Catheter | |
Positioning |
Indications Urgent and/or sterile urine sample collection. Contraindications Anatomical obstruction (eg, labial fusion, hypospadias). Advantages Low contamination: 10%. Can be effective even with low bladder volume. Risks Common: microscopic haematuria, dysuria. Very rare: urethral injury. Equipment 6 Fr enteral feeding tube or catheter, 5 mL syringe, lubricant gel. Dressing pack with gauze and sterile paper sheet/drape. Topical antiseptic wash (eg, dilute chlorhexidine). Sterile urine jar and sterile gloves. Analgesia Oral sucrose (<6 months). No benefit of intra-urethral anaesthetic gel over lubricant gel. Consider age-appropriate sedation if >1 year of age (eg, nitrous, midazolam). Preparation Assistant holds child supine with legs in frog-leg position. Hold or wrap child’s arms. Child may void with preparation—have jar ready for catch. Procedure Identify urethral orifice and clean area. Create sterile field with hole in centre of paper drape. ‘Dirty’ hand to touch patient, ‘clean’ hand to hold catheter. Lubricate catheter tip, insert catheter. Gently manipulate/rotate to advance into bladder, do not force. Discard first few drops of urine if possible (contamination). Allow urine to drip from end of catheter into sterile jar. If urine not flowing, can use syringe to aspirate. Practice points Use clean pieces of gauze to hold penile shaft/spread labia. May require gentle pressure to advance through bladder neck. Boys: may need gentle traction or change of angle of penile shaft, do not force retraction of non-retractile foreskin. Girls: if catheter inserted into vagina, leave in situ, aim superiorly with second catheter. Children >1 year of age may require larger catheter size, eg, 8 Fr 1–3 years of age. Ensure correct bed height and adequate lighting for procedure. |
Female | |
Male |
Suprapubic needle aspiration5 | |
Positioning |
Indications Urgent and/or sterile urine sample collection. Child <2 years of age. Contraindications Overlying skin trauma or infection. Risk of bleeding (eg, thrombocytopaenia, coagulopathy). Abdominal distension or intra-abdominal organ anomalies. Advantages Lowest contamination of all collection methods: 1%. Risks Common: microscopic haematuria, minor bruising. Very rare: bowel perforation, major bleeding. Equipment 23 gauge needle, 5 mL syringe, sterile gloves. Topical antiseptic wash (eg, dilute chlorhexidine) or alcohol swab. Sterile urine jar. Analgesia Oral sucrose (<6 months). Topical anaesthetic cream (unless urgent procedure). Preparation Ensure adequate bladder volume. Assistant holds child supine with legs extended. Hold or wrap child’s arms. Child may void with preparation—have jar ready for catch. Procedure Identify insertion point: suprapubic crease, midline. Clean skin. Insert needle at 90o to skin. Use smooth quick motion to penetrate skin and bladder. Advance to hub, aspirate. If no urine, continue aspirating while slowly withdrawing needle. If no urine, withdraw to just below skin, redirect slightly superiorly ×1 further aspiration attempt. When urine aspirated, remove needle, syringe urine into sterile jar. Practice points Low success rate if little urine in bladder. Ultrasound to confirm bladder volume >2 cm recommended. Otherwise ensure no wet nappy in preceding 30–60 min. Optimise hydration if bladder volume insufficient. Catheter recommended if failed suprapubic needle aspiration or low bladder volume. |
Landmarks | |
Needle insertion |