Suprapubic catheter placement

Indications

• Urethral disruption due to trauma
• Severe urethral stricture or complex prostatic disease

Contraindications

• Empty or unidentifiable bladder
  • Empty bladder introduces risk of through-and-through penetration of the bladder
  • No minimum reported bladder volume established
• Bowel anterior to bladder

Equipment Needed

• Cook peel away sheath unit is a user-friendly device for suprapubic bladder access
• If not available, any device suitable for central venous access can be inserted suprapubically via the Seldinger technique
• Ultrasound to delineate bladder anatomy
• Sterile gloves
• Skin prep
• Lidocaine
• Sterile syringe, 10 or 20 mL
• Spinal needle, 22 ga, for adult patients
• Foley catheter
• Dressing

Procedure

• Placement of the Cook peel-away sheath:
• Locate the full and distended bladder with ultrasound and palpation
• Prep skin
• Fill 6 mL syringe with 1% lidocaine and attach 22-gauge, spinal needle
• Raise skin wheal at proposed site (2-3cm above pubic symphysis)
• Infiltrate the subcutaneous tissue and rectus abdominis muscle fascia at a 10-20 degree angle toward the pelvis
• Locate the bladder by advancing the needle while aspirating the syringe
• Remove the syringe from the needle and advance a guidewire through the needle into the bladder
• Withdraw the needle while leaving only the guidewire
• Use a No. 15 scalpel blade to make a stab incision through the skin, subcutaneous tissue, and superficial anterior abdominal wall fascia
• Pass the peel-away sheath and indwelling fascial dilator together over the wire into the bladder
• Remove the guidewire and fascial dilator and leave only the peel-away sheath inside the bladder
• Pass the foley catheter through the indwelling intravesical sheath into the bladder
• Aspirate urine to confirm proper placement. Inflate the Foley balloon with of 10 mL of air, water, or saline.
• Withdraw the peel-away sheath

Complications

• Bowel perforation
• Through and through bladder penetration may lead to rectal, vaginal, or uterine injury
• Intraperitoneal extravasation
• Infection
• Hematuria

See Also

• Suprapubic bladder aspiration
• Suprapubic catheter changing or replacement
• Genitourinary trauma
• Urinary retention