Suprapubic Catheter Care Practices for Long-Term Stability

Caring for individuals who require long-term bladder drainage often involves difficult trade-offs—balancing comfort, infection risk, skin integrity, and long-term feasibility. In cases where urethral catheterization leads to repeated complications or discomfort, a suprapubic catheter may be considered as an alternative approach to support long-term stability and quality of life.

By providing continuous urinary drainage through a small abdominal incision, a suprapubic catheter can reduce urethral irritation and support safer long-term management in select patients.

In this article, we’ll review when a suprapubic catheter is indicated, how it differs from urethral catheterization, and the care practices that support safe, long-term use.

What is a suprapubic catheter?

A suprapubic catheter is a flexible tube inserted through the lower abdomen directly into the bladder. Placement is typically performed by a trained physician or urologist using sterile technique under local or general anesthesia. Once inserted, the catheter provides continuous urinary drainage without passing through the urethra—making it a practical option when urethral catheterization is not feasible or leads to repeated complications.

The suprapubic route can reduce urethral irritation, lower the risk of meatal trauma, and may offer improved comfort, particularly for individuals who require long-term catheterization.

How it works:

1. A small incision is made just above the pubic bone

2. A catheter is guided into the bladder and secured internally by a balloon or external anchoring device

3. Urine drains into a collection bag connected to the tubing

4. The insertion site is dressed and monitored regularly for healing, leakage, or signs of infection

Suprapubic catheters are used for bladder drainage in individuals with urinary retention, incontinence, or other conditions requiring ongoing catheterization.¹ In some cases, they may be considered when urethral catheterization is not feasible or is poorly tolerated.

Indications for a suprapubic catheter

Indications for suprapubic catheter placement typically center on situations where urethral catheterization poses increased risk, discomfort, or long-term management challenges. A suprapubic catheter may be selected for short-term or long-term management depending on an individual’s urologic needs.

Urinary retention or obstruction

Individuals who cannot empty their bladder because of obstruction or neurological impairment may require a more stable route for long-term drainage.² In clinical practice, the suprapubic approach is often selected when urethral catheterization is difficult, poorly tolerated, or contraindicated.

Urethral injury or postsurgical recovery

When the urethra must be protected due to trauma, surgical repair, or inflammation, suprapubic drainage reduces irritation and allows healing without repeated catheter passage.

Intolerance to urethral catheters

Some individuals experience significant discomfort, bladder spasms, or skin breakdown with urethral catheters. Transitioning to a suprapubic catheter may decrease irritation and improve tolerance over time.

Long-term management of neurologic bladder dysfunction

For individuals with chronic urinary retention or neurologic conditions requiring long-term bladder drainage, a suprapubic catheter offers an alternative that allows straightforward monitoring and care by clinical teams.

When a suprapubic catheter may not be appropriate

While a suprapubic catheter can support long-term bladder drainage in many cases, it may not be appropriate for every individual. Placement may be deferred in the presence of active infection at the proposed insertion site, certain abdominal or pelvic conditions, or anatomical factors that increase procedural risk.

Final decisions regarding placement should be guided by urologic evaluation, imaging when indicated, and consideration of individual patient needs and goals.

Care, maintenance, and infection prevention

While suprapubic catheters may reduce some complications associated with urethral catheterization, they still require consistent, structured care to prevent infection and other adverse events. The Centers for Disease Control and Prevention (CDC) includes suprapubic catheters within its broader catheter-associated urinary tract infection (CAUTI) prevention guidance, emphasizing proper insertion technique, maintenance of a closed drainage system, and ongoing assessment to minimize infection risk.³

Daily site care

Routine care includes:

• Washing hands thoroughly before handling the catheter

• Cleaning the skin around the insertion site with mild soap and water, unless otherwise directed by the provider

• Keeping dressings clean and dry, and replacing them if damp

• Inspecting the area for redness, swelling, drainage, or odor

Catheter positioning and securement

Proper securement reduces tension on the tubing, helping prevent discomfort, accidental dislodgement, and skin irritation.

