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Blind insertion of suprapubic catheter should not be undertaken in obese patients

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – It’s reasonable to insert a suprapubic catheter using a closed technique when the distended bladder is readily palpable; however, when the bladder cannot be palpated because of obesity, blind insertion should not be undertaken.

Those are two of a score of recommendations contained in practice guidelines on suprapubic catheter procedures and management issued by the British Association of Urological Surgeons and published online November 4 in BJU International.

Dr. Simon Harrison, with Pinderfields General Hospital in Wakefield, UK, and a panel of experts note that suprapubic catheterization is widely used and is generally safe, but there is a small risk of serious complications. The panel hopes the guidelines they developed “will assist in minimising morbidity associated with SPC (suprapubic catheter) usage.”

The first general recommendation is that “Clinicians who are involved in the management of patients with long-term catheters should consider in each case whether an SPC would offer advantages to the patient over the use of a urethral catheter.”

In discussing suprapubic catheterization procedures, the panel recommends that a general or regional anesthetic should be used if the bladder cannot be comfortably filled with at least 300 mL of fluid and in spinal cord injury patients with an injury level of T6 or above. Also, antibiotic prophylaxis is recommended for patients when it’s likely the urine is colonized with bacteria.

While it is reasonable to use a closed technique when the bladder is palpable, this is only applies if urine can first be easily aspirated from the bladder using a needle passed along the planned catheter track, the authors advise.

As mentioned, blind insertion is not recommended in obese patients. “In such circumstances, ultrasonography may be used to identify the distended bladder or cystoscopy may be used to ensure that an aspirating needle on the planned catheter track is entering the bladder at an appropriate point on the anterior bladder wall.”

Among recommendations for the long-term management of SPCs, the authors suggest the use of a drainage valve rather than free continuous drainage, as long as the bladder provides safe urine storage. Also, they say that systemic antibiotics should not be used to treat any local pericatheter discharge.

In concluding, Dr. Harrison and colleagues note that there is a “conspicuous” lack of research in this area. “Recurrent catheter-related urinary tract infections and repeated catheter blockages are frequently encountered in clinical practice and place a burden on the patient as well as on the resources of their supporting clinical teams,” they point out. “These are topics that should be a high priority for research efforts.”

Reference:

British Association of Urological Surgeons’ suprapubic catheter practice guidelines

BJU Int 2010;