Suprapubic bladder aspiration

Indications

1. Urine for bacteriology in children < 2
2. Phimosis
3. Urinary retention
4. Urethral trauma/stricture
5. Chronic urethral or periurethral infxn

Contraindications

1. Empty or unidentifiable bladder
2. Known bladder tumor
3. Lower abdominal wounds
4. Overlying cellulitis

Equipment

1. Sterile gloves
2. Skin prep
3. Lidocaine
4. Sterile syringe, 10 or 20 mL
5. Needle, 22 gauge (ga), 1.5 in, for pediatric patients
6. Spinal needle, 22 ga, for adult patients
7. 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 2cm above sup edge of pubic symphisis)
4. In infants, insert and appropriate length 22G needle 10-20 degrees cephalad from perpendicular and aspirate until urine returns
   1. Remember, the bladder is an abdominal organ in newborns.
   2. 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 verticle and aspirate after the skin is entered

Complications

1. Inability to aspirate urine
2. Hematuria (microscopic is common, gross is uncommon)
3. Penetration of bowel (innocuous if entered with small needle only)

Source

1. Roberts
2. emedicine