Suprapubic catheter placement: Difference between revisions
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Revision as of 21:02, 26 June 2018
Indications
- Trauma patients with urethral disruption
- Men with severe urethral stricture or complex prostatic disease
Contraindications
- Empty or unidentifiable bladder
- No absolute reported minimum bladder volume has been established
- But need enough urine in the bladder to allow the needle to fully penetrate the dome of the bladder without immediately exiting through the base
- Should not have bowel anterior to the bladder
Equipment Needed
- Cook peel away sheath unit is a user-friendly device for suprapubic bladder access
- If not available, any device suitable for central venous access can be inserted suprapubically via the Seldinger technique
- Ultrasound to delineate bladder anatomy
- Sterile gloves
- Skin prep
- Lidocaine
- Sterile syringe, 10 or 20 mL
- Spinal needle, 22 ga, for adult patients
- Foley catheter
- Dressing
Procedure
- Placement of the Cook peel-away sheath:
- Locate the full and distended bladder with ultrasound and palpation
- Prep skin
- Fill 6 mL syringe with 1% lidocaine and attach 22-gauge, spinal needle
- Raise skin wheal at proposed site (2-3cm above pubic symphysis)
- Infiltrate the subcutaneous tissue and rectus abdominis muscle fascia at a 10-20 degree angle toward the pelvis
- Locate the bladder by advancing the needle while aspirating the syringe
- Remove the syringe from the needle and advance a guidewire through the needle into the bladder
- Withdraw the needle while leaving only the guidewire
- Use a No. 15 scalpel blade to make a stab incision through the skin, subcutaneous tissue, and superficial anterior abdominal wall fascia
- Pass the peel-away sheath and indwelling fascial dilator together over the wire into the bladder
- Remove the guidewire and fascial dilator and leave only the peel-away sheath inside the bladder
- Pass the foley catheter through the indwelling intravesical sheath into the bladder
- Aspirate urine to confirm proper placement. Inflate the Foley balloon with of 10 mL of air, water, or saline.
- Withdraw the peel-away sheath
Complications
- Bowel perforation
- Through and through bladder penetration may lead to rectal, vaginal, or uterine injury
- Intraperitoneal extravasation
- Infection
- Hematuria