Suprapubic Aspirate Guideline
| See also: | UTI guideline Suprapubic Aspirate Parent handout Urine test handout References for Suprapubic Aspirate guideline |
Notes
Suprapubic aspirates are the gold standard for obtaining urine specimens for culture. Any growth of pathogenic bacteria in an SPA specimen is felt to be significant. It is a simple, safe, rapid and effective technique.
Indications:
- Any child (regardless of age) who is unable to void on request, who requires a urine specimen for the diagnosis or exclusion of UTI.
Contraindications:
- Bleeding diathesis
- Abdominal distension
- Massive organomegaly
Complications:
Complications of suprapubic aspirates are uncommon (estimates of complications reported in the literature are ~0.2% (ie 1 in 500), most of which are benign). They include:
- Macroscopic haematuria (infrequent — not usually clinically significant)
- Bladder haematoma (rare)
- Bladder haemorrhage (very rare)
- Intestinal perforation (rare — not usually clinically significant)
- Anaerobic bacteraemia or abscess formation (very rare)
Equipment
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- One assistant to hold the infant (not parent)
- Specimen jar for urine
- Ultrasound gel
- Volumetric ultrasound (BARD BladderScanTM)
- 23G needle (25 G for premature infants)
- 3ml or 5 ml syringe
Analgesia, Anaesthesia, Sedation
- Topical anaesthetic cream (AnGELTM) should be used except where specimens are required urgently (eg prior to starting antibiotic treatment in a septic infant)
- Oral Sucrose should be used for infants <3 months (see <a href="/clinicalguide/cpg.cfm?doc_id=5144"/>Analgesia guideline)
- Sedation should be considered for children older than 6 months especially where several procedures are required (eg lumbar puncture, IV cannulation)
- Non-pharmacological techniques should be used where possible, including explanation (in an older child), distraction, the presence of a parent.
Procedure
Golden Rules:
- Never undo the nappy until you have a urine jar handy and someone ready to catch!
- Do the SPA before collecting blood or CSF — as the child may void while having venepucture/lumbar puncture
- ‘Blind’ SPA has an approximately 50% chance of obtaining urine
- the use of ultrasound increases the chance of success to 80-90%
- Ultrasound does not tell you where to put the needle — only whether there is likely to be enough urine present.
View video
A. Using the Volumetric Ultrasound (BARD BladderScanTM)
- Unplug the ultrasound from the wall.
- Turn on the BladderScan
- Press ‘Scan’
- Select Male/female
- Apply ultrasound gel to suprapubic area (Keep urine jar handy!)
- Place probe firmly over bladder
(make sure that it is perpendicular to the skin, with the correct
orientation (look at the diagram on the probe))
- Press the button on the probe and hold in place until it stops vibrating
- Repeat
- See flow diagram for a guide to using bladder scan results
- If the bladder volume is >20 mls on three scans (with no scan results of ‘0’), the chance of obtaining urine is >90%)
B. What to do if no bladder ultrasound is available.
- History of no voiding in the past 30 minutes, and the presence of a dry nappy increases the chance of a successful tap
- Prehydration increases the chance of a successful blind tap
- If bladder is dull to percussion, there is a higher chance of successful aspiration
- See Flow Chart
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| View video of procedure |
C. SPA Procedure
- Ask assistant to hold infant supine with legs extended
- Ask parent to be ready to catch urine if the patient voids
- Wipe the skin with an alcohol swab
- Identify insertion point
- Midline
- Lower abdominal crease
- Insert needle perpendicular to the skin, aspirating gently as you advance the needle.
- If no success, withdraw the needle to just under the skin, and advance at an angle with the needle aimed more away from the pelvis.
- If urine is obtained, remove needle and squirt urine into sterile urine jar
Post-Procedure Care
- Place a bandaid over the puncture site (optional)
- Warn parents that there may be a small amount of blood in the urine in the next day, but that they should re-present if there are large amounts or if they are concerned.
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