Skip to Main Content

+

  • • Diagnostic evaluation of urine in an infant.

++

Absolute

+

  • • Neutropenia.

    • Thrombocytopenia and bleeding disorders.

    • Cellulitis and infection at puncture site.

    • Age greater than 2 years.

++

Relative

+

  • • Urogenital anomalies.

    • Recent urologic or lower abdominal surgery.

++
Table Graphic Jump Location
Favorite Table | Download (.pdf) | Print
• 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, or both.

+

  • • 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.

+

  • • 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.

+

  • • Keep the patient covered until ready to begin.

    • Good lighting is helpful.

+

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

+

  • • 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.

+

  • • 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 ...

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.

Ok

About MyAccess

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.

Subscription Options

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.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.