II. Indications
- Urethral Trauma
- Complete Urethral obstruction (refractory to Urinary Catheter placement)
III. Contraindications
- Coagulopathy
- No urine in Bladder
- Infection overlying skin or abdominal wall region of Suprapubic Catheter placement
- Altered anatomy or anticipated significant adhesions (e.g. pelvic cancer, radiation, suprapubic mesh)
IV. Preparation
- Suprapubic Catheter Kit
- Kits vary but include a trochar and catheter with needle (some kits include a seldinger guidewire)
- In an emergency, if Suprapubic Catheter kit is unavailable, central venous catheter may be used instead
-
Ultrasound preparation
- Use Curvilinear transducer (2-5 MHz)
- Survey the Bladder with transducer in short axis (transverse)
- Bladder must contain urine for safe procedure
- Identify overlying loops of bowel or other interfering anatomical structures
- Apply a sterile cover to Ultrasound probe
- Use sterile Surgilube packets (or similar sterile lubricant) for Ultrasound gel within probe cover
- Patient
- Position supine
V. Technique
- Prepare the Suprapubic Catheter
- With the plastic guard on the catheter to maintain its shape
- Insert the trochar within the catheter so the sharp tip protrudes from the end
- Remove the plastic outer guard
- Identify the insertion site
- Find a midline point three finger breadths (2 inches) above the Symphysis Pubis
- Prepare the insertion site
- Prepare the suprapubic skin repeatedly with Chlorhexidine or Betadine (allowed to dry)
- Drape the area
- Inject up to 10 ml Lidocaine 1% with Epinephrine at the insertion site
- Raise a skin wheel
- Inject along the anticipated tract
- Make a 4 mm horizontal incision at the insertion site
- Position the Ultrasound transducer
- Short axis (transverse)
- Superior to the catheter insertion site
- Insert the catheter
- Attach a 20 to 60 ml syringe to a Suprapubic Catheter, needle and obturator unit
- Catheter should be locked into the obturator unit until Bladder entered
- Direct the catheter caudal (inferiorly towards the Bladder neck) at a 60 degree angle
- Observe the catheter tip on Ultrasound enter the Bladder dome (approximately 2 inches below the skin level)
- Aspirate while inserting the needle, until after urine is aspirated
- Unlock the catheter from the needle obturator
- Continue to insert the catheter an additional 2 inches (5 cm)
- Remove the trochar
- Confirm placement
- Inject saline and observe on Ultrasound the jets and bubbles inside the Bladder
- Aspirate urine
- Inflate the catheter balloon (if present)
- Withdraw the catheter until it stops against inside wall of Bladder
- Secure Suprapubic Catheter to skin with tape
- Connect urine bag to the catheter via extension tubing
- Attach a 20 to 60 ml syringe to a Suprapubic Catheter, needle and obturator unit
- Catheter replacement
- Tract will mature over 4-6 weeks
- Once tract matures, catheter may be removed and new catheter inserted without difficulty
- Prior to tract maturation, catheter replacement can be difficult
- Tract will mature over 4-6 weeks
VI. Efficacy
- Suprapubic Catheters carry lower risk of Urinary Tract Infections than uretheral catheters
- Suprapubic Catheters avoid Urethral Trauma and secondary Urethral Strictures that may occur with Urethral catheters
VII. Complications
VIII. Resources
- Medscape EMedicine Suprapubic Catheterization
IX. References
- James and Palleschi in Pfenninger (1994) Procedures for Primary Care Physicians, p. 500-7
- Islam (2017) Crit Dec Emerg Med 31(11): 12-3