Suprapubic Catheter Placement

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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

See Also

External Links

References

Authors

Lisa Yee