Suprapubic Aspiration By Essam Sidqi

urinalysis
urine culture
pediatrics
adult
urine
aspiration
spinal cannula
suprapubic
phymosis
urine container
frog legged

1. Suprapubic Aspiration Prepared by: Essam Sidqi Yaqoob University of Duhok / College of Medicine Kurdistan Region – Iraq 28-Oct-2018

2. I ntroduction Suprapubic aspiration  is a procedure to obtain uncontaminated urine from the urinary bladder. It is easy to perform in the emergency department and is associated with minimal complications.  In a study for children less than 24 months old had a contamination rate of: 1% for suprapubic catheterization 12% for catheterized specimens 26 % for clean-catch

3. Indications Urinalysis or urine culture in neonates or children younger than 2 years Phimosis ( foreskin can't be retracted from around the tip of the penis) Labial adhesions or edema Urethral stricture Urethral trauma Urinary retention (prostate hyperplasia or cancer, gynecologic malignancy, spinal cord injury) Chronic infection of the urethra or periurethral glands

4. Contraindications Empty or unidentifiable bladder (child’s last urination within 1 hour , nonpalpable bladder in adults) Lower abdominal wounds or scarring Overlying  cellulitis Clinically significant bleeding disorder Massive organomegaly Known bladder tumor

5. E quipment

6. The patient should be supine with the abdomen and pubic areas exposed. At least one assistant is needed to immobilize the pediatric patient in a frog-legged position . ( preferred with diaper) For l ocalization of the bladder ultrasonography should be used , if available, even if the bladder is readily palpable. If not, delay the procedure. Ultrasound transducer should be placed in a sterile probe Location is approximately 2 cm midline above the symphysis pubis. Sterilize the area with povidone-iodine and inject local anesthetic . Technique

7. Cont... Pediatric: Insert the needle slightly cephalad, 10-20° off perpendicular, and advance. In a young child, the bladder is still an abdominal organ. Adult: Insert the needle slightly caudad , 10-20° off perpendicular. In an adult, the bladder is a pelvic organ. If the insertion is unsuccessful, do not withdraw the needle fully. Instead, pull back until the needle tip rests in the subcutaneous tissue and then redirect 10° in either direction. Do not attempt more than 3 times. Once urine is obtained, remove the needle and apply gentle pressure at the insertion site with sterile gauze. Place a sterile dressing at the site of insertion. Place the urine specimen in a sterile container approved for urinalysis and culture .

8. Complications Peritoneal perforation with or without bowel perforation (not so significant) Infection (intra-abdominal, bladder, skin, soft tissues)   (more occur with catheter). Hematuria (usually transient and microscopic, gross hematuria is uncommon )

9. References Medscape.com Nejm.org