how to change supra pubic cath

CCU NRS · Oct 8, 2004

It is really not difficult at all. Of course you undertsand the principle of the catheter(inflate balloon to keep it in bladder) the stoma that has developed is just that a stoma into the bladder you use ky and sterile technique and insert the catheter in to the stoma(supra-pubic)which is in the bladder then inflate you will need a much larger balloon 30cc which of course your company will have and send I am sure. You should be honset though and just tell them you have not actually done one and if you feel comfortable from this explainaton or from them explaining it to you and they are OK with you performing it on your comfort level then go for it!

MikeLPN · Oct 8, 2004

Be quick and be very,very,very gentle. Put the new catheter in as far as you took the old one out (you don't need to be poking the opposite wall of the bladder). Don't push until you get urine, put it in and then wait for it. I've heard of the stoma shifting with bladder spasms on removal but have never personally experienced this :) . I HAVE been kicked in the head (shoes on) during this procedure so if LOC is a problem maybe an extra set of hands would be a good thing. If they get any pain meds or bladder spasm meds maybe those would be good administered before and push, push, push the H2O after. Sterile, gentle and quick.

However, of course, any words of wisdom from the more experienced would be well read and taken to heart :rolleyes:

SRbear · Oct 8, 2004

Thanks so much for the help.....believe me I will not do any proceedure if I do not feel I know what I am doin !!! Just finished my 5th day of orientation for home health.....such a different world than the one I am used to..(25 years working in hospitals)..but I think I am going to like it..I know I just had to get out of the hospital, or just plain quit nursing. 1 more week of orientation and then.....road trip !!!!!!!

hoolahan, ASN, RN · Oct 9, 2004

Sometimes it is difficult to get the old cath out too, crusts/crystals can form. I have found that if I gently push the skin doen around the stoma, whila applying KY around the exposed cath, then twist the cath a bit to get the KY down in there, the cath usually will slip right out. This works great for G-tube changes too.

I don't know about anyone else, but I would defintle ask someone to go with me the first time, so you can be checked off, or go to watch one first, then have them watch you the next time. Even though it is easy, if it is the first time you are doing it, and you tell the pt that, I am sure they would feel more comfortable if you had another nurse on standby to be sure you were able to do it. That's how I have always seen new procedures handled at my agencies anyway.

I remember the first time I had to remove staples in a post-op. My sup came with me, the pt asked me why and I told her it was my first time. The sup took out the first one, then that poor woman was sooo nervous, she about passed out when I started. It didn't help me be less nervous, in fact I wasn't nervous at all until the pt was so freaked out. She was just nervous about the whole procedure period. By the time we were done, she was like, "That was it?" Sup smiled at her and said, See I told you there was nothing to it! Then we all had a good laugh about it.

I came to home care like you, after many years of hosp nursing, so I know just how you feel, but you will love it, all of it except the paperwork!