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


imagesPhimosis


CONTRAINDICATIONS



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


LANDMARKS



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


SUPPLIES



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)


   imagesDilator


   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



images


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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