Urology/Time window in which to put a new suprapubic when changing it.
QUESTION: Hello again, Professor.
Thank you for the help I received from you on my previous questions. Now I need your help again.
About 4 months ago I've had a suprapubic catheter installed. It's a ch10 Nelaton catheter -- it's held on site by a surgical stich and by some taping.
The procedure for changing it which is proposed by the urological department of my hospital is that I should go to the hospital every 2 months and have the catheter replaced by an urologist. This is what I did the first time. However, soon after the first replacement I had a little accident and the stitches let go, so that the catheter fell out. Fortunately, my mom, although untrained, is really good with these types of things, so that she managed to put a new cath in and also to mend the stitch.
Because the trips to hospital are a real hassle to us, and since I've read changing suprapubic catheters by family members (or even by patients themselves) is quite common, we have decided to do the changes on our own from now on.
My question concerns the fact that fixing the stitch takes up a few minutes and that it practically has to be done between removing the old catheter and putting in the new one.
Approximately, how long is the time window for the site to start closing up to the extent that might cause serious difficulty in putting in the new catheter? Is it more like 5 minutes (or less), 10 minutes or more?
I've tried to look the matter up on the internet, but I'm getting conflicting information: some places say it's 1-2 hrs, others -- that you actually have to put the new one immediately upon removing the old one.
Thank you very much in advance for your answer, Professor.
Nelaton is a manufacturing company so it's not a catheter type. Ch10 suggests a 10 French sized channel, but doesn't indicate the method for retaining the catheter. If there is no balloon or looping mechanism and it requires a surgical stitch, then it needs to be changed by professionals. This type is usually not used for long-term suprapubic drainage for the reasons mentioned above: it does not have a reliable mechanism to keep it from falling out and stitching it in place is only good temporarily as the stitches tend to pull out.
You need to ask the urologist about changing to a self-retaining type of catheter such as a Foley. The catheter you are using is particularly small which may be comfortable but it will close off quickly and should be replaced immediately if possible. Even a few hours later may be too late to salvage the passage. Typical sizes for long-term suprapubic tubes are usually a bit bigger: from 16 French up to 28 French in size. I would recommend an 18 or 20 as a good compromise between drainage and comfort.
Once a proper Foley has been placed, it is common for family to do the replacement when necessary and only check with Urology once a year or if there are special problems.
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QUESTION: Thank you, Professor.
Yes, the catheter is of that basic design that is used for intermittent catheterisation, for example. And I myself have been surprised at learning during the first replacement visit to my hospital that the replacement catheter was not going to be a Foley, but this standard type. And I was quite surprised too -- during the installation -- to learn that the suprapubic they were going to install was going to be only 10-French (I had been using a 14-French Foley for a few months prior to that).
Well, it's been difficult for me to question the expert knowledge of the urologists of the hospital.
But I guess I will have to consider discussing the subject with them again.
Meanwhile, could you please, Professor, clarify to me what you mean by "closing off" in the following passage of your answer?:
"The catheter you are using is particularly small which may be comfortable but it will close off quickly and should be replaced immediately if possible. Even a few hours later may be too late to salvage the passage."
Initially, I thought you meant that the small diameter of the drain is likely to cause quick clogging and blocking off. But now I'm not sure.
Other than that -- and just in case my mom was forced to do an emergency replacement before I visit the doctor -- could you give me a rough estimate of how quickly the passage in the body closes off after removal of a 10-French suprapubic?
I meant the passage would close off. There is no official time as this varies from one individual to another, but it can close very quickly. If the fascial planes are not aligned properly, it may be impossible to replace the catheter without a surgery.
A permanent suprapubic tube should not be the straight type that has to be stitched in place. You may need to get another urology opinion to have this sorted out correctly. I do not understand why the physicians you are seeing won't do this for you.