Suprapubic catheter placement: Difference between revisions
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==Indications==
==Indications==
*Urethral disruption due to trauma
*Urethral disruption due to trauma
*Severe urethral stricture or complex prostatic disease
*Severe urethral stricture or complex [[Benign prostatic hyperplasia|prostatic disease]]


==Contraindications==
==Contraindications==
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==Equipment Needed==
==Equipment Needed==
*Cook peel away sheath unit is a user-friendly device for suprapubic bladder access
*Cook peel-away introducer sheath  
*If not available, any device suitable for central venous access can be inserted suprapubically via the Seldinger technique
**If not available, can use central venous access kit and use Seldinger technique to insert Foley
*Ultrasound to delineate bladder anatomy
*Ultrasound
*Sterile gloves
*Sterile gloves
*Skin prep
*Chlorhexidine or other skin prep
*Lidocaine
*Lidocaine
*Sterile syringe, 10 or 20 mL
*Sterile syringe
*Spinal needle, 22 ga, for adult patients
*Spinal needle (22 gauge for adult patients)
*Foley catheter
*Scalpel
*Foley cather
*Dressing
*Dressing


==Procedure==
==Procedure==
*Placement of the Cook peel-away sheath:
#Use ultrasound to locate and mark the bladder
*Locate the full and distended bladder with ultrasound and palpation
#*May use real-time ultrasound guidance to insert the suprapubic catheter, or may landmark and use a blind approach
*Prep skin
#Prep skin
*Fill 6 mL syringe with 1% lidocaine and attach 22-gauge, spinal needle
#Fill syringe with lidocaine and attach spinal needle
*Raise skin wheal at proposed site (2-3cm above pubic symphysis)
#Raise skin wheal at marked site
*Infiltrate the subcutaneous tissue and rectus abdominis muscle fascia at a 10-20 degree angle toward the pelvis
#Infiltrate subcutaneous tissue and rectus muscle fascia
* Locate the bladder by advancing the needle while aspirating the syringe  
#Advance the spinal needle into the bladder while applying negative pressure to the syringe
* Remove the syringe from the needle and advance a guidewire through the needle into the bladder  
#After locating the needle within the bladder, remove the syringe
*Withdraw the needle while leaving only the guidewire  
#Advance a guidewire through the needle and into the bladder
*Use a No. 15 scalpel blade to make a stab incision through the skin, subcutaneous tissue, and superficial anterior abdominal wall fascia
#Remove the syringe, leaving the guidewire
*Pass the peel-away sheath and indwelling fascial dilator together over the wire into the bladder  
#Use a scalpel to make a stab incision at the site of the guidewire, extending the opening for the sheath introducer
*Remove the guidewire and fascial dilator and leave only the peel-away sheath inside the bladder
#Pass the peel-away sheath and in-dwelling dilator over the guidewire and into the bladder
*Pass the foley catheter through the indwelling intravesical sheath into the bladder  
#Remove the guidewire and fascial dilator, leaving only the peel-away sheet
*Aspirate urine to confirm proper placement. Inflate the Foley balloon with of 10 mL of air, water, or saline.
#Insert Foley catheter through sheath and into bladder
* Withdraw the peel-away sheath  
#Aspirate urine through Foley catheter to confirm placement
#Inflate Foley balloon
#Remove the peel-away sheath
#Dress the site
 
==Complications==
==Complications==
*Bowel perforation
*Bowel perforation
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==External Links==
==External Links==
===Videos===
{{#widget:YouTube|id=yTFS3FILWGY}}


==References==
==References==

Latest revision as of 20:59, 29 June 2021

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 introducer sheath
    • If not available, can use central venous access kit and use Seldinger technique to insert Foley
  • Ultrasound
  • Sterile gloves
  • Chlorhexidine or other skin prep
  • Lidocaine
  • Sterile syringe
  • Spinal needle (22 gauge for adult patients)
  • Scalpel
  • Foley cather
  • Dressing

Procedure

  1. Use ultrasound to locate and mark the bladder
    • May use real-time ultrasound guidance to insert the suprapubic catheter, or may landmark and use a blind approach
  2. Prep skin
  3. Fill syringe with lidocaine and attach spinal needle
  4. Raise skin wheal at marked site
  5. Infiltrate subcutaneous tissue and rectus muscle fascia
  6. Advance the spinal needle into the bladder while applying negative pressure to the syringe
  7. After locating the needle within the bladder, remove the syringe
  8. Advance a guidewire through the needle and into the bladder
  9. Remove the syringe, leaving the guidewire
  10. Use a scalpel to make a stab incision at the site of the guidewire, extending the opening for the sheath introducer
  11. Pass the peel-away sheath and in-dwelling dilator over the guidewire and into the bladder
  12. Remove the guidewire and fascial dilator, leaving only the peel-away sheet
  13. Insert Foley catheter through sheath and into bladder
  14. Aspirate urine through Foley catheter to confirm placement
  15. Inflate Foley balloon
  16. Remove the peel-away sheath
  17. Dress the site

Complications

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

See Also

External Links

Videos

{{#widget:YouTube|id=yTFS3FILWGY}}

References

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