pediatrics
How To Do Suprapubic Aspiration of the Bladder in a Child
Step by Step Description of Suprapubic Catheterization in a Child
Locate the bladder by percussion and palpation or using ultrasound. Locate the point of entry, which is 1 to 2 cm cephalad to the superior edge of the symphysis pubis in the midline. Cleanse the area from the pubic symphysis to the umbilicus with antiseptic solution. Begin at the planned entry site and use a circular motion outward. If usingpovidone-iodine, cleanse 3 times then allow the area to dry and remove the iodine with an alcohol swab. Place sterile drapes around the area or use a fenestrated sterile drape. Inject local anesthetic subcutaneously and into the dermis at the planned entry site. Insert the 22-gauge needle attached to a 5-mL syringe into the entry site vertically into the abdominal wall about the breadth of 2 fingers above the pubic bone in the midline. (This is typically pointing 10 to 20°caudally from the true vertical because the abdominal wall in children slopes down to the symphysis pubis.) Aspirate while advancing. Urine will appear in the syringe. If urine is not obtained, withdraw the needle to the subcutaneous tissue but do not withdraw completely. Then redirect the needle closer to the pubic bone in a downwards direction. Consider using ultrasound to identify the bladder for real-time ultrasound guidance. Place a sterile cover on the ultrasound probe. Place the probe on the abdominal wall just inferior to the planned needle-insertion site. Follow the needle as it advances through the anterior abdominal wall and into the bladder. When the needle is in the bladder, aspirate the urine. After collecting adequate urine, withdraw the syringe and needle. 