View source for 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 superior 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 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==
*[[Urinary retention]]
*[[Suprapubic catheter placement]]
*[[Suprapubic catheter changing or replacement]]

==References==
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[[Category:Procedures]]