(See also Bladder Catheterization Bladder Catheterization Bladder catheterization is used to do the following: Obtain urine for examination Measure residual urine volume Relieve urinary retention or incontinence Deliver radiopaque contrast agents or... read more and Urinary Tract Infection in Children Urinary Tract Infection (UTI) in Children Urinary tract infection (UTI) is defined by ≥ 5 × 104 colonies/mL in a catheterized urine specimen or, in older children, by repeated voided specimens with ≥ 105 colonies/mL... read more .)
Suprapubic aspiration is done when a clean-catch urine sample cannot be obtained and transurethral bladder catheterization was unsuccessful or not possible. Suprapubic aspiration is done most often in children but can also be done in adults.
A suprapubic catheter Suprapubic catheterization Bladder catheterization is used to do the following: Obtain urine for examination Measure residual urine volume Relieve urinary retention or incontinence Deliver radiopaque contrast agents or... read more may be placed when an indwelling catheter is needed. This procedure is not discussed further here.
Skin or soft tissue infection* of the abdominal wall over the bladder
* Cellulitis or significant abdominal wall infection, not diaper rash or eczema.
Major genitourinary abnormalities
Previous abdominal surgery
Suprapubic aspiration is typically safe. Possible complications include
Bowel perforation (rare, usually in patients with bowel distention from a gastrointestinal disorder). In these patients, ultrasound guidance can reduce the risk of bowel perforation.
Sterile drapes and gloves
An absorbent underpad
Antiseptic solution (eg, povidone iodine, chlorhexidine) with applicator sticks, cotton balls, or gauze pads
Lidocaine (1% with or without epinephrine), 25-gauge needle, and 5-mL syringe
For aspiration, a 5-mL syringe, 22-gauge 1.5-inch needle
Sterile cup for urine specimen
Washcloth for removing povidone iodine after the procedure
The bladder should be relatively full (confirmed by physical examination and/or ultrasonography).
The bladder lies posterior to the pubic bone and anterior to the uterus in girls and anterior to the rectum in boys.
Place the patient in a supine, frog position (hips and knees partially flexed, heels on the bed, hips comfortably abducted).
Step-by-Step Description of Procedure
Locate the bladder by percussion and palpation or using ultrasound.
Locate the point of entry, which is 1 to 2 cm cephalad to the superior edge of the symphysis pubis in the midline.
Cleanse the area from the pubic symphysis to the umbilicus with antiseptic solution. Begin at the planned entry site and use a circular motion outward. If using povidone iodine, clean 3 times then allow the area to dry and remove the iodine with an alcohol swab.
Place sterile drapes around the area or use a fenestrated sterile drape.
Inject local anesthetic subcutaneously and into the dermis at the planned entry site.
Insert the 22-gauge needle attached to a 5-mL syringe into the entry site perpendicular to the abdominal wall (this is typically pointing 10 to 20° caudally from the true vertical because the abdominal wall in children slopes down to the symphysis pubis).
Aspirate while advancing. Urine will appear in the syringe.
If urine is not obtained, withdraw the needle to the subcutaneous tissue but do not withdraw completely. Then redirect the needle in a more caudad direction, this time keeping the needle and syringe vertical to the abdominal wall.
Consider using ultrasound to identify the bladder for real-time ultrasound guidance. Place a sterile cover on the ultrasound probe. Place the probe on the abdominal wall just inferior to the planned needle-insertion site. Follow the needle as it advances through the anterior abdominal wall and into the bladder. When the needle is in the bladder, aspirate the urine.
After collecting adequate urine, withdraw the syringe and needle.
Place a bandage over the puncture site.
Warnings and Common Errors
Microscopic hematuria is common after the procedure; gross hematuria is uncommon.
Tips and Tricks
Frequently the child may spontaneously urinate stimulated by the procedure. Be prepared to collect this urine in a sterile container.
During pre-procedure examination or ultrasound, apply minimal pressure to the abdominal wall to avoid triggering urination.
If the bladder appears as a hypoechoic area 2 cm in each dimension, it is possible to obtain about 2 mL of urine.
If the bladder cannot be visualized with ultrasound, there is probably not enough urine due to dehydration or recent voiding. Provide hydration if permitted by the patient's clinical condition and repeat the ultrasound after a few minutes.