Suprapubic aspiration is a minimally invasive procedure used to collect uncontaminated urine from the bladder, particularly in children under 24 months, showing a low contamination rate compared to other methods. It requires specific equipment and techniques, including localization with ultrasound and careful insertion of the needle, with certain contraindications like unidentifiable bladder and significant bleeding disorders. The procedure is associated with a small risk of complications such as infection and hematuria.

2. Introduction
• Suprapubic aspiration is a procedure to obtain uncontaminated urine from the
urinary bladder.
• It is easy to perform in the emergency department and is associated with minimal
complications.
• In a study for children less than 24 months old had a contamination rate of:
1% for suprapubic catheterization
12% for catheterized specimens
26% for clean-catch

3. Indications
1. Urinalysis or urine culture in neonates or children younger than 2 years
2. Phimosis (foreskin can't be retracted from around the tip of the penis)
3. Labial adhesions or edema
4. Urethral stricture
5. Urethral trauma
6. Urinary retention (prostate hyperplasia or cancer, gynecologic malignancy, spinal
cord injury)
7. Chronic infection of the urethra or periurethral glands

4. Contraindications
1) Empty or unidentifiable bladder (child’s last urination within 1 hour,
nonpalpable bladder in adults)
2) Lower abdominal wounds or scarring
3) Overlying cellulitis
4) Clinically significant bleeding disorder
5) Massive organomegaly
6) Known bladder tumor

5. Sterile gloves Sterile drapes Povidone-iodine Sterile gauzes
Local anesthetic (1%
or 2% lidocaine)
Sterile syringe, 10 or 20 mL with
Needle, 22 gauge for pediatric,
Spinal needle, 20 ga, for adult
Sterile bandage Sterile urine
specimen container
Equipment

6. • The patient should be supine with the abdomen and pubic areas exposed.
• At least one assistant is needed to immobilize the pediatric patient in a frog-legged
position. (preferred with diaper)
• For localization of the bladder ultrasonography should be used, if available, even
if the bladder is readily palpable. If not, delay the procedure.
• Ultrasound transducer should be placed in a sterile probe
• Location is approximately 2 cm midline above the symphysis pubis.
• Sterilize the area with povidone-iodine and inject local anesthetic.
Technique

7. Cont...
• Pediatric: Insert the needle slightly cephalad, 10-20° off perpendicular,
and advance. In a young child, the bladder is still an abdominal organ.
• Adult: Insert the needle slightly caudad, 10-20° off perpendicular. In an
adult, the bladder is a pelvic organ.
• If the insertion is unsuccessful, do not withdraw the needle fully.
Instead, pull back until the needle tip rests in the subcutaneous tissue
and then redirect 10° in either direction. Do not attempt more than 3
times.
• Once urine is obtained, remove the needle and apply gentle pressure at
the insertion site with sterile gauze. Place a sterile dressing at the site of
insertion.
• Place the urine specimen in a sterile container approved for urinalysis
and culture.

8. Complications
1. Peritoneal perforation with or without bowel perforation (not so
significant)
2. Infection (intra-abdominal, bladder, skin, soft tissues) (more occur with
catheter).
3. Hematuria (usually transient and microscopic, gross hematuria is
uncommon)

10. References
• Medscape.com
• Nejm.org