Suprapubic bladder aspiration

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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

  1. Locate the full and distended bladder with ultrasound and palpation
  2. Prep skin
  3. Place lidocaine wheal at point of planned entry (usually midline 2-4cm above superior edge of pubic symphisis), aim caudad, 60 degrees from horizontal plane of abdomen
  4. 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
  5. If no urine is obtained, withdraw to subQ tissue and redirect
  6. In adults, insert a longer 22G needle 10-20 degrees caudad from true vertical 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