Paediatric Acute care Guidelines PMH Emergency Department

Pre-Procedure

  • The child should not have passed urine in the previous 60 minutes prior to the procedure. If so, feed the child and wait 30-60 minutes. 
  • If the child is stable it is preferrable to do the suprapubic aspiration prior to carrying out any other invasive procedures

General

  • Suprapubic aspiration of urine is a simple and safe technique for obtaining an uncontaminated specimen of urine in children
  • In stable children, perform first before other invasive procedures like bloods and lumbar puncture (in case the child voids)
  • The procedure should be done quickly once you expose the genitals, so prepare everything before you undo the nappy
  • Standard aseptic non touch technique with sterile gloves is required

Indications

  • Children < 6 months of age who need a urine culture.
  • Children < 1 year old who need a repeat urine culture because the previous urine culture is contaminated

Contraindications

  • Urinated in the previous 1 hour
  • Distended abdomen
  • Known coagulopathy
  • Skin infection over puncture site
  • Urogenital abnormality

Preparation

Staff

  • Doctor to carry out procedure
  • Nurse to hold the child throughout procedure
  • Assistant to catch urine

Equipment

 

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SPA equipment

  • 3ml or 5ml syringe
  • Alcohol wipe
  • 23 gauge needle
  • Sterile gloves
  • Urine container (yellow top)
  • IV pressure pad (‘dot’)

 

Procedure

Medications

  • Can give a small amount of sucrose to infants prior to the procedure

Positioning and technique

supa pub inj

  • Confirm the patient has not passed urine in the last 60 minutes. If they have then give a feed and wait for 30-60 minutes.
  • The child lies supine in a frog leg position
  • The nurse is to hold the child steady and restrain the legs in an extended position
  • An assistant is to be ready to catch the urine with an open urine jar, if the patient passes urine

Check the bladder size /volume using one of the following 3 methods:

  1. Curvilinear ultrasound probe to check bladder volume:
    Transverse view, depth (D) 2-3 cm or Transverse diameter (T) 3.5cm (recommended method) or
  2. Bladder scanner (minimum 20ml) – scan 3 times to confirm, or
  3. Gently percuss the bladder, fundus should be 1-2 finger breadths above the pubic symphysis (PS)

 

1. Wipe the skin from the pubis to umbilicus in a circular motion 5cm diameter with the alcohol wipe
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2. Insert the needle perpendicular to the skin at 1-2cm superior to the pubic symphysis (the suprapubic crease level) at midline
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3. Aspirate gently after the needle goes through the skin. Remember to aspirate as you insert, as well as when you withdraw the needle.

4. Advance the needle 2-3cm deep if needed (i.e. whole length of the 23G needle)

  • If urine is not obtained, do not remove the needle, but withdraw it to a subcutaneous layer and redirect it slightly more superior, and then more inferior to the pubic symphysis if needed
  • The procedure should be abandoned if still unsuccessful and an alternate method of urine collection should be considered
  • Further attempts at SPA should be at the discretion of the Senior Doctor on duty

Post-Procedure

Complications

All these complications are rare:

  • Transient, gross or microscopic haematuria
  • Intestinal perforation
  • Bladder haematuria
  • Abdominal wall abscess

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References

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