Suprapubic Tap or Aspiration

CHAPTER 114 Suprapubic Tap or Aspiration



Robert E. James, James R. Palleschi


Suprapubic aspiration is a valuable diagnostic procedure, and, occasionally, it may even be a valuable therapeutic tool. In most cases, suprapubic aspiration can be performed safely at the bedside or in the clinician’s office. (For insertion of suprapubic catheters, see Chapter 113, Suprapubic Catheter Insertion and/or Change.)


To review the anatomy, clinicians should be aware that the dome of the bladder has peritoneal attachments and that needle penetration into this area can cause injury to bowel or an intraperitoneal bladder perforation. The colon lies posterior and inferior to the bladder, so the clinician should avoid advancing the needle through both walls of the bladder. Alongside the bladder, in the pelvis, lie significant vascular structures, including the common iliac and hypogastric vessels. Aspiration in this area may lead to inadvertent and significant hemorrhage.


A properly directed needle will penetrate only the skin and subcutaneous tissue of the lower anterior abdominal wall, the rectus sheath, the peritoneum, and the anterior bladder wall.



Indications



• Collection of a urine specimen for analysis, culture, and sensitivity using sterile technique

• Temporary relief of acute urinary retention in patient not able to be catheterized


Contraindications



• Anticoagulated patient or patient with coagulopathy (either the anticoagulation/coagulopathy should be reversed or urology consulted)

• An uncooperative patient (see Chapter 2, Procedural Sedation and Analgesia)

• Infection or cellulitis of the suprapubic area

• Full bladder not palpable*

• Patient not able to lay supine or have his or her bladder palpated*

• Surgical scar in suprapubic area, or bladder or pelvic anatomic abnormality from previous surgery, cancer, or trauma (small bowel may be interposed in the retropubic space)*

• Abnormalities of genitourinary anatomy, enlargement of pelvic organs (e.g., ovarian cysts, uterine fibroids), distention or enlargement of abdominal viscera (including intestinal obstruction)*



Equipment



• Local anesthetic: 10 mL lidocaine 1%

• Needles:
• For anesthetic: image-inch, 25- to 30-gauge needle

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

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