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Changing Supra Pubic Catheters

It is important to use a sterile technique when changing supra pubic catheters. It is also a good idea to watch a doctor or nurse perform a supra pubic catheter change before you attempt to do your first one. Check that the old and new catheters are the same size. Look for matching numbers eg: 18fr and that the catheter port ring colors match. A supra pubic catheter change of different sizes should only be performed in a hospital by qualified medical staff.

Why and how often to change a supra pubic catheter depends on the user and catheter type. Catheters are durable but they do not last forever. The longer a catheter is left in the more chance of infection, blockage, sticking and other problems. Depending on the type of catheter, they have a shelf life of several years and use life of one to three months max. Silicone Foley and silver coated catheters may be changed every 3 months. Check the catheter packaging for details.

Changing Supra Pubic Catheters Silicone Foley

NOTE: I take no responsibility for how you use or misuse these guides or any problems that may result from that use. Many have asked me things about changing supra pubic catheters. This is only my personal experience (and explanations). In an emergency such as a blocked catheter call an emergency service! In the event that is not possible and the situation is life threatening, here is a quick emergency 3 step guide to changing supra pubic catheters. You can do this in a seated position or laying flat. Please only attempt this if you have already called emergency services and you are really, really desperate.

3 Step Emergency Supra Pubic Catheter Change

  1. Plug a 10cc syringe onto the old catheter port and deflate the catheter balloon.
  2. Remove the old catheter and insert the new one as far in as the old one was.
  3. Plug the 10cc syringe onto the new catheter port and inflate the balloon.

I have had to do this and survived. Sterility comes second in an emergency. Your first supra pubic catheter change should be done by a doctor or a nurse six weeks after install.

10 Step Easy Safe Supra Pubic Catheter Change

Catheter Change Equipment:

  • Catheter change pack (often these include all below but the new catheter and drain bag).
  • Lubricant (to lessen the pain and ease the new catheter in).
  • New sterile catheter of appropriate size (to replace the old catheter).
  • New drainage bag (don’t plug a dirty drain bag onto a sterile catheter).
  • Pair of sterile gloves (to avoid infection).
  • Sterile saline or water (to inflate the catheter balloon).
  • Two 10cc syringes (one to deflate and one inflate the balloon).

Catheter Change Method:

Have the supra pubic catheter user take a big drink of water and lay face up. Thoroughly wash your hands and forearms, remove any dressing, and clean around the supra pubic catheter site. Prepare your workspace. Then take a deep breath and try to relax. We know it can be a daunting task. My mother has been changing supra pubic catheters for years. My beautiful Mum has done 100’s of catheter changes for me and still gets nervous every time I ask her too. I love you Mum.

Caution: When changing supra pubic catheters note how far the old one was inserted. This is where most people go wrong. I have bleed from the penis for days because a new catheter was pushed in to far. On two occasions at the hands of doctors who failed to make this vital observation. You can mark the old catheter with a pen or clip something onto it near the skins surface prior to removal if you wish.

  1. Using a sterile method open out your catheter change pack and check for or add; a new sterile catheter (open the packet dropping the catheter onto your sterile field), two 10cc syringes, sterile saline or water, a sterile lubricant and gloves.
  2. Wash your hands and forearms thoroughly and dry with a clean dry towel.
  3. Using a sterile technique put the gloves on.
  4. Open the lubricant and apply it liberally to the first two inches of the catheter tip (that is the pointy end where the eyelets are).
  5. Fill one 10cc syringe with 8cc of saline (or clean water) and plug it firmly onto the new catheter port (where the colored ring is, you may test inflate the balloon at this point if you wish, but don’t waste time).
  6. Plug the second empty 10cc syringe onto the old catheter port and draw back on it to deflate the balloon (it may have less than 8cc). Remove the catheter (you may feel some mild resistance. If you are sure the balloon is fully deflated, it’s alright to give it a little tug). 
  7. As you withdraw the old catheter it is VERY important to note how far in it was. Also note, your hands are now no longer sterile.
  8. Pick up the pre-lubricated catheter and insert it. Only push it in as far as the previous catheter was (if you insert it too far it may go into a ureter or the urethra).
  9. A little bleeding is common after changing supra pubic catheters. If some urine starts to flow it usually means you have the catheter in the correct position. Keep holding the catheter in position and slowly inflate the balloon with 8cc of sterile water. Once the syringe is empty unplug it from the catheter port.
  10. Attach a new clean drainage bag.

