Vol. 118, October Printed in U.SA.
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
A SIMPLE NON-TOUCH TECHNIQUE FOR CONTINUOUS SUPRAPUBIC URINARY DRAINAGE MICHAEL M. KRAUSZ*
AND
AMOS SHAPIRO
From the Departments of Surgery and Urology, Hadassah University Hospital, Jerusalem, Israel
ABSTRACT
A simple non-touch technique for urinary paracentesis with a standard intracath is described. The application of this method for continuous urinary drainage in the relatively contaminated bedside environment may reduce the chance of bladder injury and infection in gravely ill patients until a more definite procedure is feasible. Needle paracentesis is used as an emergency measure to relieve the well distended bladder in acute urinary retention. This procedure involves some risk because of the danger of inciting vesical bleeding and hematoma, especially after evacuation of urine. Therefore, continuous needle drainage of urine is not possible. Several methods of trocar cystostomy were described for continuous suprapubic drainage, especially for patients in whom urethral catheterization is not desired or cannot be accomplished. All of these methods involve either abdominal wall incision or expensive percutaneous systems that are not always available and involve manual manipulation of the catheter in the relatively contaminated emergency bedside environment. 1 A simple bedside non-touch technique of suprapubic bladder paracentesis with a standard intracath for prolonged sterile urinary drainage is described herein. TECHNIQUE
With the patient in the supine position the upper border of the well distended bladder must be examined by palpation and percussion to assure an elevated peritoneal reflection well above the site of paracentesis. A 10 by 10 cm. area of skin in the midline just above the pubic bone is shaved, prepared with iodine-alcohol solution and draped. The puncture site is in the midline about 3 cm. above the symphysis pubis. A standard 14gauge intracath needle directed backward and !;ilightly downward is introduced carefully into the distended bladder. Once the needle has penetrated the bladder and urine appears the intracath catheter covered by the guard sleeve is inserted immediately through the needle into the bladder (see figure). The needle is then withdrawn carefully over the catheter and its tip is covered with the plastic case provided to avoid damage to the catheter. The catheter should not be inserted into the bladder unless urine appears. It also should never be pulled back through the needle, since its sharp point might cut off a portion of the catheter that may remain in the bladder. As soon as the flow of urine is satisfactory the adapter is connected to a urinary bag for gravity drainage. To ensure retention of the draining catheter inside the bladder it should be anchored externally, using a suture or adhesive tape, and the puncture site must be protected by the sterile cover. This method permits the rapid and sterile establishment of cystostomy. The catheter may be retained as long as necessary
Standard untouched 14-gauge intracath covered by guard sleeve is inserted through needle into bladder. and the patient is able to move around or be transported while on drainage. For smaller children and infants the standard 17gauge catheter may be used.
Accepted for publication December 3, 1976. * Requests for reprints: Department of Surgery, Hadassah University Hospital, Jerusalem, Israel.
558
REFERENCE
1. Campbell, M. F. and Harrison, J. H.: Urology, 3rd ed. Philadelphia: W. B. Saunders Co., p. 2338, 1970.
THE JOURNAL OF UROLOGY
Copyright © 1977 by The Williams & Wilkins Co.
A SIMPLE NON-TOUCH TECHNIQUE FOR CONTINUOUS SUPRAPUBIC URINARY DRAINAGE MICHAEL M. KRAUSZ*
AND
AMOS SHAPIRO
From the Departments of Surgery and Urology, Hadassah University Hospital, Jerusalem, Israel
ABSTRACT
A simple non-touch technique for urinary paracentesis with a standard intracath is described. The application of this method for continuous urinary drainage in the relatively contaminated bedside environment may reduce the chance of bladder injury and infection in gravely ill patients until a more definite procedure is feasible. Needle paracentesis is used as an emergency measure to relieve the well distended bladder in acute urinary retention. This procedure involves some risk because of the danger of inciting vesical bleeding and hematoma, especially after evacuation of urine. Therefore, continuous needle drainage of urine is not possible. Several methods of trocar cystostomy were described for continuous suprapubic drainage, especially for patients in whom urethral catheterization is not desired or cannot be accomplished. All of these methods involve either abdominal wall incision or expensive percutaneous systems that are not always available and involve manual manipulation of the catheter in the relatively contaminated emergency bedside environment. 1 A simple bedside non-touch technique of suprapubic bladder paracentesis with a standard intracath for prolonged sterile urinary drainage is described herein. TECHNIQUE
With the patient in the supine position the upper border of the well distended bladder must be examined by palpation and percussion to assure an elevated peritoneal reflection well above the site of paracentesis. A 10 by 10 cm. area of skin in the midline just above the pubic bone is shaved, prepared with iodine-alcohol solution and draped. The puncture site is in the midline about 3 cm. above the symphysis pubis. A standard 14gauge intracath needle directed backward and !;ilightly downward is introduced carefully into the distended bladder. Once the needle has penetrated the bladder and urine appears the intracath catheter covered by the guard sleeve is inserted immediately through the needle into the bladder (see figure). The needle is then withdrawn carefully over the catheter and its tip is covered with the plastic case provided to avoid damage to the catheter. The catheter should not be inserted into the bladder unless urine appears. It also should never be pulled back through the needle, since its sharp point might cut off a portion of the catheter that may remain in the bladder. As soon as the flow of urine is satisfactory the adapter is connected to a urinary bag for gravity drainage. To ensure retention of the draining catheter inside the bladder it should be anchored externally, using a suture or adhesive tape, and the puncture site must be protected by the sterile cover. This method permits the rapid and sterile establishment of cystostomy. The catheter may be retained as long as necessary
Standard untouched 14-gauge intracath covered by guard sleeve is inserted through needle into bladder. and the patient is able to move around or be transported while on drainage. For smaller children and infants the standard 17gauge catheter may be used.
Accepted for publication December 3, 1976. * Requests for reprints: Department of Surgery, Hadassah University Hospital, Jerusalem, Israel.
558
REFERENCE
1. Campbell, M. F. and Harrison, J. H.: Urology, 3rd ed. Philadelphia: W. B. Saunders Co., p. 2338, 1970.
![[Puncture sets for suprapubic catheter drainage of the bladder].](/assets/img/hold.png)
