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Thread: Suprapubic tube pulled out... Now what?

  1. #1

    Suprapubic tube pulled out... Now what?

    So... an unfortunate little thing just happened! As usual, my balls felt like I was sitting on them, so I decided to reach under and try to pull them out. In a moment of sheer stupidity, I must have gotten my hand caught near my suprapubic tube and ripped it right out. Fortunately it had been in there for about 5 weeks, and the balloon was mostly deflated so it didn't bleed too much. I immediately called my PCA and ask her to get here as quick as possible in hopes that I could get a new one in before the stoma closed up. It was snowing outside, so it took her a little bit longer then usual and we didn't make it. The new spt wouldn't go in. So she put a bandage over the stoma and inserted a Foley into my urethra.

    Given that it's Saturday night, there's no sense heading into the hospital in hopes of getting a new stoma installed. I'd just rot in the ED getting pressure sores and no bowel management. In fact, with the holiday on Monday I bet they wouldn't do it until Tuesday. So my plan is just to hang out at home and continue with these catheters in the meantime. Any reason this doesn't make sense? And the big question is, what to do on a more permanent basis? My occupational therapist has been telling me that I should get rid of the SPT and self cath instead. Maybe this is the right jumping off point to start that process? Is it even possible after having a suprapubic tube for the last 18 months, considering that my bladder has probably shrunk significantly?
    Last edited by ejl10; 01-18-2020 at 11:24 PM.
    C5/6 complete (maybe) circa June 2018

  2. #2
    A newly installed SP stoma can close up in just a few minutes, which is why the catheter is not changed for 6 weeks post-op. Even a well established SP stoma can close up if a new catheter is not inserted within 3-5 minutes after the old catheter was removed.

    The best solution, is what you did; inserting a urethral indwelling catheter until you can see your urologist. The stoma may need to be reopened. Once you can change that catheter, your PCA and other caregivers need to learn how to safely reinsert/change the SP catheter, and it needs to be done immediately if inadvertently dislodged like this. The technique is not the same as for an indwelling urethral catheter.

    For any indwelling catheter, be sure you are using a securement device. This both prevents pistoning of the catheter in/out of the stoma (which can lead too UTIs) and helps to prevent inadvertent dislodgement.

    Sorry to step in on the on-duty SCI-Nurse's week, but I saw this question and thought you should have an immediate response.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
    Quote Originally Posted by SCI-Nurse View Post
    A newly installed SP stoma can close up in just a few minutes, which is why the catheter is not changed for 6 weeks post-op. Even a well established SP stoma can close up if a new catheter is not inserted within 3-5 minutes after the old catheter was removed.

    The best solution, is what you did; inserting a urethral indwelling catheter until you can see your urologist. The stoma may need to be reopened. Once you can change that catheter, your PCA and other caregivers need to learn how to safely reinsert/change the SP catheter, and it needs to be done immediately if inadvertently dislodged like this. The technique is not the same as for an indwelling urethral catheter.

    For any indwelling catheter, be sure you are using a securement device. This both prevents pistoning of the catheter in/out of the stoma (which can lead too UTIs) and helps to prevent inadvertent dislodgement.

    Sorry to step in on the on-duty SCI-Nurse's week, but I saw this question and thought you should have an immediate response.

    (KLD)
    Thanks so much for the quick reply. Glad to hear I'm on the right track at least. Fortunately, my PCA knows how to properly install both an SP and an indwelling catheter.
    C5/6 complete (maybe) circa June 2018

  4. #4
    Senior Member pfcs49's Avatar
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    One night I woke up from a terrible nightmare and when I turned the light on, saw what looked like an opium poppy on a long stem: my catheter!

    I must have gotten my hand between my thigh and my well tagged down catheter/leg bag tubing, and dreamed somebody was holding me down.
    Well I certainly got loose from that son of a bitch, but it wasn't too pretty!
    69yo male T12 complete since 1995
    NW NJ

  5. #5
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    Something similar happened to me but I chose not to have another surgery, I use a foley through my urethra. I was told that the SP didn't decrease the chances of acquiring infections by a large percentage.

    I've read of people deciding to do CIC after using foley catheters for years and some had no problems with shrunken bladders. If it was possible for me to do CIC, I would see if I could possibly have the surgery where you insert the IC into a stoma in your belly button. It seems like it would be a lot simpler.

  6. #6
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    Quote Originally Posted by Brent K View Post
    Something similar happened to me but I chose not to have another surgery, I use a foley through my urethra. I was told that the SP didn't decrease the chances of acquiring infections by a large percentage.

    I've read of people deciding to do CIC after using foley catheters for years and some had no problems with shrunken bladders. If it was possible for me to do CIC, I would see if I could possibly have the surgery where you insert the IC into a stoma in your belly button. It seems like it would be a lot simpler.
    I would do that inm a heart beat if I lived back up by shephard in atlanta . I thought about here but the only doctor qualified in 6 hrs away not no can do, but I wish I had know 18years ago I would have had it done

  7. #7
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    Quote Originally Posted by pfcs49 View Post
    One night I woke up from a terrible nightmare and when I turned the light on, saw what looked like an opium poppy on a long stem: my catheter!

    I must have gotten my hand between my thigh and my well tagged down catheter/leg bag tubing, and dreamed somebody was holding me down.
    Well I certainly got loose from that son of a bitch, but it wasn't too pretty!
    ypu should be a writer you have away with words

  8. #8
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    Quote Originally Posted by Brent K View Post
    Something similar happened to me but I chose not to have another surgery, I use a foley through my urethra. I was told that the SP didn't decrease the chances of acquiring infections by a large percentage.
    I’d thought UTI risks were similar for indwelling urethral catheters and suprapubic catheters too. However according to the Canadian Urological Association it is much higher for urethral catheters.

    Transurethral indwelling catheterization carries >5-fold increase risk of recurrent UTIs when compared to suprapubic catheterization (SPC) and CIC.
    https://cuaj.ca/index.php/journal/ar...view/6041/4110

  9. #9
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    Quote Originally Posted by beckman View Post
    I’d thought UTI risks were similar for indwelling urethral catheters and suprapubic catheters too. However according to the Canadian Urological Association it is much higher for urethral catheters.

    Transurethral indwelling catheterization carries >5-fold increase risk of recurrent UTIs when compared to suprapubic catheterization (SPC) and CIC.
    https://cuaj.ca/index.php/journal/ar...view/6041/4110
    That's what I was told by my urologist during the discussion of scheduling another surgery. If it made no difference, I didn't want to go through another surgery. I couldn't change my catheter on my own with the SP. I've been lucky, in the 20 years of being paralyzed, I've only been treated 8 times for uti's. All occurred before switching to foley usage.
    Last edited by Brent K; 01-23-2020 at 11:05 PM.

  10. #10
    We used to think it was less with SPTubes, but research was done that showed it wasn't necessarily. It does help some but over time, if frequent UTI'
    occurred with urethral catheter, then just a matter of time for the Sputbe catheter to cause UTIs. The surgeons do not promise less UTis or SPtube surgery, just a possibility.
    CWO
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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