Please consider these under the following headings, as management differs:
Leaking around catheter
Supra pubic catheter problems
Catheter fallen out
Unable to remove catheter
Male urethral erosion/traumatic hypospadias
This is a common problem with long-term catheters. It requires urgent attention, as the patient will be in retention.
1. Exclude a kinked catheter or drainage tube.
2. A gentle washout out the bladder with a small volume of saline (30-50ml initially) may resolve the blockage. If it doesn’t, remove the catheter and re-insert a new one straight-away.
3. If this does not work, please make an urgent referral, or send the patient directly to the nearest ED.
It is common for the frequency of blockages to increase the longer a catheter has been in situ. If you are able to unblock each time, but this is troublesome for you or the patient, please make a referral. Bladder stones or excess debris may be causing this.
Leaking around the catheter
May be caused by catheter blockage (see above), erosion of a long term catheter, or an overactive bladder.
1.Rule out a catheter blockage.
2.Don’t insert a larger catheter unless you are sure erosion is not an issue….a larger catheter will make the erosion worse.
3.You can try anticholinergic medication in appropriate patients, but urological referral will often be needed to help with these problems.
Suprapubic catheter problems
Skin changes - minor ulceration is common. If problematic, please refer. Very occasionally, squamous cell carcinoma can develop in these areas of chronic irritation.
Excess epithelialisation is reasonably common and harmless, but if you are concerned about a lesion, please refer. Very occasionally, squamous cell carcinoma can develop in these areas of chronic irritation.
Blockages are treated as per urethral catheters. If you have to replace a SPC, please make sure it is done immediately, as the track can close quickly. If you have trouble getting a SPC in, please refer immediately.
Leaking around an SPC – treat as per a urethral catheter (see above).
Catheter fallen out
If a catheter has been pulled out, urethral trauma may make it difficult to put back it. Blood at the meatus is an indication for immediate urology referral.
Women with long-term catheters can develop urethral/bladder neck erosion, making it very difficult for them to retain a catheter. If expulsion of a catheter is an ongoing problem please refer.
Unable to remove a catheter
If the patient is in retention from a blocked catheter that you cannot remove, please refer as an emergency.
If the catheter is still draining, please refer urgently.
Male urethral erosion
This is a common problem in men who have permanent urethral catheters. It looks alarming, but is chronic and harmless. The only solution to the problem is placement of a suprapubic catheter. Please refer is necessary.