• 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 ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.