A national UK audit of suprapubic catheter insertion practice and rate of bowel injury with comparison to a systematic review and meta‐analysis of available research

Abstract

Objectives Limited data exist on the risks of complications associated with a suprapubic catheter (SPC) insertion. Bowel injury (BI) is a well‐recognized albeit uncommon complication. Guidelines on the insertion of SPC have been developed by the British Association of Urological Surgeons, but there remains little evidence regarding the incidence of this complication. This study uses contemporary UK data to assess the incidence of SPC insertion and the rate of BI and compares to a meta‐analysis of available papers. Methods National Hospital Episodes Statistics data were searched on all SPC insertions over an 18‐month period for operating procedure codes, Code M38.2 (cystostomy and insertion of a suprapubic tube into bladder). Patients age, 30‐day readmission rates, 30‐day mortality rate, and catheter specific complication rate were collected. To estimate the BI rate, we searched patients who had undergone any laparotomy or bowel operation within 30 days of SPC insertion. Trusts were contacted directly and directed to ascertain whether there was SPC‐related BI. PubMed search to identify papers reporting on SPC related BI was performed for meta‐analysis Results 11 473 SPC insertions took place in the UK in this time period. One hundred forty‐one cases had laparotomy within 30 days. Responses from 114 of these cases reported one BI related to SPC insertion. Meta‐analysis showed an overall BI rate of 11/1490 (0.7%). Conclusions This is the largest dataset reported on SPC insertions showing a lower than previously reported rate of BI. We recommend clinicians use a risk of BI of less than 0.25% when counseling low‐risk patients.

Inadvertent Bowel Injury Following Repeated Suprapubic Catheterisation in a Patient of Post-Pelvic Radiotherapy

“…Although the earlier series reported a 2%-3% rate of bowel injuries [2,5], a recent audit from the UK on 11,473 patients revealed an improving trend with rates ranging from 0% to 0.2% [11]. This improvement is because of the National Patient Safety Agency (NPSA) report published in 2009 and BAUS guidelines published in 2011, which recommended ultrasound-guided insertion in all patients having high-risk features, as stated above, however only by a practitioner with appropriate training and experience [6,12].…”

British Association of Urological Surgeons (BAUS) and Nurses (BAUN) consensus document: management of the complications of long‐term indwelling catheters

“…There is a small but definite risk of bowel injury (<1%) occurring during SPC insertion, but this is increased in patients with a history of lower abdominal surgery [7]. Difficulties may also arise in patients whose bladder cannot be filled adequately or who are obese.…”

British Association of Urological Surgeons suprapubic catheter practice guidelines – revised

“…Analysis of the rates of bowel injury prior to the NPSA alert and the publication of the original BAUS guidelines suggests a historical bowel injury risk of approximately 2.5% [4,5]. Studies published subsequent to the NPSA alert and BAUS guideline publication suggest a bowel injury rate of 0–0.2% [7–12,28]. Caution must be exercised when drawing conclusions from the comparison of these different studies, as differences in populations and methodology will introduce bias.…”