheter falls out, they must notify their nurse AT ONCE.

If unable to contact the district nurse the patient should access the emergency contact details.

Please note:

• Prior to opening packs and commencing the procedure, it may be necessary to cleanse the ostomy site with soap and water.
• If encrustation is suspected prior to changing the catheter, a catheter maintenance solution (SubiG/Sol R) may be instilled half an hour prior to removal.
• Two catheters should always be available in event of fault or contamination to the first.
• Once the channel has been established a Silicone Foley or Hydrogel catheter with a minimum size 16ch with a 10ml retention balloon can be used.
• If clots or debris is present a size 18ch or 20ch may be necessary.
• Catheters over 20ch should be unnecessary, except on the instructions of the urologist.

Equipment

• Instillagel
• Alcohol hand rub
• Sterile syringe
• PPE
• Sterile dressing pack, containing galipot and disposable swabs
• Fixation device
• Drainage bag
• Pre-filled syringe with sterile water/glycerine
• Disposable bag as per Waste Management Policy
• Gloves: 2 pairs sterile nitrile gloves and 1 pair non-sterile
• Clinical waste bag in accordance with Waste Management Policy.

Procedure

Action

1. Explain the procedure to the patient.
2. Assist the patient to get into supine position with the legs extended.
3. Ensure comfort, privacy and modesty.
4. Decontaminate hands as per the WHO 5 moments for hand hygiene.
5. Prepare equipment required on a clean working surface.
6. Open the outer cover of the dressing pack.
7. Using an aseptic technique, open the supplementary packs.
   
   Catheter change
8. Decontaminate hands as per the WHO 5 moments for hand hygiene.
   Put on PPE.
9. Deflate the balloon with syringe - ensure completely deflated. Withdraw the catheter from the tract. You may need to turn the catheter a little and there may be a gush of urine as you withdraw it - therefore have some gauze ready. Note the angle that the catheter is withdrawn at, to aid the insertion of the new catheter.
10. Discard old catheter as per Waste Management Policy. Re-apply sterile gloves.
11. Clean insertion site with saline solution.
    Insert Instillagel into tract for 3-5 mins as per manufacturer's guidelines.
12. Remove gloves and decontaminate hands as per the WHO 5 moments for hand hygiene.
13. Re-apply gloves.
14. Insert new catheter so that the same length has been inserted into the bladder at the same angle. There may be some resistance felt at the bladder wall therefore apply gentle pressure to ensure the catheter enters the bladder. Avoid inserting the catheter further than the previous one as it may find its way into the urethra.
15. Ensure that urine is draining through the new catheter 30-50mls.
16. Inflate the balloon according to the manufacturer’s direction with sterile water, and ensure the catheter is draining properly beforehand. Inadvertent inflation of the balloon in the urethra causes pain and urethral trauma. Deflate the balloon, remove immediately and seek advice.
17. Attach catheter to drainage collection system and then attach the fixation device.
18. Remove PPE and decontaminate hands as per the WHO 5 moments for hand hygiene.
19. Ensure the patient is comfortable and that clothing is adjusted before leaving the patient.
20. Dispose of equipment as per Waste Management Policy.
21. Implement appropriate documentation e.g. patient held record/CAUTI bundle.