Chapter 32. Suprapubic Catheterization

• • 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.

• • 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 ...