Procedure

Suprapubic Bladder Aspiration

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Suprapubic Bladder Aspiration, Suprapubic Aspiration

  • See Also
  1. Urethral Catheterization
  2. Suprapubic Catheter
  • Indications
  1. Urine Culture in infants or toddlers age <24 months (e.g. febrile without source)
    1. Rarely performed in modern era and replaced by Urethral Catheterization
    2. May be considered in cases where Urethral Catheterization is difficult
      1. Labial adhesions, Urethral Strictures or Phimosis
  • Contraindications
  1. Abdominal wall or Skin Infection overlying insertion site
  2. Abdominal Distention (esp. intervening bowel)
  3. Coagulopathy
  4. Nonpalpable Bladder (or voided within last hour)
  • Complications
  1. Infection
  2. Bleeding
  3. Failed procedure
  4. Injury to intraabdominal adjacent structures
  • Technique
  1. Informed Consent
  2. Consider Analgesics or Anxiolytics
  3. Assistant to restrain the infant
    1. Position infant in a frog-legged position
  4. Ultrasound guidance
    1. Suprapubic Bladder Aspiration was historically performed by pediatricians with landmark only
    2. Bedside Ultrasound is widely available in ED, and useful in a procedure that is now rarely performed
  5. Site preparation
    1. Mark entry
    2. Topical Antiseptic (e.g. Chlorhexidine,Povidone Iodine)
    3. Local Anesthetic (e.g. Lidocaine 1% with Epinephrine)
  6. Needle insertion
    1. Obtain 10-mL syringe for aspiration sample
    2. Neede: 3 inch 22 gauge spinal needle (1.5 inch may be sufficient in infants)
    3. Insert needle through prepared site and direct toward Bladder
    4. Continually aspirate while advancing needle until urine is obtained
      1. Direct visualization of needle may be performed with Bedside Ultrasound
      2. Redirect needle as needed
  7. Procedure Completion
    1. Remove needle and dress the entry site
    2. Send Urine Culture
  • References
  1. Warrington (2025) Crit Dec Emerg Med 39(2): 21-2
  2. Peters (2024) Suprapubic Aspiration, StatPearls, Treasure Island, FL
    1. https://www.ncbi.nlm.nih.gov/books/NBK557545/