• Thrombocytopenia and bleeding disorders.
• Cellulitis and infection at puncture site.
• Age greater than 2 years.
|• All equipment
should be latex free. Allergy to latex is common, particularly in
certain populations (such as patients with meningomyelocele.)|
• 22-gauge, 2–3-cm needle.
• 3-mL or 5-mL syringe.
• Sterile collection cup.
• 10% povidone-iodine (or equivalent).
• Sterile gloves, drapes, gauze.
• Topical anesthetic or buffered 1% lidocaine solution,
• Infection (rare).
• Intestinal perforation (very rare).
• Failure to obtain urine (success rates vary widely but less successful
• Psychological stress (common, as child is restrained for procedure).
• Pain (certain; can be limited somewhat with anesthesia).
• Appropriate patient restraint is critical to
the success of the procedure.
• More than 2 or 3 attempts do not add to success rates.
• Ultrasonography has been reported to increase success rates in
• Because spontaneous voiding may occur during skin preparation
or as the procedure is initiated, have a sterile container available
to collect the urine.
• The needle is passed through the abdominal wall
just rostral to the pelvic rim in the midline.
• The bladder in an infant is located in the abdomen, which allows
for direct access to the bladder lumen with a needle. (The bladder
in an older child and adult is located in the pelvis.)
• Various methods to improve success have been cited and include
• Ensuring that time has passed since the last void.
• Encouraging the child to drink.
• Percussing the abdomen to ascertain bladder fullness.
• Obtaining an ultrasonogram. This can be used to ensure bladder
fullness or to guide needle insertion.
• Observe sterile procedure.
• Strongly consider applying a topical anesthetic before starting
• Leaving the topical anesthetic on for a sufficient time period
provides a reasonable degree of topical anesthesia.
• Remove the topical anesthetic prior to skin preparation.
• The practice of additional injection of lidocaine varies; the
injection represents a separate needle stick and is associated with
pain from lidocaine infiltration.
• Apply 10% povidone-iodine solution to the skin surface of
the abdomen 1–2 cm above the pubic symphysis.
• Attach the syringe to the needle.
• The provider should be ...
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