Congratulations you are done.

Tips on Changing Supra Pubic Catheters

  • A quick change is a good change.
  • Using a topical numbing gel around the catheter site prior to change to help ease pain.
  • Sterilize water by boiling and set aside until cool.
  • Do not leave a person alone after changing supra pubic catheters. Watch for any bleeding or adverse reactions.
  • A few blood clots in the tubing are common. If it lasts for more than a few hours something may be wrong.
  • Some bleeding is common after changing supra pubic catheters. If it lasts for more than an hour something is likely to be wrong.
  • Profuse bleeding at the site, in the tube, or from anywhere else is not common. If it lasts for more than five minutes something is terribly wrong. Call a doctor.
  • Check, and if needed top up the amount of fluid in a catheter balloon every four weeks.
  • Never leave a supra pubic catheter out for more than a few minutes.
  • Never cut a catheter trying to release it.

Resources

 

49 thoughts on “Changing Supra Pubic Catheters”

  1. This information is so useful. I am going for surgery this week to have a suprapubic cath installed. My urologist is sparse with the information and even my family dr was not overly familiar with spc’s.

  2. I have a question my urologist kind of shrugged off. I was using a regular indwelling catheter for a few years but my bladder started rejecting them. Are there other catheters for supra pubic besides foley. Has anyone else had a spasming bladder?

  3. Hi MissPies, Foley is the name of the original designer, surgeon Frederick Foley of Boston, Massachusetts, in1930. Catheters have since evolved into many brands made from modern materials. Silicone Foley catheters have lead the market for some time. More recently silver coated Foley catheters are proving popular for comfort which means less spasm, and less urinary tract infections. We cover these and anti-spasm medications in detail here: super supra pubic catheters

    IDC, SPC, CIC… All bladder drainage catheters are essentially Foley, and have Dr. Foley to thank for his brilliant initial concept. A flexible tube passed into the bladder held in place by a balloon. The tube has two separate channels. One is open at both ends, to allow urine to drain into a collection device. The other has a port (with valve) on the external end to inflate the internal balloon holding it in place.

  4. Hi Graham, thanks for your response. I was aware of all the different types and origin of the foley. My body doesn’t seem to tolerate the balloon – my bladder has become very tiny (I really do have TB haha). My family doc said he thought there were other kinds. I don’t want to go thro surgery to have this rejected. Any insight?

  5. Hi Graham, I,m back. I read further and note that my bladder may be the size of a grape and the meds I could use to stop or control spasms. This site is amazing. The info is so accurate, at least according to my expanding awareness. I hope my bladder will give me another chance at catheters. Not having a cath is sentencing me to the house and daily laundry. Very dis-couraging. Thank you for such a great sight.

  6. I have lived with my Supra pubic catheter for the past 11 months and like other contributors to this site I received virtually no in depth instruction from any of the medical people involved. I have since done my own research and with the experience of ‘using’ the catheter I now feel much more confident and manage it with ease. The biggest step forward for me was the discovery of the ‘belly bag’ which I cannot praise enough. It allows me to play golf and do other activities which were very difficult when using the ‘leg bag’. Points of interest: When using the belly bag out of the wrapper be aware that the ‘nozzle’ is slightly open and must be fully closed to avoid leakage and after emptying the bag ensure that the nozzle is fully closed.

  7. My poor husband is currently suffering and has suffered for the last month because he is having pain in his penis and also some bleeding episodes at the head of his penis. He currently is urinating through his penis, at least some of the time, bypassing the catheter.

    He is under Hospice and they change the catheter out once a month, primarily because there is so much sediment in my husband’s urine.

    After reading your article, I suspect that they are putting the tube in too far.

    Your website is so appreciated, I’m sure. Such helpful info!

  8. Im going on 5yrs with sp tube, the last 3months ive been changing my catheter like every 10 days becauseit gets clogged up with white rocky stuff , and urine is fine but I also see like thick milky stuff floating in my leg bag. Does any one have idea how to take care of this? is my bladder filled with puss?

  9. I use belly bag for years. how can bladder drain fully using belly bag since it’s located so close to bladder. shouldn’t catheter hang down so it can empty. i have had my share of UTI’S. every once in awhile my bladder lets loose expelling a LARGE amount of urine with no warning. i can’t find a pad that will absorb all of it. i’m afraid to leave the house. i change cath every other month with no problems. any help would be appreciated.

