Suprapubic bladder catheterization is a procedure used to access the bladder when transurethral approaches are not feasible or appropriate. It involves puncturing the bladder through the abdominal wall to insert a catheter.

Indications

Therapeutic:

• When a transurethral catheter cannot be placed (e.g., urethral stricture)
• Long-term catheterization

Diagnostic:

• Microbiological urine analysis

Contraindications

• Coagulation Disorders: INR > 1.5, Quick < 50%, PTT > 50 seconds, platelets < 50,000/µl
• Bladder Cancer: Presence of malignancy in the bladder

Complications

• Injury to intra-abdominal organs
• Peritonitis

Materials Needed

• Catheter Set: (e.g., Cystofix)
• Local Anesthetic: (e.g., 0.5–1% lidocaine)
• Scalpel
• Urine Bag
• Sterile Supplies: Gloves, swabs, drapes, disinfectant
• Additional Equipment: Syringes, sterile water, gauze, needles, single-use razor, dressing material, kidney dish

Procedure

Prerequisite: A full bladder.

Tip: If the bladder is not naturally full, it can be retrogradely filled with 0.9% NaCl using an indwelling catheter.

• Identify Puncture Site:
  • Use ultrasound to determine the bladder’s position and fullness.
  • Optimal puncture site is 2–3 cm above the symphysis pubis along the midline.
• Prepare the Area:
  • Shave and disinfect the puncture site thoroughly.
  • Cover the area with a sterile drape and wear sterile gloves.
• Puncture and Aspiration:
  • Attach a syringe to the puncture needle and insert it perpendicular to the skin while aspirating.
  • Stop advancing once urine flows into the syringe.
• For Catheterization:
  • Administer local anesthesia up to the bladder wall, aspirating regularly. Note the depth at which urine is aspirated.
  • Make a small skin incision with a scalpel.
  • Insert the catheter needle (with the catheter inside) perpendicular to the skin.
  • Once urine flows, advance the catheter further and remove the needle.
  • For balloon catheters, inflate the balloon with 5 ml of sterile water and gently retract the catheter until resistance is felt.
  • For non-balloon catheters, retract to the marked position and secure with a suture or specialized holder.
  • Connect the catheter to a sterile urine bag, secure it, and apply a sterile dressing.

Long-term Catheter Replacement

• Suprapubic catheters should be replaced at least every 8 weeks. Specialized catheter replacement sets are available.
• If urine appears cloudy, encrusted, or shows signs of infection, the catheter must be replaced immediately.

Antibiotic Prophylaxis

• The lower urinary tract is prone to infection during any manipulation.
• Common pathogens include E. coli, Enterococci, Staphylococcus spp., and Pseudomonas.
• Current guidelines do not recommend antibiotic prophylaxis for transurethral or suprapubic catheters.
• Sterile technique and equipment are the best preventive measures.