II. Indications

  1. Complete Urethral obstruction
  2. Urethral Trauma

III. Contraindications

  1. Coagulopathy

IV. Preparation

  1. Ultrasound preparation
    1. Use Curvilinear transducer (2-5 MHz)
    2. Survey the Bladder with transducer in short axis (transverse)
    3. Apply a sterile Tegaderm (10x12 cm) ro Ultrasound probe
    4. Use sterile Surgilube packets (or similar sterile lubricant) for Ultrasound gel
  2. Patient
    1. Position supine

V. Technique

  1. Prepare the Suprapubic Catheter
    1. 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
    2. Remove the plastic outer guard
  2. Identify the insertion site
    1. Find a midline point three finger breadths (2 inches) above the symphysis pubis
  3. Prepare the insertion site
    1. Prepare the suprapubic skin with chlorhexidine or betadine
    2. Drape the area
    3. Inject Lidocaine 1% with Epinephrine at the insertion site
      1. Raise a skin wheel
      2. Inject along the anticipated tract
    4. Make a 1/2 inch horizontal incision at the insertion site
  4. Position the Ultrasound transducer
    1. Short axis (transverse)
    2. Superior to the catheter insertion site
  5. Insert the catheter
    1. Direct the catheter caudal (inferiorly towards the Bladder neck) at a 60 degree angle
    2. Observe the catheter tip on Ultrasound enter the Bladder dome (approximately 2 inches below the skin level)
      1. Aspirate while inserting the needle
      2. Insert the catheter and trochar an additional 2 inches
      3. Remove the trochar
    3. Confirm placement
      1. Inject saline and observe on Ultrasound the jets and bubbles inside the Bladder
      2. Aspirate urine
    4. Inflate the catheter balloon (if present)
      1. Withdraw the catheter until it stops against inside wall of Bladder
    5. Secure catheter to skin
    6. Connect urine bag to the catheter
  6. Catheter replacement
    1. Tract will mature over 4-6 weeks
      1. Once tract matures, catheter may be removed and new catheter inserted without difficulty
    2. Prior to tract maturation, catheter replacement can be difficult
      1. Risk of urine leakage out of Bladder into Abdomen
      2. Consider seldinger technique (place guide via old catheter, withdraw, and place new catheter over guide)

VI. References

  1. James and Palleschi in Pfenninger (1994) Procedures for Primary Care Physicians, p. 500-7
  2. Medscape EMedicine Suprapubic Catheterization
    1. http://emedicine.medscape.com/article/145909-overview#showall

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Ontology: Urinary vesicostomy (C0087042)

Concepts Therapeutic or Preventive Procedure (T061)
MSH D003559
SnomedCT 129252005, 149707002, 176205002, 129251003, 40173000
English Cystostomies, Suprapubic, Cystostomy, Suprapubic, Suprapubic Cystostomies, Suprapubic catheterisation, Suprapubic catheterization, Suprapubic urinary catheterisation, Suprapubic urinary catheterization, Suprapubic urinry catheteristn, Insertion of suprapubic catheter, Insertion suprapubic catheter, suprapubic cystostomy (treatment), suprapubic cystostomy, Suprapubic catheter insertion, Insertion;catheter;suprapubic, insertion of suprapubic catheter, suprapubic catheterization, urinary cystostomy, suprapubic catheter insertion, suprapubic catheterisation, Urinary cystostomy (procedure), Suprapubic catheterisation (procedure), Urinary cystotomy, Suprapubic cystostomy, Urinary cystostomy, Suprapubic cystostomy (procedure), Urinary vesicostomy, Suprapubic Cystostomy, insertion of a suprapubic catheter
Portuguese Cistostomia Suprapúbica, Inserção suprapúbica de cateter
Spanish Cistostomía Suprapubica, Cateterización urinaria suprapúbica, vesicostomía urinaria, cistostomía urinaria, cistostomía urinaria (concepto no activo), cistostomía suprapúbica (procedimiento), cistostomía suprapúbica
German Suprapubische Zystostomie, suprapubische Einfuehrung eines Katheters, Suprapubische Blasenfistelung
Italian Inserzione di catetere sovrapubico, Cistostomia sovrapubica
French Insertion de cathéter supra-pubien, Cystostomie supra-pubienne, Cystostomie suspubienne, Cystostomie sus-pubienne, Vésicostomie sus-pubienne, Vésicostomie supra-pubienne, Vésicostomie suprapubienne, Cystostomie suprapubienne, Vésicostomie suspubienne
Dutch suprapubische inbrenging van katheter, Cystostomie, suprapubische
Japanese チコツジョウカテーテルソウニュウ, 恥骨上カテーテル挿入
Czech Epicystostomie
Hungarian Suprapubicus katéter behelyezés
Norwegian Suprapubisk cystostomi