Suprapubic Catheterization

imagesUrethral trauma (e.g., partial or full transection)

imagesUrethral stricture

imagesChronic urethral infection

imagesUrinary retention in which a urethral catheter cannot be passed (e.g., prostate obstruction, gynecologic malignancy or other pelvic mass, neurogenic bladder)

imagesPatients requiring a long-term indwelling urethral catheter



imagesAn empty or nonpalpable urinary bladder

imagesHistory of previous lower abdominal surgery

imagesLower abdominal wound or cellulitis

imagesPrevious pelvic radiation with resultant scarring

imagesPresence of a femoral–femoral bypass graft in the suprapubic subcutaneous tissue

imagesSignificant uncorrected coagulopathy

imagesKnown bladder cancer

imagesGeneral Basic Steps

   imagesPatient preparation

   imagesUrinary bladder localization

   imagesNeedle insertion

   imagesFoley catheter insertion

   imagesSecuring the catheter


imagesIn the adult, the urinary bladder is a pelvic organ located immediately posterior to and extending slightly above the symphysis pubis (FIGURE 38.1)

imagesIn the child, the urinary bladder is still an abdominal organ, located in the midline, slightly superior to the symphysis pubis


imagesPovidone–iodine antiseptic solution

imagesSterile gloves and drapes

imagesSuprapubic catheterization kit (e.g., Cook cystostomy kit), which typically includes:

   imagesLocal anesthetic (1% lidocaine), 10-mL syringe, 25-gauge needle

   images22-gauge, 1.5-inch (for children) or 3-inch (for adults) spinal needle

   images4- × 4-cm gauze pads

   imagesJ-tip guidewire

   imagesScalpel (no. 11 blade)


   imagesIntroducer sheath

imagesFoley catheter (size should be 1 French smaller than the diameter of the introducer sheath)

imagesSterile, closed system urinary drainage bag

imagesSterile dressing


FIGURE 38.1 Relationship of bladder to symphysis pubis. (From Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 7th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2013:374, with permission.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Suprapubic Catheterization
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