Ver el código de «Suprapubic catheter placement»

==Indications==
*Trauma patients with urethral disruption 
*Men with severe urethral stricture or complex prostatic disease

==Contraindications==
* Empty or unidentifiable bladder
**No absolute reported minimum bladder volume has been established
**But need enough urine in the bladder to allow the needle to fully penetrate the dome of the bladder without immediately exiting through the base
*Should not have bowel anterior to the bladder 

==Equipment Needed==
*Cook peel away sheath unit is a user-friendly device for suprapubic bladder access
*If not available, any device suitable for central venous access can be inserted suprapubically via the Seldinger technique
*Ultrasound to delineate bladder anatomy
*Sterile gloves
*Skin prep
*Lidocaine
*Sterile syringe, 10 or 20 mL
*Spinal needle, 22 ga, for adult patients
*Foley catheter
*Dressing

==Procedure==
*Placement of the Cook peel-away sheath:
*Locate the full and distended bladder with ultrasound and palpation
*Prep skin
*Fill 6 mL syringe with 1% lidocaine and attach 22-gauge, spinal needle
*Raise skin wheal at proposed site (2-3cm above pubic symphysis)
*Infiltrate the subcutaneous tissue and rectus abdominis muscle fascia at a 10-20 degree angle toward the pelvis
* Locate the bladder by advancing the needle while aspirating the syringe 
* Remove the syringe from the needle and advance a guidewire through the needle into the bladder 
*Withdraw the needle while leaving only the guidewire 
*Use a No. 15 scalpel blade to make a stab incision through the skin, subcutaneous tissue, and superficial anterior abdominal wall fascia 
*Pass the peel-away sheath and indwelling fascial dilator together over the wire into the bladder 
*Remove the guidewire and fascial dilator and leave only the peel-away sheath inside the bladder 
*Pass the foley catheter through the indwelling intravesical sheath into the bladder 
*Aspirate urine to confirm proper placement. Inflate the Foley balloon with of 10 mL of air, water, or saline.
* Withdraw the peel-away sheath 
==Complications==
*Bowel perforation
*Through and through bladder penetration may lead to rectal, vaginal, or uterine injury
*Intraperitoneal extravasation
*Infection
*Hematuria

==See Also==
*[[Suprapubic bladder aspiration]]
*[[Genitourinary trauma]]
*[[Urinary retention]]

==External Links==

==References==
<references/>

[[Category:Procedures]]
[[Category:Urology]]