It has been a while but, I had a number of patients with this type of catheter in a chronic rehap. setting. So, here's what we did. You use the regular cath. set but with the larger sized cath/balloon needed for the suprapubic cath. With the patient laying on their back, prep and treat the stoma like the urinary meatus. MD's told us not to take the old one out until we were ready with the new one as the stoma was created in the muscle wall and you could have the rare possibility it spasming close. They said the same thing about gastric tubes and I think that is the real one to be concerned with. Just before insertion we would grasp the catheter 3 1/2 inches before the tip, insert tip straight into the stoma (you are pointing the tip towards the patient's back.) until your fingers hit the abd. wall. Holding the catheter firmly in place, slowly expand the 30 cc balloon. Except in a rather obese patient 3 1/2 inches was supposed to be enough distance to put the catheter into the bladder without risking it heading for the uretha or ureters. Although the urethra is usually sutured closed, in a male there is still a distance the catheter could go before hitting the closure. After filling the balloon we would gently pull the catheter towards us just to check if it had mobility - not stuck in the urethra, abd wall, etc. I changed hundreds without a problem.
But the following is why were so careful to measure. I came into work one day 3-11 shift and one of my especially favorite patients had had his suprapubic changed on the day shift. They stated he was having "some discomfort", the urinary drainage was bloody and decreased and he had a bit of blood at the end of his penis. They didn't think there was any problem with the catheter placement and felt the patient was being just a baby with his inappropriate swearing and cussing at them.
Well, I fast tracked these twits though report on the other stable 50 patients, grabbed a cath kit and ran to this young man room. He was crying in pain, sweated through his sheets and was bleeding freely from his urethra:angryfire :angryfire :angryfire This patient and I had a wonderful friendly relationship and thank goodness he trusted me to fix this mess. As I took out the old catheter he swore a blue streak at the day shift nurses. (Ah, post traumatic brain injury. It allows you to fly off whenever your brain says go and in this case I was thinking "Go for the gold babe!") They had inserted the suprapubic catheter into the stoma and then pushed it in all the way into the catheter "Y".
When they blew up the balloon it was positioned in the patient's prostate. Once I removed that catheter then the real bleeding began. We had to irrigate his bladder q10min. for the whole shift just to decrease the bleeding and remove the large clots. In the end he fully recovered but, he suffer from 11 am until I got to him at 4 pm. So, there's an example of why you carefully measure the distance before inserting. Good Luck!