Review Procedure
Suprapubic Bladder
Catheterization
(Percutaneous Cystostomy)         LOGO

                              ...
LOGO




       www.themegallery.com
Contents
LOGO

       1 II   Introduction


       2I     Indications and Contraindications



       3      Equipments


...
Introduction
LOGO

 Complaint of lower genitourinary symptoms is
  most common Urologic Problems
 Urine play role for di...
Introduction
LOGO

 Suprapubic bladder catheterization has
  become the treatment of choice for the patient
  with acute ...
Indications
LOGO

   Iatrogenic urethral injuries
   Obstructing urethral lesions
   Bladder neck lesions
   Enlarged ...
Contraindications
LOGO

 Patients with a coagulopathy
 Prior lower abdominal surgery

 Relative Contraindications
   H...
Equipments
LOGO

   Percutaneous cystostomy catheter kit
   Foley catheter, 14 to 16 French
   60 mL catheter-tipped sy...
Equipments
    LOGO

   Local anesthetic solution, 1% lidocaine
   4x4 gauze squares
   25 gauge needle, 1 inch long
 ...
LOGO




       www.themegallery.com
LOGO




       www.themegallery.com
Patient Preparation
    LOGO

   Risk and benefit discussion
   Obtain an informed consent
   Place the patient supine
...
Techniques
LOGO

 Seldinger Technique with a Peel-
  Away Sheath

 Obturator Technique




                             ...
LOGO




       www.themegallery.com
LOGO




       www.themegallery.com
TIPs
LOGO

 Midline has no vessels
 Don’t move needle it s might injure the
  bladder




                              ...
LOGO




       www.themegallery.com
LOGO




       www.themegallery.com
Aftercare
LOGO

 Secure the catheter to the abdominal wall
 Place 4x4 gauze squares over the pubic
  symphysis
 Apply t...
Aftercare
LOGO

 Examine the puncture site twice a day for any
  signs of infection
 If removed within 7 days, heal with...
LOGO




       www.themegallery.com
Complications
LOGO

   Bowel perforation
   Intraabdominal viscera injury
   Uncontrolled hemorrhage
   Vascular injur...
LOGO
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Suprapubic Cystos

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Suprapubic Cystos

  1. 1. Review Procedure Suprapubic Bladder Catheterization (Percutaneous Cystostomy) LOGO 29 April 2009 Emergency Medicine Procedures
  2. 2. LOGO www.themegallery.com
  3. 3. Contents LOGO 1 II Introduction 2I Indications and Contraindications 3 Equipments 4 Patient Preparation and Techniques 5 Complications www.themegallery.com
  4. 4. Introduction LOGO  Complaint of lower genitourinary symptoms is most common Urologic Problems  Urine play role for diagnosis and management  Transurethral is preferred method  When the transurethral route is contraindicated  A Percutaneous approach becomes the solution www.themegallery.com
  5. 5. Introduction LOGO  Suprapubic bladder catheterization has become the treatment of choice for the patient with acute urinary retention  Commonly performed in the trauma patient with a known or suspected urethral injury  Use local anesthesia  It is a relatively safe procedure but does have potential complications that are significant. www.themegallery.com
  6. 6. Indications LOGO  Iatrogenic urethral injuries  Obstructing urethral lesions  Bladder neck lesions  Enlarged prostates  Urethral strictures  Urethral scarring  Ubstructing phimosis  Urethral foreign body  Traumatic urethral or prostatic disruption www.themegallery.com
  7. 7. Contraindications LOGO  Patients with a coagulopathy  Prior lower abdominal surgery  Relative Contraindications  History of pelvic cancer or pelvic radiation therapy, ascites, urinary tract infections, or who are uncooperative www.themegallery.com
  8. 8. Equipments LOGO  Percutaneous cystostomy catheter kit  Foley catheter, 14 to 16 French  60 mL catheter-tipped syringe  10 mL syringes  24 to 25 gauge spinal needle, 3 inches long  No.11 Surgical scalpel blade on a handle  3.0 nylon suture  Needle driver  Povidone iodine solution www.themegallery.com
  9. 9. Equipments LOGO  Local anesthetic solution, 1% lidocaine  4x4 gauze squares  25 gauge needle, 1 inch long  18 gauge needle  Urine meter or urine leg bag  Sterile towels  Sterile gloves  Sterile drapes  Tincture of benzoin  2 inch tape  Ultrasound machine (optional) www.themegallery.com
  10. 10. LOGO www.themegallery.com
  11. 11. LOGO www.themegallery.com
  12. 12. Patient Preparation LOGO  Risk and benefit discussion  Obtain an informed consent  Place the patient supine  Apply povidone iodine solution to the lower abdomen www.themegallery.com
  13. 13. Techniques LOGO  Seldinger Technique with a Peel- Away Sheath  Obturator Technique www.themegallery.com
  14. 14. LOGO www.themegallery.com
  15. 15. LOGO www.themegallery.com
  16. 16. TIPs LOGO  Midline has no vessels  Don’t move needle it s might injure the bladder www.themegallery.com
  17. 17. LOGO www.themegallery.com
  18. 18. LOGO www.themegallery.com
  19. 19. Aftercare LOGO  Secure the catheter to the abdominal wall  Place 4x4 gauze squares over the pubic symphysis  Apply tincture of benzoin to the abdominal wall and allow it to dry  Tape over the catheter and gauze www.themegallery.com
  20. 20. Aftercare LOGO  Examine the puncture site twice a day for any signs of infection  If removed within 7 days, heal without complications  After 10 to 14 days, the tract is epithelialized and mature  The catheter may be exchanged through the mature tract www.themegallery.com
  21. 21. LOGO www.themegallery.com
  22. 22. Complications LOGO  Bowel perforation  Intraabdominal viscera injury  Uncontrolled hemorrhage  Vascular injury  Peritonitis  Catheter misplacement www.themegallery.com
  23. 23. LOGO
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