Suprapubic Bladder Aspiration Flashcards
Indications
To obtain urine for culture
Contraindications
Empty bladder as a result of recent void or dehydration (A full bladder is essential for success of the procedure and avoidance of complications).
Skin infection over the puncture site.
Distention or enlargement of abdominal viscera (e.g., dilated loops of bowel, massive hepatomegaly).
Genitourinary anomaly or enlargement of pelvic structures (e.g., ovarian cyst, distention of vagina or uterus).
Uncorrected thrombocytopenia or bleeding diathesis.
Precautions
Use strict aseptic technique.
Delay the procedure if the infant has urinated in the last hour.
If the infant is systemically ill, do not delay antibiotic therapy to wait for further urine production.
Correct bleeding diathesis before the procedure. Consider catheterization as an alternative.
Be certain of landmarks. Do not insert the needle over the pubic bone or off the midline.
Aspirate urine using only gentle suction. The use of too much suction can draw the bladder mucosa to the needle, obstructing the collection of urine and increasing the risk of injury to the bladder.
How to determine the presence of urine in the bladder
Verify that the diaper has been dry for at least 1 hour.
Palpate or percuss the bladder.
Optionally, use transillumination light (14) or portable ultrasound guidance
Proper landmarks
Palpate the top of the pubic bone. The site for needle insertion is 1 to 2 cm above the symphysis pubis in the midline
Needle insertion and aspiration technique
Palpate the symphysis pubis, and insert the needle (with syringe attached) 1 to 2 cm above the pubic symphysis in the midline
Maintain the needle perpendicular to table or directed slightly caudad.
Advance the needle 1 to 3 cm. A slight decrease in resistance may be felt when the bladder is penetrated.
Aspirate gently, as the needle is slowly advanced, until urine enters the syringe. Do not advance the needle more than 3 cm
Complications
Minor transient hematuria
Bleeding
Infection
Perforation