  10. Jay it sounds like you have bladder stones. My client had them bad for months and her doctor perscribed her a medicine we irrigate with to inhibit the stones from forming. Weve finally got them under control but it took at least 6 months. Talk with your doctor to see if you should start doing that as well. Even irrigating with saline solution will help move the sediment around to keep the tube from blocking, though i will warn you, its not comfortable.

  11. I current have a SPC for a month and I am having pain in my penis. It feels as if my bladder is contracting and let thr urine flow. This is very painful can someone help please

  12. The last tip says “Never cut a catheter trying to release it”
    Why ? What is the problem ? I am about to try it myself

  14. my wife supper pubic blocks at least ever 1 to 2 weeks this is very upsetting for her help

  15. I’m having my surgery the 13th. Any advice. Can anyone tell me where to get belly bags? I’m a hands on medically capable girl does this mean I could change the SP foley myself?? Thanks everyone! ALL input is needed and appreciated!!!

  16. Jay, Do you use any medication for heartburn? Gaviscon is known to block catheters. If you use gaviscon it might be worth asking your GP to prescribe an alternative eg omeprazole.

  17. hi for anyone having trouble with the ballon. iv had this problem where the ballon felt like it was cutting me, real painfull.after trying several cath sizes, and still having this problem, i tried a child pediatric cath, the baloon only inflates to a 5ml its great, i dont even no i have it in. im only a small framed female, so maybe that is why i could not tolerate the adult ones.

  18. The balloon would not be cutting what you have perhaps felt is the tip and drainage eyes cutting the bladder wall. I would be interest to learn how the small cath is doing regarding clogging and amount of drainage volume?

    Thanks
    Greg

  19. i’ve been using supra catheters for almost ten yrs.for some reason i’m unable to get urine flow.i’ve taken all the normal steps,checked tube for malfunction,still no urine.anyone have any other suggestions?

  20. Ive had my suprapubic catheter for 16 months now. I have had it changed a number of the time the only problem being it gets a bit stuck. I had it changed yesterday and for the first time with not a lot if pain. When the balloon was being inflated it hurt a bit. I told the nurse, she said its fine. I then struggled with it for the rest of the evening and had to ring the night nurses out. They said they though the balloon was in the wrong place so took it out and put another catheter in. Today I’m suffering a lot of pain and can really feel the balloon. Was just looking to see if anyone else has had this problem or a bit of advice. Thank you Charlotte

  21. Hey charlotte,
    It sounds like the nurse didnt push the catheter up far enough, so when she inflated the balloon it inflated in your urethra. From what i’ve heard just keep the catheter from sitting at the bottom of your bladder because that can prolongue the healing process, and make sure it doesnt get pulled. Since I only know about these things from experience and not from school, it might be a good idea to talk with a nurse about what damages this can cause. If your pee looks especially dark, make sure the nurses know because that is a sign of blood in your urine. It sounds like its not too serious, you just have to let it heal and hopefully the nurses will be more careful next time!

  22. Thank you for your response. I’ve taken some orca morph and the pains settled. I’m wondering if the nurse will get a telling off. I really hope not because she’s so lovely and don’t want to get her in to any trouble. Charlotte

  24. Oh good i’m glad you found something for the pain and it wasn’t more serious then what I thought. Hopefully they will pardon her because it is easy to make that mistake!

  25. The balloon was in the wrong place. The night nurses come and changed the catheter again. Pain and discomfort settled straight away when they had sorted it out. Thank god

  26. Hi Charlotte

    I was reviewing the last several comments and wanted to ensure i correctly understood the events you had mentioned.

    I was understanding you are SPT for the past 1 1/2 years? So I do not believe the balloon was positioned incorrectly. Surely it would have nothing to do with being inflated in your Urethra, as two totally different paths are utilized. So that clarifies the balloon item and also perhaps takes some of the blame off the nurse. Respectfully if it was inflated in your urethra much more serious clinical issues would have taken place.

    If you had a traditional 100% silicone, which all long term catheter users should, employ it may have been the balloon “cuffing” upon removal.

    Traditional silicone manufactures do not fabricate a top quality silicone catheter. The market and money I am afraid and sad to say is in the hospital markets, where latex is mainly sold and has higher profit margins for the industry leader (CR Bard). So that is probably what occurred and caused the pain.

