Suprapubic bladder aspiration
Indications
- Urine for bacteriology in children < 2
- Phimosis
- Urinary retention
- Urethral trauma/stricture
- Chronic urethral or periurethral infection
Contraindications
- Empty or unidentifiable bladder
- Known bladder tumor
- Lower abdominal wounds
- Overlying cellulitis
Equipment
- Sterile gloves
- Skin prep
- Lidocaine
- Sterile syringe, 10 or 20 mL
- Needle, 22 gauge (ga), 1.5 in, for pediatric patients
- Spinal needle, 22 ga, for adult patients
- Dressing
Procedure
- Locate the full and distended bladder with ultrasound and palpation
- Prep skin
- Place lidocaine wheal at point of planned entry (usually midline 2-4cm above sup edge of pubic symphisis), aim caudad, 60 degrees from horizontal plane of abdomen
- In infants, insert and appropriate length 22G needle 10-20 degrees cephalad from perpendicular and aspirate until urine returns
- Remember, the bladder is an abdominal organ in newborns.
- Be prepared for a spontaneous void during stimulation of bladder
- If no urine is obtained, withdraw to subQ tissue and redirect
- In adults, insert a longer 22G needle 10-20 degrees caudad from true verticle and aspirate after the skin is entered
Complications
- Inability to aspirate urine
- Hematuria (microscopic is common, gross is uncommon)
- Penetration of bowel (innocuous if entered with small needle only)
See Also
References
- Roberts
- emedicine