Field Guide to Urgent & Ambulatory Care Procedures
1st Edition

Chapter 41
Suprapubic Bladder Aspiration and Placement of a Suprapubic Catheter
Suprapubic bladder aspiration is used to obtain a sterile urine specimen, as well as to aid in placement of a suprapubic catheter.
In children under 2 years of age, the bladder is an abdominal organ. The suprapubic bladder aspiration is an extremely successful and simple method to obtain a sterile urine specimen without having to pass a urethral catheter. After 2 years of age, the bladder moves into the pelvis, and transabdominal aspiration becomes a less attractive option unless the bladder is felt to be massivelydilated.
A suprapubic catheter may be indicated in the following conditions:
  • Impassable urethral stricture, obstruction, or contracture of the bladder neck
  • A requirement for bladder drainage in the setting of severe urethral or prostatic infection
  • Urethral trauma or recent reconstructive surgery to the urethra or bladder neck
  • Inability to tolerate a urethral catheter or inability to self-catheterize
Contraindications to suprapubic aspiration and suprapubic catheter placement include but are not limited to:
  • Empty bladder
  • Uncooperative patient
  • Bleeding diathesis or uncorrectable coagulopathy
  • Bowel distention
  • Abdominal wall infection at site of suprapubic puncture
Suprapubic Aspiration
Often a pediatric procedure, suprapubic bladder aspiration is generally quite straightforward. A full bladder is a must.
What You Need
Betadine or other skin antiseptic solution
Mask, gown, sterile gloves
5-mL syringe with 22-gauge 1-inch needle
Gauze pads
Additional Useful Equipment:
1% or 2% lidocaine WITH epinephrine
3-mL syringe with 25-gauge needle for infiltration
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For the Adult Patient,
60-mL syringe with attached 4-inch 20-gauge spinal needle
Clinical Technique
  • Obtain appropriate history from patient (or caregiver) and perform a physical examination. The bladder MUST be full for this procedure.
  • Discuss the procedure with the patient (or caregiver) and obtain consent if clinically appropriate.
  • Wash hands; don mask, gown, and sterile gloves.
  • Expose lower abdomen of patient. Position patient in a supine position. Prep skin with Betadine or other skin antiseptic.
  • Palpate bladder and make a mental note of its contours.
  • Draw up lidocaine into the 3-mL syringe; raise a small skin wheal of anesthetic using the 25-gauge needle. (Some clinicians omit this step.)
  • Have assistant gently restrain patient (if very young).
  • Attach aspiration needle to appropriately sized syringe. (Use a 5-mL syringe if a pediatric patient; use the 60-mL syringe if an adult). Hold the syringe in your DOMINANT hand; place index and middle fingers of your NONDOMINANT hand on the top of the pubic bone to act as a guide.
  • Direct the needle into the bladder, aspirating continuously, advancing slowly and at a slightly caudad angle. Stop advancing when urine flows into the syringe; the needle does not have to be advanced to its full depth (Fig. 41.1).
    FIG. 41.1. Suprapubic bladder aspiration in an infant.
    If Only Urine Sample Is Required,
  • Remove needle from bladder and abdominal wall. Empty specimen into a sterile container.
  • Apply a sterile dressing to abdominal wall puncture site. The bladder puncture itself will seal as soon as the needle is withdrawn.
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What You Need
Placing a Suprapubic Catheter Using a Guidewire and Cook Peel-Away Sheath:
Suprapubic cystotomy and catheter kit containing the following: (a) 30-mL syringe, (b) 20-gauge 4- inch spinal needle, (c) guidewire with J-type loop, (d) fascial dilator with peel-away sheath (Cook-type, or similar), (e) 16 Fr Foley catheter, and (f) No. 11 blade
Closed urine drainage system
Betadine or similar skin antiseptic solution
4 × 4 gauzes
Sterile draping
1% or 2% lidocaine WITH epinephrine
5-mL syringe with 25-gauge 1.5-inch needle for infiltration
Mask, gown, sterile gloves
Clinical Technique
  • Obtain history from patient and perform appropriate physical examination. Do the indications exist for suprapubic catheter placement?Discuss procedure with patient and obtain consent (if clinically appro-priate).
    If Proceeding,
  • Assemble materials on a bedside table. Wash hands; don mask, gown, and gloves.
  • Draw up 1% or 2% lidocaine WITH epinephrine into 5-mL syringe; attach 25-gauge 1.5-inch needle for infiltration.
  • Place patient in a supine position; uncover lower abdomen. Prep skin of lower abdomen with Betadine or similar skin antiseptic. Drape to define a sterile field.
  • Infiltrate lidocaine at point of suprapubic aspiration. This will be5 cm above the symphysis pubis, in the midline, and will be directlyover the distended bladder. Infiltrate the overlying skin and the deeper tissues.
  • Attach 20-gauge 4-inch spinal needle to the 30-mL syringe. Perform suprapubic bladder aspiration by angling needle caudad and aspirating constantly. STOP advancing when urine returns into the syringe.
  • Disconnect syringe. Leave the needle in the bladder. Advance guidewire through needle into bladder; leave 12 to 18 inches of guidewire free distal to the needle hub.
  • Remove needle, leaving guidewire in place. Make a nick in the skin with the No. 11 blade along the course of the guidewire.
  • Pass the fascial dilator with the peel-away sheath over the guidewire and into the bladder (Fig. 41.2).
    FIG. 41.2. Fascial dilator with peel-away sheath inserted into the bladder over the guidewire.
  • Remove guidewire and fascial dilator. The peel-away sheath will remain in place.
  • Pass the Foley catheter inside the peel-away sheath into the bladder. Inflate the Foley balloon with sterile water. Connect the Foley to the closed collection system.
  • Begin peeling away the sheath. It will come free of the bladder and abdominal wall. Continue peeling apart until it comes free of the Foley catheter (Fig. 41.3).
    FIG. 41.3. “Peeling-away” the sheath from the Foley catheter.
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  • Withdraw Foley until the balloon makes good contact with the anterior bladder wall. This will “seal” the cystotomy site. Attach closed drainage system to catheter.
  • Dress abdominal puncture site with gauze.
Follow-Up:
Patients will require follow-up with a urologic consultant within 24 hours.