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  • • Diagnostic evaluation of urine in an infant.

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Absolute

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  • • Neutropenia.

    • Thrombocytopenia and bleeding disorders.

    • Cellulitis and infection at puncture site.

    • Age greater than 2 years.

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Relative

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  • • Urogenital anomalies.

    • Recent urologic or lower abdominal surgery.

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• All equipment should be latex free. Allergy to latex is common, particularly in certain populations (such as patients with meningomyelocele.)
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  • • 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, or both.

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  • • Infection (rare).

    • Intestinal perforation (very rare).

    • Failure to obtain urine (success rates vary widely but less successful than catheterization).

    • Psychological stress (common, as child is restrained for procedure).

    • Pain (certain; can be limited somewhat with anesthesia).

    • Hematuria.

    • • Microscopic is very common.

      • Macroscopic is uncommon.

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  • • 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 some studies.

    • Because spontaneous voiding may occur during skin preparation or as the procedure is initiated, have a sterile container available to collect the urine.

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  • • Keep the patient covered until ready to begin.

    • Good lighting is helpful.

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  • • The child is placed supine in the frog-leg position.

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  • • 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 the following:

    • • 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.

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  • • Observe sterile procedure.

    • • Wear sterile gloves.

      • Use 1 hand to touch the patient if necessary, while keeping the hand with the needle clean.

    • Strongly consider applying a topical anesthetic before starting the procedure.

    • 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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