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 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
- 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
- Prep skin
- Fill syringe with lidocaine and attach spinal needle
- Raise skin wheal at marked site
- Infiltrate subcutaneous tissue and rectus muscle fascia
- Advance the spinal needle into the bladder while applying negative pressure to the syringe
- After locating the needle within the bladder, remove the syringe
- Advance a guidewire through the needle and into the bladder
- Remove the syringe, leaving the guidewire
- Use a scalpel to make a stab incision at the site of the guidewire, extending the opening for the sheath introducer
- Pass the peel-away sheath and in-dwelling dilator over the guidewire and into the bladder
- Remove the guidewire and fascial dilator, leaving only the peel-away sheet
- Insert Foley catheter through sheath and into bladder
- Aspirate urine through Foley catheter to confirm placement
- Inflate Foley balloon
- Remove the peel-away sheath
- 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
- Suprapubic bladder aspiration
- Suprapubic catheter changing or replacement
- Genitourinary trauma
- Urinary retention
External Links
Videos
{{#widget:YouTube|id=yTFS3FILWGY}}