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Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
Suprapubic Cystos
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Suprapubic Cystos

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  • 1. Review Procedure Suprapubic Bladder Catheterization (Percutaneous Cystostomy) LOGO 29 April 2009 Emergency Medicine Procedures
  • 2. LOGO www.themegallery.com
  • 3. Contents LOGO 1 II Introduction 2I Indications and Contraindications 3 Equipments 4 Patient Preparation and Techniques 5 Complications www.themegallery.com
  • 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. 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. 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. 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. 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. 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. LOGO www.themegallery.com
  • 11. LOGO www.themegallery.com
  • 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. Techniques LOGO  Seldinger Technique with a Peel- Away Sheath  Obturator Technique www.themegallery.com
  • 14. LOGO www.themegallery.com
  • 15. LOGO www.themegallery.com
  • 16. TIPs LOGO  Midline has no vessels  Don’t move needle it s might injure the bladder www.themegallery.com
  • 17. LOGO www.themegallery.com
  • 18. LOGO www.themegallery.com
  • 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. 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. LOGO www.themegallery.com
  • 22. Complications LOGO  Bowel perforation  Intraabdominal viscera injury  Uncontrolled hemorrhage  Vascular injury  Peritonitis  Catheter misplacement www.themegallery.com
  • 23. LOGO

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