PERCUTANEOUS SUPRAPUBIC PUNCTURE – Indication, Method and Complications
Suprapubic bladder aspiration is the introduction of a needle through the anterior abdominal wall and into the bladder to obtain a urine specimen under strict sterile technique. It is performed primarily to diagnose urinary tract infections. It is most commonly performed in children under the age of 2 years as part of the septic work-up
The procedure is quick, simple to perform, safe and has a low rate of complications. The main advantage of suprapubic bladder aspiration is that it bypasses the urethra and minimizes the risk of obtaining a contaminated urine specimen. Urinary sampling remains the cornerstone for the diagnosis of many disease processes including metabolic derangements, infectious processes, catabolic states, and neoplastic conditions. In cases when the usual means of voided urine collection or bladder drainage is not possible or preferable, suprapubic bladder aspiration becomes a viable option both therapeutically and diagnostically. If properly performed, this technique can yield an uncontaminated urine sample without urethral or skin flora contamination
INDICATIONS
- Acute retention of urine when urethral catheterization and passage of filiforms bougies are unsuccessful
- Urethral disruption due to pelvic trauma
- Bladder drainage required in the presence of urethral or prostatic infection
METHOD
Confirmation of distended bladder by palpation is crucial. After adequate shaving, painting and draping of the suprapubic area
Infiltrate local anesthetic in the middle about two-finger breadth above the pubis down to and including the anterior bladder wall. Take a 14 – gauge intracatheter needle and, with a 60 degrees caudal angle insert it through the skin with a short firm thrust to penetrate fascia and enter the bladder; aspirate urine to confirm. Advance intracatheter cannula through the needle into the bladder and withdraw the needle from the bladder. Then lock the needle and cannula hubs together. Ascertain cannula position by aspiration. Then suture catheter in place and attach urosac (urine collection system). Apply sterile dressing.
COMPLICATIONS
- Bleeding hematuria may occur due to injury to submucosal vessels or rapid decompression of chronically distended bladder. Do slow decompression in chronic urinary retention
- Injury to surrounding viscera: perforation of bowel due to incorrect site, improper position of the needle or when the bladder is not distended. Do not puncture two-finger breadth away from the symphysis pubis or in an undistended bladder
- Pericatheter leakage
- Blockage of catheter
- Infection
