Post by Lαrα on Jun 19, 2014 2:36:15 GMT -8
Effective bladder management for people with Spinal Cord Injury is a big issue in terms of health and lifestyle. So choosing and finding the best option of emptying your bladder needs careful consideration.
So when discussing bladder management with your medical advisor think about how your management needs to fit in with your daily routine and life. You will need to consider the practicalities
If your injury level is high, hand function may be impaired so self intermittent catheterising may be difficult. Of course you can be assisted with this but there are other options of bladder emptying.
The alternatives to self intermittent catheterising that are commonly available are indwellings catheters, condom catheters (for men) and Suprapubic catheters....
On this thread we are discussing Suprapubic Catheterisation 
So what is a Suprapubic catheter?
This is a catheter that goes directly to the bladder via the abdomen. It stays in place and then the bladder voids into a bag as it would if using an indwelling catheter via the urethra.
A hollow flexible tube that is used to drain urine from the bladder. It is inserted into the bladder through a cut in the tummy, a few inches below the navel (tummy button).
What happens to the urine?
You can choose from two options:
Free drainage - This is where the urine drains out from the catheter and into a drainage bag.
Catheter valve - a valve at the end of the catheter used in place of a drainage bag. Urine is stored in the bladder and is emptied through the catheter straight into the toilet or bag.
Female Male
What does the procedure involve of having a Suprapubic catheter fitted ?
The procedure is usually carried out in Theatre by a surgeon. A general anaesthetic or a spinal anaesthetic will be used, depending on the level of your spinal cord lesion and any associated condition, such as autonomic dysreflexia.
What are the advantages of a Suprapubic catheter as bladder management?
-When a urethral catheter is used, the urethra may become damaged over a period of time, resulting in urinary leakage around the catheter. Additionally the balloon of a urethral catheter can cause damage to the bladder neck, leading to urinary leakage. A catheter that is forced through the external sphincter can cause damage.
-The catheter is less likely to be sat on and accidentally ‘pulled’.
-If a suprapubic catheter becomes blocked, urine can drain via the urethra (although this may not be possible for everyone). This can act as a ‘safety net’ if you suffer from autonomic dysreflexia when your catheter blocks. With a suprapubic catheter you have an alternative entry point to your bladder (via the urethra), if problems occur with a blocked suprapubic catheter or a catheter cannot be passed suprapubically.
-It helps your sex life!..A suprapubic catheter leaves your genitals free for sexual activity as oppose to an indwelling or a catheter condom.
-It is easier to maintain hygiene around the site of a suprapubic catheter.
-If you have adequate hand function you can be taught to change your suprapubic catheter. The site of a suprapubic catheter is more accessible to you than the urethra.
-The procedure is reversible. The suprapubic site will heal quickly on permanent removal of the catheter.
-A larger size catheter can be used suprapubically, reducing the risk of blocked catheter. Urethral catheters should not exceed size 14Ch, whereas a suprapubic catheter can be gradually increased over a period of time from a size 16Ch up to a size 20Ch.
Disadvantages of a Suprapubic Catheter
-A small minority of people experience hypersensitivity around the suprapubic catheter site, but this often reduces with time.
-If you are very overweight it may be difficult to site the catheter.
-The catheter site may produce a discharge. In some people this dries up after a few weeks, but in others it may be persistent. It may be necessary to wear a simple dressing over the site.
-You may notice an increase in spasm in the subsequent weeks
-The Spinal Centre advises that an indwelling catheter should be changed every 6-8 weeks by a District Nurse, Carer or yourself (if able).
-All indwelling catheters are more likely to cause urinary tract infections and bladder stones, than other bladder management methods such as intermittent catheterisation or sheath drainage.
-Over time you may suffer from frequent catheter blockages which may require you to have a cystoscopy (a surgical procedure in which the inside of your bladder is viewed and is washed out).
Types of Suprapubic Catheters
If you have a latex allergy you will need to use 100% silicone catheters. These can be more difficult to remove from the suprapubic site than other catheters.
NB some 100% silicone catheters are not licensed for suprapubic use The usual type used is a hydrogel coated latex catheter.
In Theatre a size 16Ch catheter is usually inserted.
At the first catheter change an attempt is made to replace the size 16Ch catheter with a size 18Ch catheter.
The size of catheter can be reviewed at each subsequent change, usually up to a size 20Ch, if necessary.
The larger the catheter, the larger the drainage holes, which reduces the frequency of catheter blockages.
How do I look after my suprapubic catheter?
Always remember to wash your hands before and after emptying your catheter bag, or before and after emptying your bladder using the valve.
You should wash the area around the insertion site with cooled boiled water. Some people find cleaning the wound with a sterile saline solution a good method of keeping the area clean.
A dressing will cover the wound after the operation and you should keep it in place until the wound has healed. Many people prefer to wear a dressing around the wound all the time although this isnt necessary.
The type of dressing may vary. Some people use a dry gauze swab but using tape to secure it can be difficult sometimes due to pubic hair. Dressings with a hole in them have proved successful for some people. Avoid using creams or talc around the site.
After the operation It is advised to take showers rather than baths as sitting in water for long periods may delay the wound from healing. For the first few days after the operation, you should keep a waterproof dressing on. Once the wound has healed it is perfectly okay to shower normally, although avoid using scented products as these can irritate the skin.
Source
Related threads:
Bladder Capacity and 'Back up'
The Neurogenic Bladder and Retention
