Operative note 05 Core
Suprapubic catheter
What it does: drain the bladder through the skin above the pubis.
- Prove the bladder is full. Examine. Aspirate urine with a needle.
- Old lower tummy scar? Bowel may stick under it. Go well to the side, or use ultrasound.
- Fill the bladder to 500 mL if not full. Full bladder rises against the wall and pushes bowel up, out of the way.
- Spinal cord injury patient? Big fills can spike BP. (This is autonomic dysreflexia.) Consider GA.
- Tilt the head of the bed down.
- Entry point: 2-3 cm above the pubic bone. Too low and you hit the bone.
- Freeze skin and rectus sheath.
- Aspirate urine with the needle first. That needle angle is your track.
- 1 cm blade cut.
- Trocar: one hand pushes, one hand stops overshoot. Aim down and back, towards the pelvis. Never straight in, 90 degrees to skin.
- Urine returns. Out with the trocar. In with the catheter, all the way.
- Inflate the balloon. Peel away the sheath. Draw back till the balloon sits on the bladder wall. Secure without traction.
- Watch: Bowel injury ~2 in 100. Mostly neuropathic bladders.
- 2026 update: Most units now use Seldinger kits (needle, wire, dilator, peel sheath). Less force.
- 2026 update: Ultrasound guidance is routine where available.
From the UroRef Operative Quick Guide.