Suprapubic aspiration of urine

Disclaimer

These guidelines have been produced to guide clinical decision making for the medical, nursing and allied health staff of Perth Children’s Hospital. They are not strict protocols, and they do not replace the judgement of a senior clinician. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline. 

Read the full PCH Emergency Department disclaimer.

Aim

To guide PCH ED staff with performing a suprapubic aspiration of urine.

Pre-Procedure

  • The child should not have passed urine in the previous 60 minutes prior to the procedure 
    • If so, feed the child and wait 30 to 60 minutes
  • If the child is stable it is preferrable to do the suprapubic aspiration prior to carrying out any other invasive procedures.

General

  • Suprapubic aspiration of urine is a simple and safe technique for obtaining an uncontaminated specimen of urine in children
  • In stable children, perform first before other invasive procedures like bloods and lumbar puncture (in case the child voids)
  • The procedure should be done quickly once you expose the genitals, so prepare everything before you undo the nappy
  • Standard aseptic non-touch technique with sterile gloves is required.

Indications

  • Children less than 6 months of age who need a urine culture
  • Children less than 1 year old who need a repeat urine culture because the previous urine culture is contaminated.

Contraindications

  • Urinated in the previous 1 hour
  • Distended abdomen
  • Known coagulopathy
  • Skin infection over puncture site
  • Urogenital abnormality.

Preparation

Staff

  • Doctor to carry out procedure
  • Nurse to hold the child throughout procedure
  • Assistant to catch urine.

Equipment

Sterile dressing pack with equipment for suprapubic aspiration.

SPA equipment

  • 3ml or 5ml syringe
  • Alcohol wipe
  • 23 gauge needle
  • Sterile gloves
  • Urine container (yellow top)
  • IV pressure pad.

Procedure

Medications

  • Can give a small amount of sucrose to infants prior to the procedure.

Positioning and technique

Position and technique for suprapubic aspiration of urine

  • The child lies supine
  • The nurse is to hold the child steady and immobilise the legs in an extended position. An assistant is to be ready to catch the urine with an open urine jar, if the patient passes urine.

Check the bladder size /volume using one of the following 3 methods:

  • Curvilinear ultrasound probe to check bladder volume:
    • Transverse view, depth (D) 2-3 cm or Transverse diameter (T) 3.5cm (recommended method) or
  • Bladder scanner (minimum 20ml) - scan 3 times to confirm, or
  • Gently percuss the bladder, fundus should be 1-2 finger breadths above the pubic symphysis (PS).

1. Wipe the skin from the pubis to umbilicus in a circular motion 5cm diameter with the alcohol wipe:

Cleaning suprapubic aspirate site with alcohol swab.

2. Insert the needle perpendicular to the skin at 1-2cm superior to the pubic symphysis (the suprapubic crease level) at midline:

Technique to insert needle for suprapubic aspirate.

3. Aspirate gently after the needle goes through the skin. Remember to aspirate as you insert, as well as when you withdraw the needle.

4. Advance the needle 2-3cm deep if needed (i.e. whole length of the 23G needle)

  • If urine is not obtained, do not remove the needle, but withdraw it to a subcutaneous layer and redirect it slightly more superior, and then more inferior to the pubic symphysis if needed
  • The procedure should be abandoned if still unsuccessful and an alternate method of urine collection should be considered
  • Further attempts at SPA should be at the discretion of the Senior Doctor on duty.

Post-procedure

Complications

All these complications are rare:

  • Transient, gross or microscopic haematuria
  • Intestinal perforation
  • Bladder haematuria
  • Abdominal wall abscess.

Bibliography

  1. Abbott GD, Shannon FT. How to aspirate urine suprapubically in infants and children. Clinical Pediatrics. 1970; 9:277.
  2. Bajal L, Bothner J. Urine collection technique in children. UpToDate. Last updated: June 14, 2012. Accessed at www.uptodate.com.
  3. Chu RW, Wong YC, Luk SH, et al. Comparing suprapubic urine aspiration under real-time ultrasound guidance with conventional blind aspiration. Acta Paediatrica. 2002; 91:512–516.
  4. García-Nieto V, Navarro JF, Sánchez-Almeida E, García-García M. Standards for ultrasound guidance of suprapubic bladder aspiration. Pediatric Nephrology. 1997 Oct; 11(5):607-9.
  5. Munir V, Barnett P, South M. Does the use of volumetric bladder ultrasound improve the success rate of suprapubic aspiration of urine? Pediatric Emergency Care. 2002 Oct; 18(5):346-9.
  6. Porter FN. Percussion as aid to suprapubic aspiration. Archives of Disease in Childhood. 1988 August; 63(8): 998.
  7. Harrison S. Urinary Tract Infection. Pediatric Nephrology; Chapter 53:P 1014.
  8. Loiselle JM. Ultrasound assisted suprapubic bladder aspiration.  Textbook of Paediatric Emergency Procedures.Chapter 133. P1221-1226.
  9. Gochman RF, Karasic RB, Heller MB. Use of portable ultrasound to assist urine collection by suprapubic aspiration.Annals of Emergency Medicine. 1991; 20: 631-5.
  10. Fairhurst JJ, Rubin CM, Hyde I, Freeman NV, Williams JD. Bladder capacity in infants. Journal of Pediatric Surgery. 1991; 26(1):55-57.
  11. Barkemeyer BM. Suprapubic aspiration of urine in very low birth weight infants. Pediatrics. 1993; 92:457.

Endorsed by:  Director, Emergency Department  Date:  Jun 2017


 Review date:   Feb 2021


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