Suprapubic Bladder Aspiration Versus Urethral Catheterization in Ill Infants: Success, Efficiency, and Complication Rates☆,☆☆,★

Presented at the annual meeting of the Society for Academic Emergency Medicine, Toronto, Ontario, May 1992.
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Abstract

Study objective: To compare success rates, complications, and efficiency of suprapubic bladder aspiration with urethral catheterization in ill infants. Design: Prospective, randomized clinical study. Setting: The pediatric emergency department at the University of Mississippi Medical Center in Jackson. Participants: Convenience sample of infants under 6 months of age requiring an uncontaminated urine specimen for the evaluation of febrile illness, suspected urinary tract infection, or sepsis. Infants with wet diapers were excluded. Interventions: Patients were randomized to undergo timed suprapubic bladder aspiration (performed by a physician and a nurse) or urethral catheterization (performed by two nurses). If suprapubic bladder aspiration was unsuccessful, urethral catheterization was performed immediately and the bladder was drained; emptying volume was recorded. All patients had a next-void "bag" urinal ysis performed for post-procedure hematuria. Results: Fifty patients underwent primary suprapubic bladder aspiration. The success rate (defined by obtaining at least 2 mL of urine) was 46%. Mean ± SD time per successful suprapubic bladder aspiration was 16.73 ± 7.73 seconds. Fifty patients underwent primary urethral catheterization. The success rate was 100%; the mean time required was 80.70 ± 46.52 seconds. After failed suprapubic bladder aspiration, urethral catheterization was 100% successful, with a mean draining volume of 2.95 ± 2.38 mL. No immediate problems were identified among any instrumented patients; later complications (next-void hematuria after either procedure, other visceral injury with suprapubic bladder aspiration) were not detected. Conclusion: Both suprapubic bladder aspiration and urethral catheterization afford the emergency physician low-risk access to uncontaminated urine in ill infants. Suprapubic bladder aspiration is less efficient in that it requires physician participation and failure rates are higher. These data suggest that successful suprapubic bladder aspiration is primarily dependent on the volume of urine in the bladder; thus, in the ill or febrile ED infant who may be dehydrated, the likelihood of success decreases. The authors recommend that ED nursing and physician staff become comfortable with performing urethral catheterization on infants. [Pollack CV Jr, Pollack ES, Andrew ME: Suprapubic bladder aspiration versus urethral catheterization in ill infants: Success, efficiency, and complication rates. Ann Emerg Med February 1994;23:225-230.]

Section snippets

INTRODUCTION

A complete emergency department evaluation for suspected sepsis in the infant includes a CBC, urinalysis, chest radiograph, and cerebrospinal fluid cytologic and chemical analysis, as well as cultures of blood, urine, cerebrospinal fluid and, if applicable, sputum and stool. 1 While great care is routinely exercised in collecting uncontaminated culture specimens of blood and cerebrospinal fluid, many physicians collect a "bag" urine from infants (a plastic bag is adhered onto the perineal skin

MATERIALS AND METHODS

The study protocol was approved by the Investigational Review Board of the University of Mississippi Medical Center. Informed consent was obtained from the parent or guardian of each infant enrolled.

One hundred consecutive infants of either gender, 6 months of age or younger, who were being evaluated for an acute febrile illness in the pediatric ED were entered into the study. Once the decision was made by the attending physician to obtain urine for culture, the patient was assigned to one of

RESULTS

One hundred children were entered into the protocol, 50 in each group. Data are shown in the Table. Success was statistically more likely with UC; SPA, when successful, however, was significantly faster. Time required for successful UC was not related to the gender of the infant, despite the fact that 71% of the boys in the study were uncircumcised.

Table.Suprapubic aspiration versus urethral catheterization in febrile infants

SPAUCP
No. of patients5050
No. successful (%)23 (46)50 (100)<.0001
Time

DISCUSSION

The importance of obtaining uncontaminated urine for culture is underscored by the findings that as many as 40% of urinary tract infections in infants are asymptomatic,13, 14 while up to one third of urinary tract infections may be associated with bacteremia with life-threatening sepsis and meningitis.7, 12, 14 Urinary tract infection is the second most common bacterial infection among children.15 Moreover, urinary tract infection in an infant may result in a 25% incidence of pyelonephritic

CONCLUSION

Emergency physicians frequently are faced with the need for obtaining uncontaminated urine specimens from infants. Two accepted methods, suprapubic bladder aspiration and urethral catheterization, are available. SPA is rapid and safe; however, in the relatively dehydrated infant most likely to require the procedure in the ED, it is successful less than half the time. UC is likewise safe and efficient, with careful preparation and technique should not introduce infection into the bladder, and

References (43)

  • LL Leape et al.

    Office urine cultures in pediatric practice

    Postgrad Med

    (1974)
  • Redman JF, Bissada NK: Direct bladder catheterization in infant females and young girls: Description of an effective...
  • J Boehm et al.

    Bacteriology of "midstream catch" urines

    Am J Dis Child

    (1966)
  • WA Bonadiio

    Urine culturing technique in febrile infants

    Pediatr Emerg Care

    (1987)
  • J Hardy et al.

    Comparison of sterile bag, clean catch and suprapubic aspiration in the diagnosis of urinary tract infection in early childhood

    Br J Urol

    (1976)
  • JM McCarthy et al.

    Clean voided and catheter neonatal urine specimens

    Am J Dis Child

    (1963)
  • CV Pryles et al.

    A comparative study of bacterial cultures and colony counts in paired specimens of urine

    Pediatrics

    (1961)
  • WA Durbin et al.

    Management of urinary tract infections in infants and children

    Pediatr Infect Dis

    (1984)
  • GH McCracken

    Diagnosis and management of acute urinary tract infections in infants and children

    Pediatr Infect Dis J

    (1987)
  • GB Stickler

    Urinary tract infection in children: Diagnosis and treatment

    Postgrad Med

    (1979)
  • EE Anderson et al.

    How we manage urinary tract infections in children

    Med Times

    (1978)

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    ☆

    From the Departments of Emergency Medicine* and Pediatrics,† Maricopa Medical Center, Phoenix, Arizona; and the Division of Biostatistics,‡ Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, Mississippi.

    ☆☆

    Address for reprints: Charles V Pollack, Jr, MD, Department of Emergency Medicine, Maricopa Medical Center, 2601 E Roosevelt, Phoenix, Arizona 85010

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    Reprint no. 47/1/52826

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