Suprapubic aspiration and urinary catheterisation

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Target exams

Red flags

• A blind suprapubic aspiration on an empty bladder because the deflated bladder lies below the pubic symphysis and the bowel is in the needle path, which risks a failed tap and a bowel injury
• Any growth from a suprapubic aspirate because the bladder urine is sterile and any organism at any count is a true infection
• Forceful urethral catheterisation against resistance because it causes the urethral and the meatal trauma, the false passage, and the later stricture; stop, reposition, and seek a urology opinion
• A urinary catheter left in place longer than clinically indicated because every additional day of dwell time increases the catheter-associated urinary tract infection risk
• Diagnosing a urinary tract infection from a bag or pad specimen because the contamination rate of up to 50 to 85 percent makes the false positive and the unnecessary antibiotic treatment
• A febrile infant under two months given an antibiotic before a sterile urine specimen is obtained by catheterisation or aspiration because the contaminated sample is then uninterpretable

Life stages

Care settings

Clinical exam formats

Board mappings

• States that suprapubic aspiration and urethral catheterisation are the two low-contamination methods for collecting urine for culture in non-toilet-trained children, in contrast to the high-contamination bag and pad methods that should never be used to diagnose a urinary tract infection
• Describes the indication for a sterile urine sample as a febrile illness in an infant or young child, suspected sepsis, or the need to monitor urine output in an acutely unwell child
• Recognises the complications of suprapubic aspiration including a failed tap from an empty bladder, transient haematuria, and the rare bowel injury, and the complications of catheterisation including trauma and catheter-associated urinary tract infection
• Applies the suprapubic aspiration technique with the midline entry point one to two centimetres above the pubic symphysis, the use of point-of-care bladder ultrasound to confirm a full bladder, and the limitation to two attempts
• Selects the appropriate paediatric catheter size of a 6 to 8 French feeding tube for an infant and an 8 to 10 French catheter for an older child, and applies the aseptic no-touch technique
• Constructs the catheter-associated urinary tract infection prevention bundle of avoiding unnecessary catheterisation, aseptic insertion, a closed drainage system, daily review of the ongoing need, and prompt removal
• The contamination rates of the four collection methods with suprapubic aspiration under 1 percent, urethral catheterisation approximately 1 to 10 percent, clean catch approximately 25 to 30 percent, and the bag or pad up to 50 to 85 percent
• The anatomical landmark for suprapubic aspiration in the midline one to two centimetres above the pubic symphysis and the role of point-of-care ultrasound in raising the success rate to over 90 percent
• The catheter-associated urinary tract infection prevention bundle and the catheter dwell time as the single strongest modifiable risk factor
• Performs and supervises the suprapubic aspiration and urethral catheterisation with correct technique, positioning, and the use of bladder ultrasound guidance
• Communicates the indication, the procedure steps, the risks and the aftercare to the family and obtains consent appropriate to the urgency and the age of the child
• Recognises and manages the complications including the failed suprapubic aspiration, the urethral trauma, and the catheter-associated infection
• Level 1: Recognises the need for a low-contamination urine sample in the febrile infant and selects suprapubic aspiration or urethral catheterisation over the bag method
• Level 2: Performs suprapubic aspiration and urethral catheterisation with the correct landmark, technique, and aseptic practice, and uses bladder ultrasound guidance where available
• Level 3: Leads the catheter-associated urinary tract infection prevention bundle and teaches the procedures to junior staff
• The four urine collection methods and their contamination rates with suprapubic aspiration and urethral catheterisation as the low-contamination methods
• The anatomical landmark for suprapubic aspiration at one to two centimetres above the pubic symphysis in the midline and the role of point-of-care bladder ultrasound
• The risk factors and the prevention bundle for the catheter-associated urinary tract infection with the dwell time as the strongest modifiable risk factor
• Demonstration of the suprapubic aspiration technique on the infant with the correct landmark and positioning in a structured oral or objective structured clinical examination
• Demonstration of the urethral catheterisation with the correct catheter size and aseptic technique and the communication of the steps and the risks
• Discussion of the management of a failed suprapubic aspiration and the prevention of the catheter-associated infection
• The American Academy of Pediatrics recommendation that a urine specimen be obtained by catheterisation or suprapubic aspiration before any antimicrobial is given to the febrile infant two to twenty-four months in whom a urinary tract infection is suspected
• The contamination rates of the collection methods and the contraindication of diagnosing a urinary tract infection from a bag specimen
• The catheter-associated urinary tract infection risk factors and the prevention bundle focused on avoidance, asepsis, closed drainage, daily review, and prompt removal
• Performs suprapubic aspiration and urethral catheterisation with the correct technique and aseptic practice as a core procedural competency
• Recognises and counsels on the complications including the failed aspiration, the haematuria, the urethral trauma, and the catheter-associated infection
• Leads the prevention bundle and the daily review of the ongoing need for the urinary catheter
• The Canadian approach to urine collection in the febrile infant with suprapubic aspiration or urethral catheterisation as the preferred methods for culture
• The point-of-care ultrasound guidance for the suprapubic aspiration and the prevention of the failed tap
• The catheter-associated urinary tract infection surveillance and the prevention bundle in the paediatric intensive care unit