Drainage bag management

Drainage bags should remain below bladder level to support continuous flow and reduce the risk of urine backflow.

Replacement schedule

A suprapubic catheter is typically changed every 4 to 12 weeks, depending on provider recommendations, catheter type, and individual response.⁴ Signs such as reduced urine flow or leakage may indicate the need for earlier replacement.

Signs of complications

Care teams should monitor for:

• Fever or chills

• Cloudy or foul-smelling urine

• Pain around the bladder or insertion site

• Reduced urine output

• Blood in the tubing or drainage bag

Benefits and considerations for long-term use

Compared with urethral catheters, suprapubic catheters offer several potential advantages for long-term use, along with considerations that help determine whether this approach is appropriate.

Potential benefits

• Improved comfort: For some individuals, the suprapubic route may be better tolerated during long-term catheter use.¹

• Reduced urethral trauma: Avoids repeated urethral catheterization, which may be problematic in individuals with urethral injury or stricture.²

• Improved perineal hygiene: Allows easier access for toileting, bathing, and skin care.

• May support privacy and sexual comfort: The absence of a urethral tube can reduce discomfort during intimate activities.

Considerations and risks

• Procedure required: Placement involves a sterile incision and may require anesthesia.

• Infection risk: While some evidence suggests potential differences in infection risk between catheter types, all indwelling catheters—including suprapubic devices—are associated with an increased risk of CAUTIs.³

• Obstruction or buildup: Mineral deposits may form inside the catheter over time.

• Skin complications: Irritation, leakage, or granulation tissue may develop at the insertion site.

Example: integrating suprapubic catheter care into practice

Scenario

A patient with longstanding urinary retention related to pelvic organ dysfunction has required multiple urethral catheterizations over time. Despite appropriate technique, the patient reports persistent discomfort and recurrent irritation, making long-term management increasingly challenging. After consultation with a urologist, the care team transitions the patient to a suprapubic catheter to improve comfort and reduce urethral trauma.

How care planning changed

Rather than focusing solely on drainage, the care team reframes management around long-term stability and complication prevention. Care routines are standardized and clearly documented to ensure consistency across providers.

• Daily site inspection and cleaning are performed at each visit, with findings documented to track subtle changes over time.

• Catheter securement and bag positioning are reviewed routinely to minimize tension, support continuous drainage, and reduce leakage risk.

• Staff training emphasizes sterile technique for bag changes and early recognition of infection or obstruction.

• When intermittent leakage develops, the team communicates promptly with the prescribing provider, allowing adjustments before complications escalate.

Clinical takeaway

This approach highlights how suprapubic catheter care extends beyond device placement. Consistent monitoring, shared care expectations, and early escalation of concerns help reduce avoidable complications while supporting patient comfort and long-term success.

Supporting safe, long-term suprapubic catheter care

A suprapubic catheter can offer a stable, patient-centered option for individuals who require long-term urinary drainage and cannot tolerate urethral catheterization. When clinicians understand appropriate indications and follow consistent care routines—including site monitoring, infection prevention, and timely replacement—this approach can support comfort, safety, and long-term outcomes.

For more step-by-step guidance and competency-based training, explore the Medbridge Clinical Procedure Manual.  This on-the-go resource delivers expert-reviewed instructions, safety checks, and video demonstrations designed to support home health clinicians at the point of care.

References

1. MedlinePlus. (2025, January 1). Suprapubic catheter care. U.S. National Library of Medicine. https://medlineplus.gov/ency/patientinstructions/000145.htm

2. Cleveland Clinic. (n.d.). Suprapubic catheter. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/25028-suprapubic-catheter

3. Centers for Disease Control and Prevention. (2022, September 14). Catheter-associated urinary tract infections (CAUTI). U.S. Department of Health and Human Services. https://www.cdc.gov/infection-control/hcp/cauti/index.html

4. National Health Service. (2023, October 19). Living with a urinary catheter. https://www.nhs.uk/tests-and-treatments/urinary-catheters/living-with/