View source for Suprapubic catheter placement

==Indications==
*Urethral disruption due to trauma
*Severe urethral stricture or complex [[Benign prostatic hyperplasia|prostatic disease]]

==Contraindications==
* Empty or unidentifiable bladder
**Empty bladder introduces risk of through-and-through penetration of the bladder
**No minimum reported bladder volume established
*Bowel anterior to bladder

==Equipment Needed==
*Cook peel-away introducer sheath 
**If not available, can use central venous access kit and use Seldinger technique to insert Foley
*Ultrasound
*Sterile gloves
*Chlorhexidine or other skin prep
*Lidocaine
*Sterile syringe
*Spinal needle (22 gauge for adult patients)
*Scalpel
*Foley cather
*Dressing

==Procedure==
#Use ultrasound to locate and mark the bladder
#*May use real-time ultrasound guidance to insert the suprapubic catheter, or may landmark and use a blind approach
#Prep skin
#Fill syringe with lidocaine and attach spinal needle
#Raise skin wheal at marked site
#Infiltrate subcutaneous tissue and rectus muscle fascia
#Advance the spinal needle into the bladder while applying negative pressure to the syringe
#After locating the needle within the bladder, remove the syringe
#Advance a guidewire through the needle and into the bladder
#Remove the syringe, leaving the guidewire
#Use a scalpel to make a stab incision at the site of the guidewire, extending the opening for the sheath introducer
#Pass the peel-away sheath and in-dwelling dilator over the guidewire and into the bladder
#Remove the guidewire and fascial dilator, leaving only the peel-away sheet
#Insert Foley catheter through sheath and into bladder
#Aspirate urine through Foley catheter to confirm placement
#Inflate Foley balloon
#Remove the peel-away sheath
#Dress the site

==Complications==
*Bowel perforation
*Through and through bladder penetration may lead to rectal, vaginal, or uterine injury
*Intraperitoneal extravasation
*Infection
*Hematuria

==See Also==
*[[Suprapubic bladder aspiration]]
*[[Suprapubic catheter changing or replacement]]
*[[Genitourinary trauma]]
*[[Urinary retention]]

==External Links==
===Videos===
{{#widget:YouTube|id=yTFS3FILWGY}}

==References==
<references/>

[[Category:Procedures]]
[[Category:Urology]]