Pediatric Suprapubic Bladder Aspiration

CHAPTER 183 Pediatric Suprapubic Bladder Aspiration



Carlos A. Moreno


Suprapubic bladder aspiration is a method of obtaining a sterile urine specimen in a young infant when other methods are unsatisfactory. This procedure is most successful in an infant younger than 2 years of age because at that age the bladder is an abdominal organ. After 2 years, as the child grows, the bladder moves into the pelvis, increasing both the difficulty of the procedure and the risk of complications. (See Chapter 225, Emergency Department, Hospitalist, and Office Ultrasonography [Clinical Ultrasonography], for a method of confirming a full bladder and determining where to direct the needle.)



Indications



• To obtain sterile urine for culture in an infant or child younger than 2 years of age (e.g., suspected urinary tract infection [UTI] or sepsis)

• To decompress the urinary bladder when there is urethral obstruction (after decompression, a referral should be made to pediatric urology)


Contraindications



Absolute


There are no absolute contraindications.


NOTE: Some experts now consider “blind” aspiration to be an absolute contraindication. They suggest that the bladder location should be confirmed by palpation, percussion, or transillumination or visualized with ultrasonography.



Relative



• Bleeding abnormality or coagulopathy

• Infection or loss of integrity of skin or fascia at the site of needle insertion (e.g., burn, cellulitis)

• Anatomic genitourinary tract anomalies

• Bowel distention (e.g., ileus, obstruction)

• Scars from previous lower abdominal surgery that might cause adhesions

NOTE: With ultrasonography-directed aspiration, the last three contraindications may be overcome (see Chapter 225, Emergency Department, Hospitalist, and Office Ultrasonography [Clinical Ultrasonography]).



Equipment and Supplies



• Povidone–iodine solution

• 70% isopropyl alcohol

• Sterile 4 × 4 gauze pads

• Sterile gloves

• 3-mL sterile syringe with 1- or image-inch, 22- or 23-gauge needle

• Sterile urine specimen container

• Adhesive bandage

• 1% lidocaine in a tuberculin syringe with image-inch, 27-gauge needle (optional)

• High-frequency ultrasound (5- to 10-MHz) probe and acoustic gel (optional)

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May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Pediatric Suprapubic Bladder Aspiration

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