Long-term Suprapubic Catheter-Related Care Requirements When Living at Home: Development of a Best Practice Guide.

PURPOSE: The purpose of this study was to develop a best practice guideline specific to the health care needs of adults living at home with a long-term suprapubic catheter (SPC). DESIGN: Guided by the theory of social constructionism, a mixed-methods, 2-phased study design enabled an integration of experiences and consensus from 2 groups of experts. SUBJECTS AND SETTING: The first group of experts involved 10 people living with a long-term SPC at home. The second group comprised 23 nurses who provided care to people living with a long-term SPC at home. METHODS: During phase 1, semistructured in-depth interviews were completed to explore people's day-to-day self-care practices and support needs when living at home with a long-term SPC. These data were evaluated via thematic analysis. The themes identified in phase 1 provided the phase 2 question framework in the development of a 3-round Delphi survey involving the expert nurse group. The first round elicited the respondents' opinions on specific aspects of SPC-related care. Using qualitative content analysis, practice statements were generated and used in subsequent survey rounds. The respondents rated their level of agreement to each statement. The guideline comprises the statements that achieved consensus. RESULTS: The 6 elements of the best practice guideline contracted using this mixed-methods study were psychological support needs, cystostomy site care, SPC replacement, drainage equipment practices, complication avoidance and management, and planning ahead. CONCLUSIONS: This best practice document provides a valuable resource to guide health professionals, promoting standardized best practices when caring for persons living at home with an SPC.

Suprapubic Catheter Change Methods: A Crossover Comparison Cohort Trial.

PURPOSE: The purpose of this study was to compare 2 methods of suprapubic catheter (SPC) change, instillation and observation. The instillation method requires instillation of saline to the bladder prior to SPC removal; the observation method is completed taking note of the angle and length at which the indwelling SPC is withdrawn and observation of urine from the newer catheter when inserted. DESIGN: Nonrandomized crossover trial. SUBJECTS AND SETTING: Fifty-nine community-dwelling adults who were long-term SPC users participated in the study. There were 38 males and 21 females, with a mean age of 68.5 years. Most had chronic, progressive, or complex comorbidity. The mean duration of SPC use was 3.5 years. METHODS: Participants underwent 4 SPC changes using the instillation method, followed by 4 changes using the observation method. Data were collected using a 3-part survey document; it queried demographic and catheter-related clinical information, the number of symptomatic catheter-associated urinary tract infections (CAUTIs) requiring antibiotic treatment, the number of catheter blockages that occurred during data collection, and nurses' experiences during catheter changes (including narrative feedback-related problems, concerns, or comments in relation to each catheter change). The comparative CAUTI and blockage outcomes were analyzed using McNemar's test for 2 paired samples. Narrative data were analyzed using thematic analysis. RESULTS: There were 231 SPC changes using the observation method. No episodes of catheter displacement occurred. Analysis of nurses' narrative revealed concerns regarding "slowness" of urine drainage from the newly inserted catheter. This concern was addressed by promotion of adequate hydration prior to catheter change. There were 120 paired useable surveys included in the CAUTI and blockage incidence comparison; no statistically significant differences in CAUTI occurrences were found based on catheter change method (11 vs 11, P = .7728). No differences in the catheter blockage episodes were found based on catheter change method (8 vs 6, P = .7237). CONCLUSION: The observation method of SPC change was as effective as the instillation method.

Suprapubic catheters--a shared understanding, from the other side looking in.

OBJECTIVE: The objective of this study was to explore the experiences of people living with a suprapubic catheter. METHOD: This descriptive study was guided by the philosophy of Gadamerian hermeneutics. Data were gathered via indepth interviews with 6 adults living in the community who had a suprapubic catheter for long-term urinary bladder drainage. Interpretation of the data occurred via thematic analysis of the participants' stories. RESULTS: Two distinct but interrelated themes emerged. Participants shifted, over time, from negative to positive experiences (psychologically, physically, and practically) to adjustment to life with a catheter. Participants also related that health professionals had not adequately prepared or supported them as they learned to live with a suprapubic catheter. Many of the participants' initial negative experiences were augmented by this deficiency. Issues revolved around perceptions of being psychologically unprepared, the changed body image, altered sexuality, and support needs. CONCLUSION: The findings of this study revealed that the insertion of a suprapubic catheter brought about significant life changes for the participants. The data highlighted disparities between the needs of people who have a supra-pubic catheter and health professionals' perceptions of their needs.