    Also another possible issue may have been the bladder wall being stuck in the drainage eyes of the catheter. When the nurse began removing it it pulled the lining and caused pain.

    I hope my understanding was/is correct.

    Sincerely,

    Greg

  27. Oh your right I accidentally wrote urethra instead of sup tract! Can the suprapubic catheter have the same problem of being inflated in the tract? I was imagining it was inside the bladder while it was being inflated but the bottom part of the balloon was inflated partially in the tract. She said the catheter change didn’t hurt this time, which is why I thought it was problems with the insertion, not damage caused from removing the catheter

  28. There can be many possibilities right. My reason for looking somewhere other than the balloon was in knowing the general shape of the balloon would not allow it to stay in the canal. As she mentioned “in pain for a long time”, if it was in canal it only would have been partly. If it was completely inflated in the middle with 10mL as mentioned about urethral balloon inflation she would have had much more sever issues. This would have been a dilation in the extreme.

    May be but not probable

    Sincerely,
    Greg

  29. I will have the surgery on Jan. 10the for the pubic catheter. Any
    advice would be greatly appreciated.

  30. It’s been 1 month since my surgery and after going to my first post op appt I told my surgeon that the past several days I was having a pressure in my penis and experienced a little leakage from same and he told me not to worry it will go away. My question is, has anyone else experienced this. At times the feeling that I have to urinate and it is very uncomfortable.
    My second question is, I have to have my first change in 4 weeks, and I have a low tolerance to pain (yes I’m a woosy) and my fear of the unknown has been making me crazy. Can anyone share with me what it is like as far as what should I expect as far as pain?
    Thank you for this site, it has been real informative !
    Bob

  31. Bob; read through some of the comments above. You are not alone with low pain tolerance. Many find taking an over the counter painkiller is all the help they need. I don’t advise it for first change, as it limits what stronger medications they can give you, should you need them. Also you may be worried over nothing as the majority by far have pain free changes but you don’t state any spinal cord injury level. For the leakage ask your doctor about a drug like Ditropan to ease bladder spasms.

  32. Sylvia; it’s a reversible, fairly simple procedure so relax. Limit activity afterwards, keep it clean etc… everything you need to know is in the article. Good luck tomorrow.

  33. Hi I wonder if anyone can help me out? Im a reg.Nurse working in a Dementia unit I have a patient who pulls his supra pubic catheter out sometimes with balloon still inflated! How far do I put the new catheter in? I havent done many and have only just done the course so this worries me no end! Thanks for any advice anyone can give me

  34. hi .any one every had a spc change, that as been real comfy then 6week plus you can feel the balloon rubbing ?

  35. I have had my SPC for about 7 mths I have had more good luck with this than the indwelling. I still battle infections and lots of bladder spasms. What medication is out there for the spasms? Losing faith
    I am an under 40 yr old female that lost the use of my bladder after contracting meningitis. I am looking for answers as this is a life long thing now so I want to help myself live better.
    Thank you
    Naomi

  36. Hi everyone,
    I just started my own tube changes. I have a spastic bladder and have had a SPC for 6 yrs. I have full sensation but have lost the use of my legs and have limited use of my arms due to neurological disease. I have done 4 changes and found having a intermittent catheter on hand helpful. My first change I could not get the new tube in. I had a partial box of intermittent catheters left over from the early days and was able to insert and drain. We used warm compresses on my abdomen, waited the spasms out and were successful. We have had to use this method twice and now I include an intermittent tube in my emergency kit I carry with me. Thanks for all your support,
    Laurie

  37. Hi. Im due to have my super pubic changed on monday. 6 weeks after having it fitted. But im so scared. Does it hurt and can i get strong pain meds to help me ??

  39. I have a SPC now going on 8 months. In regard to changing it and pain, it’s very little and only last for 10 seconds with me. Any one have info on the belly bags? Like where they can be had?

  40. bua ma poate ajuta si pe mine cineva cu sonde foley de silicon ca imi trebuie sa mi le introduc singur in uretra ca am strictura uretrala

  41. I have had a Supra Pubic Catheter now for 6 months. Its three months since I had an operation to remove 2 large bladder stones.

    What it has taught me is:-

    -You have to get into a routine from the moment you get up to the moment you go to bed

    – you have to be very careful

    – empty and discard the night bag

    – clean the stoma carefully with a saline solution and then when in the shower with a non perfumed shower gel

    – I always remove one of the leg straps because its so difficult to stop them crinkling up.

