Evidence‑Based Management of a Non‑Functioning Suprapubic Catheter

Initial Assessment and Troubleshooting

Gentle irrigation of a suspected obstructed suprapubic catheter with sterile saline using aseptic technique is recommended as the first step before attempting catheter removal. 1
Bladder scanning should be used to evaluate urinary retention; a bladder volume > 300 mL in symptomatic patients or > 500 mL in asymptomatic patients indicates significant retention requiring intervention. 1

Strict sterile (aseptic) technique must be maintained throughout the entire suprapubic catheter replacement procedure. 1
After insertion of a new catheter, it should be securely anchored to the abdomen to prevent migration and urethral traction. 1

The drainage system must remain closed at all times; breaking the closed system increases the risk of catheter‑associated infection. 1
Routine catheter care should consist of standard hygiene only; routine irrigation or the instillation of antiseptic solutions is not recommended as a preventive measure. 1
Catheter changes should be performed only when clinically indicated (e.g., malfunction, obstruction, scheduled replacement), not routinely for infection prevention. 1
Routine use of antimicrobial‑coated suprapubic catheters is not recommended. 1

Placement of a temporary indwelling urethral catheter can be used to decompress the bladder while definitive suprapubic catheter management is arranged. 2
Clean intermittent catheterization may be employed temporarily for patients who are able to tolerate it. [3][4]