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