[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Procedures](https://durgical.com/en/nursing/areas/procedures/) › Suprapubic catheters, external catheters and catheter irrigation # Suprapubic catheters, external catheters and catheter irrigation - Procedure Other ways to drain urine: a sheath over the penis, a catheter through the lower abdomen, and irrigation only when a blocked catheter is expected. Updated Nov 12, 2026 ## Key points - An external catheter is an alternative to an indwelling catheter in cooperative men without retention or outlet obstruction. - If a suprapubic catheter comes out, the tract can close quickly: protect the site and call at once. - Bladder irrigation is not routine: only when obstruction is expected, and then preferably closed and continuous. - Keep the bag below the bladder, off the floor, with the system closed. - Change an external catheter at least every other day and check the skin of the penis. ## What it is An external catheter (a soft sheath worn over the penis) collects urine without entering the body, so it is an alternative to an indwelling catheter in cooperative men without urinary retention. A suprapubic catheter is inserted into the bladder through a small incision above the pubis; it is used for long-term drainage or when the urethra cannot be used. Bladder irrigation is not routine: the CDC guideline reserves it for cases where obstruction is expected, such as bleeding after prostate or bladder surgery, and then prefers closed continuous irrigation. Every device drains into a closed system with the bag below the bladder. ## Indications - External catheter: incontinence in men who can empty their bladder. - Suprapubic catheter: long-term drainage, urethral injury or stricture, and after some urological or gynaecological surgery. - Closed continuous irrigation: to keep clots from blocking the catheter after prostate or bladder surgery, on medical order. - Intermittent irrigation of a blocked catheter: only on medical order and as the protocol describes. ## Contraindications and precautions - An external catheter does not drain a bladder that cannot empty: it is not for retention or obstruction. - External catheter size: snug but not tight; a tight sheath damages the skin. Ask about latex allergy. - Suprapubic catheter: the first change is done by the treating team; never pull it out; no creams, powders or sprays at the site. - Routine irrigation with antimicrobials is not recommended. - Irrigation needs sterile technique and keeping the system closed as much as possible. ## Equipment - External catheter in the right size, drainage bag or leg bag, scissors or clippers to trim hair, skin protectant. - For a suprapubic site: mild soap, water, gauze, tape or a securement device, clean gloves. - For irrigation: the ordered sterile solution, a closed irrigation set with a three-way catheter, or a sterile syringe and tray. - Measuring container and fluid balance sheet. ## Step by step (and why) - Check the order, identify the patient, ensure privacy and explain — protects dignity and allows consent. - External: wash and dry the penis, trim hair if needed and inspect the skin — the sheath sticks to clean, dry skin. - Roll the sheath on, leaving space at the tip, and connect it to a bag below the bladder — avoids rubbing; gravity drains. - Change it at least every other day and check for redness, swelling or broken skin — prevents skin injury and infection. - Suprapubic: check the site for redness, pain, swelling or pus; wash with mild soap and pat dry — the site is an entry point. - Secure the tube to the abdomen without kinks, bag below the waist — avoids pulling and backflow of urine. - Continuous irrigation: run the ordered solution in and watch outflow and colour — flow prevents clots; colour shows bleeding. - Record the device, skin, urine characteristics and fluid balance — allows follow-up. ## Complications - Skin irritation, maceration or swelling of the penis from a tight external catheter. - Urinary tract infection with any device. - Suprapubic catheter: site infection, leaking, blockage, displacement, and stones or sediment. - Irrigation: the catheter can still block with clots, so the outflow must be watched. ## Next step: when to call for help - Irrigation: stop the inflow and call if the outflow stops or bleeding and clots increase. - Suprapubic catheter out: cover the site and call at once, because the tract can close quickly. - Call for fever, chills, cloudy or foul urine, sediment, leaking around the catheter or bleeding at the site that does not stop. - External catheter: remove it and call if the penis is swollen, discoloured or the skin is broken. ## Test yourself Think of the answer, then tap the question to see it. ## In which patients is an external catheter a good alternative to an indwelling catheter? In cooperative men who need urine collection but have no urinary retention or bladder outlet obstruction. ## When does the CDC guideline accept bladder irrigation? Only when obstruction is expected, such as bleeding after prostate or bladder surgery, and then preferably as closed continuous irrigation. ## Why is it urgent if a suprapubic catheter comes out? Because the tract through the abdominal wall can close quickly, and replacing the catheter becomes difficult. ## What should be checked first if a suprapubic catheter stops draining? The tubing, for kinks, and the bag position below the waist. If it still does not drain, the catheter may be blocked: call. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/suprapubic-catheters-external-catheters-and-catheter-irrigation/) ## Connections ## Related 4 - [Indwelling catheter care and removal](https://durgical.com/en/nursing/indwelling-catheter-care-and-removal/) - [Urinary catheterization](https://durgical.com/en/nursing/urinary-catheterization/) - [Urinary elimination: retention, incontinence and bladder scanning](https://durgical.com/en/nursing/urinary-elimination-retention-incontinence-and-bladder-scanning/) - [Fluid balance: recording intake and output](https://durgical.com/en/nursing/fluid-balance-recording-intake-and-output/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Guideline for Prevention of Catheter-Associated Urinary Tract Infections (2009)](https://www.cdc.gov/infection-control/media/pdfs/Guideline-CAUTI-H.pdf) (Centers for Disease Control and Prevention (CDC), HICPAC, 2009); [Suprapubic catheter care: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/patientinstructions/000145.htm) (MedlinePlus, US National Library of Medicine, 2026); [External incontinence devices: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003974.htm) (MedlinePlus, US National Library of Medicine, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/suprapubic-catheters-external-catheters-and-catheter-irrigation/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/suprapubic-catheters-external-catheters-and-catheter-irrigation/