    – dry carefully and then put a non gauze plaster over the entry site

    – replace leg strap so that the leg bag is secured by the main thigh strap and two others (I use a short leg bag)

    – I also use a sticking tape to secure the catheter to my leg so that it minimises any pull on the entry site

    – I clean the entry site again during the day and replace the plaster.

    – it is important to do all you can to prevent infection. Wash your hands very very regularly.

    – I did try a flip flo valve but this was a disaster. I got many spasms and caught an infection and felt dreadful for weeks. Leg Bags are much better. It takes some time to find the best position and the best tightness, but it will be ok.

    The main thing with a indwelling supra pubic catheter is accepting that you have it . It may be for life. If so, and it takes time, you must try to be positive. Getting your head around the issues does take time.

    It helps if you have an understanding GP and District Nurse. Having someone to talk to is worth its weight in gold. The frustrating thing is that there are not many people who do understand and can advise well.

    Changing the catheter is not something that I would trust to anyone. Get yourself a good nurse who is experienced in SPCs . It should be relatively painless but it will mean that there is some discomfort for a couple of days afterwards. Don’t be afraid to return to your nurse if there is a problem with pain.

    I think its better , if you can, to take control of the ordering of your medical supplies yourself. If you can obtain disposable night bags, so much the better.

    I try to drink 1.5 litres of water to 2.0 litres a day.

    I do not recommend Cranberry Juice if you are prone to bladder stones. Cranberry Juice, whilst help fighting infections, can cause bladder stones!

    My biggest problem after 3 operations, has been chronic fatigue. Stress and anxiety don’t help. Confidence is everything

    Best bet is to speak to your GP if you are suffering. Your GP will arrange for any tests to be taken to eliminate other problems.

    Depression is very common. Its quite easy to feel isolated.

    Set yourself milestones. You will know when you are able to walk further, feel comfortable driving and lifting . I still would advise not lifting anything too heavy. If you do you will feel uncomfortable.

    Do everything to avoid UTIs. Somewhat inevitable but drinking can be the greatest help.

    I have started to have Manuka Honey. 10+. Its expensive but I think it helps.

    Best advice is try to stay positive. Don’t ever think you can go back towards life before your catheter. You can’t.

    Best advice I can give is try to live your life to the fullest you can. You will get setbacks but you will get more setbacks if you don’t try. Depression will grab you by the throat and that is so hard to overcome.

  42. The Dr told us to flush with 2 oz ( 60 ml) normal saline with 60 ml syringe, after pushing 1 oz in try to pull saline backout but u get air, just pull back 5-10 ml couple times. This will help mucous loosen and drain. Then push rest of fluid in bladder. Drain into bag.

  43. Alison ( June 6th 2014)
    How did you make out wit your dementia patient ? My father has dementia and is currently being straight cathed 5-6 times per day. We are strongly considering the SPC. Would be interested in knowing your thoughts as we also have the concern of him pulling it out. We plan on investigating a covering wrap of some kind.

    Thanks

  44. I’ve lived with a supra pubic catheter now for 18yrs, I’ve been changing it with no difficulty. The biggest problem I’ve found is frequent infection and high cost of catheters and urine collection bags here in Uganda.
    Right now my biggest problem with SPC is bladder and kidney infection that occurs frequently.

  45. im using spc from 7 years now…it has been a part of my body …. and im just 21 years old im going india next week to meet urethra reconstructive specialist dr. sanjay kulkarni with a hope i would get rid of it this time as many surgeries have faild year back

  46. Tasha, I wish you a successful surgery. Update us on how it has progressed.

  47. My father had a sec fitted in hospital. His catheter has cone out once and his overnight bag has leaked once in 3 weeks. I tried to change his leg bag again last night and couldn’t get it out of the connecting tube. Had to call the district nurses again. Does it get any easier?

  48. I am having my surgery on July 6th, and I have absolutely no idea what to expect. I have had a indwelling catheter for about a year off and on and my urologist has finally reccomended the SPC. Can someone please tell me what to expect at the beginning?

    Thank you,

    Barry

  49. Hi Barry,
    You will notice some blood in your urine but that should clear up within a few days. Drink a lot of water. After a week or two external bleeding should also stop. You can keep it covered with a dressing until then to avoid infection. Limit physical activity to aid healing and avoid any yanking on the supra pubic catheter. Over time most find it continues to clear up and need little to no care bar changing.

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