Technique for Suprapubic Drainage of the Urinary Bladder

 

Equipment required:

(1) suitable needle (spinal needle OR venipuncture needle >= 2 inches for an adult OR venipuncture needle >= 1.5 inches for a pediatric patient)

(2) antiseptic skin preparation

(3) large syringe

(4) 3-way stopcock

(5) IV tubing with hub matching the stopcock

(6) large drainage bag attached to the opposite end of the IV tubing

(7) local anesthetic (1% lidocaine, other) in a 5 to 10 mL syringe

(8) Kelly or other locking clamp

 

Ultrasonography may be helpful in complex cases (history of surgery with a midline scar, etc.)

 

Steps:

(1) Palpate the bladder. If the bladder cannot be palpated stop and reconsider.

(2) Clean the skin centered about a point 1 finger width above the pubic bone in the midline.

(3) Inject the local anesthetic into the dermis, subcutaneous tissues and fascia.

(4) Assemble the large syringe, stopcock and IV tubing.

(5) A spinal needle will have an obturator; a venipuncture needle may not. Insert the needle perpendicular to the skin in the center of the cleaned and anesthetized skin (i.e., 1 fingerbreadth above the pubic bone in the midline).

(6) The bladder lumen should be about 1 inch below the skin surface in a non-obese individual.

 

If urine is encountered:

(1) Push the needle in a further quarter of an inch.

(2) Lock a clamp on the needle shaft to prevent further penetration.

(3) Withdraw urine into the syringe. Once full, turn the stopcock to allow emptying of the urine in the syringe into the IV tubing.

(4) Once the syringe is empty reset the stopcock to allow aspiration of the urine into the syringe. Repeat Step 4 until urine drainage is complete.

(5) Once complete the needle is withdrawn and the site cleaned.

 

If urine is not encountered:

(1) Attach the syringe to the needle hub.

(2) Aspirate while slowly withdrawing the needle out.

(3) Do not poke around with the needle.

 

The placement of a suprapubic catheter done in a similar fashion, but the catheter can be left in place for a longer period of time.