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

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

• Urinary retention
• Suprapubic catheter placement
• Suprapubic catheter changing or replacement