Procedure

Photo here

Introductory remarks here

Explain the prodecure

Prepare the patient

Place the catheter

EXPLAIN THE PROCEDURE TO THE PATIENT
The procedure should be explained to the patient. Tell the patient that the abdomen will be numbed with anesthetic medication via a small needle and that a thin tube will be gently placed through the abdomen and into his/her bladder to allow urine to exit. Point out that while this is usually a successful procedure, occasionally the tube may be harder to place in the correct location than expected. In that case, a consultant may need to be called to assist in the procedure. The use of ultrasound to identify the bladder and surrounding tissues may be a helpful adjunct in the correct placement of a SPC.
PREPARE YOURSELF, THE PATIENT, AND YOUR EQUIPMENT
allergies Ensure the patient has no allergies. If the patient has an allergy to latex do not use latex gloves or a latex catheter. If the patient has an allergy to iodine do not use betadine prep. Premedication Some urologists recommend one dose of a flouroquinolone, or other appropriate antibiotic, prior to suprapubic catheterization. It may be appropriate in some circumstances to use systemic analgesics or anxiolytic medications such as opiates or benzodiazepines to help facilitate catheter placement
Positioning The patient should be lying supine and the patient's abdomen should be palpated or percussed to assess the level of the bladder in this position. The bladder must be above the pubic symphysis. Bedside ultrasound is useful for assessing bladder position. Sterile Preparation Wear sterile, well-fitting gloves for the procedure. It is important to remember that sterility is essential in this procedure since urinary tract infections and bacteremia can be the consequence of poor technique. Widely prep the midline of the suprapubic region. You may consider shaving the area for improved sterility. Drape the skin of the midline of the suprapubic region.	insert FLASH here
Local Anesthesia Use 1% lidocaine to anesthetize the skin and subcutaneous tissue two fingerbreadths (3-4 cm) cephalad to the suprapubic skin crease. PLACE THE CATHETER Needle Entry Into the Bladder After anesthetizing the abdominal wall, insert a 20 guage spinal needle into the abdominal wall, directed towards the anus. Aspirate as you advance the needle to assure your are not entering an artery. With continuous pressure and in the same direction, continue to insert the needle until you feel a pop at which point you should be able to aspirate urine. If you are not able to retrieve urine and if air is aspirated instead, you should terminate the procedure and obtain a consultant to assist with the procedure. Assuming you are successful in obtaining urine, you should not remove the needle, noting its direction.
Catheter and Trocar Placement Make a 1cm horizontal incision in the midline of the suprapubic region where you had previously anesthetized the skin and subcutaneous tissue (3-4 cm cephalad to the suprapubic skin crease). A suprapubic catheter covering a trocar (available in the percutaneous suprapubic cystostomy kit) is now inserted through the incision into the abdomen in the same direction that the spinal needle had coursed. The non-dominant hand is placed on the abdomen to help stabilize the placement as the dominant hand gently directs the catheter. The bladder wall puncture is often palpable. Urine may drain now through the catheter despite the trocar if it is under pressure. The catheter is advanced 3cm as the trocar is removed.	insert FLASH here
Connect to Collection Device A urinary collection bag is connected to the catheter and the tube is secured to the skin with a 3-0 nylon suture. Folded gauze dressings can be placed on either side of the catheter to prevent kinking. The dressings are secured and the catheter is taped to the patient's abdominal wall.