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3 Cards in this Set
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Suprapubic catheter insertion (percutaneous suprapubic cystostomy)
1, What are the indications? 2. What are the contraindications? |
1. Any pt who would require urethral catheter but in whom it cannot be passed. 3 commonest emergency indications
- urethral strictures - complex prostatic disease - trauma with urethral disruption Less commonly quadriplegics, paraplegics or others with neurogenic bladder who would normally self catheterise are unable to, and can develop AUTONOMIC HYPERREFLEXIA ASSOCIATED WITH ACUTE BLADDER DISTENSION. They may present profusely perspiring, hypertensive. Bladder decompression via either suprapubic needle aspiration or suprapubic cystostomy dramatically resolves their sx. 2. - Bladder cannot be defined - not enough urine in bladder to a) displace bowel from ant-sup surface b) allow needle entry without through and through injury...NB there is no established minimum volume Care in pts with lower abdo surgery, intraperitoneal surgery, irradiation - may have adhesions or bowel adherent to bladder. Do not perform blind. Bleeding diatheses pt may bleed...usually self limiting. |
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How is it done?
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R&H recommends Cook's peel away sheath unit.
Site is central, 2-3cm above pubic symphysis, aim 10-20degrees towards pelvis (e.g. 20deg from vertical). R&H states spinal needle 22g, with 6mL syringe with 1% lidocaine, advance until aspirate urine then utilise a Seldinger technique to introduce a) guidewire b) peel away sheath c) foley through sheath centre. Then 10mL balloon inflation, withdraw catheter to insertion site, then peel away sheath |
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Complications?
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Traverse peritoneum - intraperitoneal infection, collection, haemorrhage, extravasation urine
Bowel perforation Infection space of Retzius (Retropubic space is the extraperitoneal space between the pubic symphysis and urinary bladder. It is also known as "Retzius' space", after Anders Retzius.) Extraperitoneal extravasation of urine Through and through injury rectum, vagina, uterus Ureteral catheterisation Haematuria IDC blocks, falls out |
