Suprapubic catheter placement

(Redirected from Suprapubic catheterization)

Indications

  • Urethral disruption due to trauma
  • Severe urethral stricture or complex 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

  1. 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
  2. Prep skin
  3. Fill syringe with lidocaine and attach spinal needle
  4. Raise skin wheal at marked site
  5. Infiltrate subcutaneous tissue and rectus muscle fascia
  6. Advance the spinal needle into the bladder while applying negative pressure to the syringe
  7. After locating the needle within the bladder, remove the syringe
  8. Advance a guidewire through the needle and into the bladder
  9. Remove the syringe, leaving the guidewire
  10. Use a scalpel to make a stab incision at the site of the guidewire, extending the opening for the sheath introducer
  11. Pass the peel-away sheath and in-dwelling dilator over the guidewire and into the bladder
  12. Remove the guidewire and fascial dilator, leaving only the peel-away sheet
  13. Insert Foley catheter through sheath and into bladder
  14. Aspirate urine through Foley catheter to confirm placement
  15. Inflate Foley balloon
  16. Remove the peel-away sheath
  17. 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

External Links

References

Authors:

Ross Donaldson