Chapter 24

1. Indications. To obtain urine for culture when a less invasive technique is not possible. It is the most accurate and preferred culture source for infants when compared with urethra catheterization and bag urine specimens. Any bacteria or growth on a suprapubic culture is considered abnormal and requires treatment.

2. Equipment. Sterile gloves, povidone-iodine solution, a 23- or 25-gauge 1-in needle (a 21- to 22-gauge 11/2-in needle can be used in a larger infant) with a 3-mL syringe attached, 4 × 4 gauze pads, gloves, and a sterile container. Transillumination or ultrasound may also be used.

3. Procedure

1. Bladder aspiration is contraindicated in thrombocytopenia, bleeding disorders, cellulitis at the site, after recent lower abdominal or urologic surgery or if the bladder is empty.

1. Verify that voiding has not occurred within the previous hour so there will be enough urine in the bladder to make collection worthwhile. Transillumination or ultrasound of the bladder can help determine the size and location of the bladder. Ultrasound significantly improves diagnostic yield; a minimum volume on ultrasound of 10 mL is associated with a 90% successful bladder aspiration. If the cephalocaudal diameter of the bladder (sagittal view) was >20 mm and the anteroposterior diameter was >15 mm, the success rate approaches 100%.

1. An assistant should hold the infant in a supine position with the legs in the frog-leg position.

1. Locate the site of bladder puncture, which is ~1–2 cm above the pubic symphysis, in the midline of the lower abdomen. In neonates the bladder is located predominantly intra-abdominally.

1. Put on sterile gloves, and clean the skin at the puncture site with antiseptic solution three times. Local anesthesia often turns this from a "one-stick" to a "two-stick procedure." Lidocaine or topical anesthetic agents may be used. (See Chapter 69.)

1. Palpate the pubic symphysis. Insert the needle 1–2 cm above the pubic symphysis at a 90-degree angle (Figure 24–1).

1. Advance the needle while aspirating ~2–3 cm. Once urine is seen in the syringe, do not advance the needle >1–2 cm; this helps prevent perforation of the posterior wall of the bladder. Use gentle suction when aspirating to prevent the needle from suctioning the bladder wall and preventing the collection of urine.

1. Withdraw the needle, maintain pressure over the site of puncture, and apply a bandage.

1. Place a sterile cap on the syringe or transfer the specimen to a sterile urine cup, and submit the specimen to the laboratory.

4. Complications

1. Bleeding. Microscopic hematuria is common and rarely causes concern. Gross hemorrhage is more likely if there is a bleeding disorder. With thrombocytopenia, the procedure should not be performed. Hematomas (abdominal wall, pelvic and bladder wall) are rare.

1. Infection (rare). Infection is not likely to occur if strict sterile technique is used. Sepsis, abdominal wall abscess, and osteomyelitis of the pubic bone have all been reported but are very rare.

1. Perforation of the bowel or other pelvic organs. With careful identification of the landmarks, this complication is rare. If the ...

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