# Suprapubic Bladder Aspiration

## Overview

This module describes how to perform suprapubic bladder aspiration to obtain uncontaminated urine in children or adults.

## Indications

1. Obtaining an uncontaminated urine sample where catheterisation is impossible or has failed

2. Temporary relief of bladder outlet obstruction such as urethral injuries or strictures, if equipment for suprapubic catheterisation is not available

## Contraindications

1. Empty bladder (or the patient has voided in the past hour)

2. Infection or injury of the overlying skin

3. Markedly distended abdomen

4. Coagulopathy

5. Major genitourinary abnormalities

6. Recent abdominal surgery

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I need to remove urine from your (or your child’s) bladder. I cannot put in a catheter, so I have to use a needle and syringe instead.”

### What can my patient expect?

“This will only take a few seconds. You will feel a sharp sting when I insert the needle, but this procedure is very quick, and first giving you an injection for pain will hurt just as much as the procedure itself.”

### What is my patient’s role?

“Let me know if you have had recent surgery, any allergies or a bleeding tendency, or use blood thinners. Fearing blood or needles is normal, but tell me if you have fainted from it. Keep as still as possible. If you feel strange sensations or severe pain, tell me immediately.”

## Preparation

Prepare a trolley with equipment. If the patient is a child, an assistant is required to immobilise the legs.

### Documentation

1. Patient notes

2. Patient labels

3. Laboratory request forms

### Equipment

1. Alcohol-based hand rub

2. Sharps container
   Sharps container

   If a sharps container is not within arm's length, use a kidney dish or other hard container to temporarily hold used sharps and to carry them to the sharps container for disposal.

3. Sterile gloves

4. Sterile pack

5. Skin disinfectant
   Skin disinfectant

   Commonly used preparations include 0.5-2% chlorhexidine in 70% alcohol (Steriprep), or 10% povidone iodine. There is no consensus on the superiority of one agent above another. Caution: chlorhexidine solutions may be associated with burns and skin breakdown in infants < 2 months old.

6. 5 ml syringe or larger for therapeutic aspiration

7. 22 G needle

8. Cotton ball

9. Sterile collection bottle and laboratory specimen bag (if required)

## Site and Positioning

Position the patient supine with their heels drawn up to their bottom and legs parted.

## Procedure

Follow medical asepsis with sterile gloves.

1. Perform hand hygiene.

2. Open the sterile pack to create a sterile field. Pour skin disinfectant into the well. Open the syringe and needle onto the field.

3. Don sterile gloves.

4. Clean
   Clean

   Start in the middle and work in concentric circles outward until the area from the umbilicus to the pubis is cleaned.

   and drape the area.

5. Assemble the needle and syringe.

6. Puncture 1-2 cm above the pubis, in the midline. Angle 10-20° towards the head in children or 10-20° towards the feet in adults. Maintain gentle traction on the plunger.

7. Advance until urine is aspirated.

8. For therapeutic aspiration, withdraw as much urine as needed for temporary relief.

9. Withdraw the needle and syringe and apply pressure with a cotton ball until bleeding stops.

10. For diagnostic aspiration, transfer the urine to a sterile collection bottle.

11. Dispose of medical waste safely.

12. Label the bottle and send it to the laboratory in a specimen bag with the laboratory request form.

13. Record the completion of the procedure in patient notes.

## Troubleshooting

I’m not getting urine.

Don’t attempt multiple times. Withdraw and ask a senior’s advice. Ultrasound may be a helpful adjunct in difficult cases.

## Risks

1. Pain

2. Bleeding, haematoma, or haematuria

3. Bowel wall perforation (usually not clinically significant)

4. Local infection

5. Sharps injury to healthcare personnel

6. Vasovagal response (fainting)

## References

1. Peters A, Medina-Blasini Y. Suprapubic Aspiration. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557545/

2. DeCotiis KN. How To Do Suprapubic Aspiration of the Bladder in a Child. In: MSD Manual. 2021. Available from: https://www.msdmanuals.com/professional/pediatrics/how-to-do-pediatric-urologic-procedures/how-to-do-suprapubic-aspiration-of-the-bladder-in-a-child

3. Saloojee H, Couper I. How To Do a Suprapubic Bladder Aspiration in an Infant. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010: 24-25.

4. Ponka D, Baddar F. Top 10 forgotten diagnostic procedures: suprapubic bladder aspiration. Can Fam Physician. 2013;59(1):50.