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Policies,Clinical,UWHC Clinical,Department Specific,Nursing Patient Care,Diagnostic Tests and Procedures

Assisting with Suprapubic Aspiration (Pediatric) (11.30P)

Assisting with Suprapubic Aspiration (Pediatric) (11.30P) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Diagnostic Tests and Procedures

11.30P


NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
October 27, 2017
amended: 1/26/2018

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 11.30P

Original
Revision

Page
1
of 4

Title: Assisting with Suprapubic Aspiration
(Pediatric)

I. PURPOSE

To outline nursing care for the patient undergoing suprapubic aspiration. Suprapubic
aspiration is a procedure to obtain uncontaminated urine. This technique is considered
to be superior to clean-catch or transurethral catheterization for collection of urine for
urinalysis or bacterial study in neonates or children less than 2 years of age.

II. POLICY

The provider is responsible for performing suprapubic aspiration. The registered
nurse (RN) will assist in the procedure as directed by the provider. Any
administration of local anesthetic agents will be performed by the provider and not
the RN. This procedure requires a consent.


III. EQUIPMENT

A. Topical anesthetic cream (e.g. LMX) and adhesive bandage
B. Bladder scanner
C. Sterile gloves
D. Sterile drapes
E. Chlorhexidine swabs or alternative skin prep
F. Sterile Saline or saline wipes (for neonates)
G. Sterile gauze
H. Oral sucrose (if appropriate)
I. Local anesthetic
J. 25 gauge, 5/8 or 1 inch needle with syringe for local anesthetic
K. 10 or 20 mL sterile syringe for sampling
L. 22 or 23 gauge, 1.5 inch needle for aspiration
M. Sterile dressing or adhesive bandage
N. An additional assistant (optional if parent/caregiver is participating)
O. Sterile specimen container
P. Patient label
Q. Lab requisition form


Page 2 of 4

IV. PROCEDURE

A. Prior to performing, the provider should explain the procedure to the patient, as
appropriate, and parents/caregiver, assess understanding, and obtain consent.
Hospital policies regarding the Universal Protocol should be followed and
documented in the clinical record. Hospital policies regarding hand hygiene will
be followed throughout the procedure per policy (UW Health Clinical Policy
4.1.13, Hand Hygiene).
B. Verify the presence of urine in the bladder with a bedside bladder scan. Infants
should have greater than or equal to 50ml. Older children should demonstrate the
presence of urine. If no urine is present, wait 20-30 minutes, rescan, then tap if
urine is present.
C. Apply topical anesthetic 1-2 finger breadths above the symphysis pubis and cover
anesthetic with an adhesive bandage. This is most effective if applied 20-30
minutes prior to the procedure.
D. Oral sucrose is recommended for infants during this procedure.
E. Consider using Child Life for therapeutic hold techniques and to support the
caregivers during the procedure.
F. Assist with positioning the patient throughout the duration of the procedure.
Position the patient supine, with the abdomen and upper pubic area exposed.
Parents/caregivers may help hold and calm the patient once they have been
educated how to do this. Place the legs in a frog-legged position.



G. Assist as needed with skin preparation of the needle insertion site, and
administration of local anesthetic.
H. Assist with aspiration as needed. If the insertion is unsuccessful, the needle should

Page 3 of 4

not be withdrawn fully. Instead, the needle should be pulled back and then
redirected 10 degrees in either direction. Redirection should not occur more than
three (3) times.
I. Once urine is obtained, the needle should be withdrawn and gentle pressure
applied at the needle insertion site with sterile gauze.
J. Place a sterile dressing or adhesive bandage over the insertion site.
K. Place the urine specimen into a sterile container approved for urinalysis and
culture. Label specimen at the bedside comparing label and requisition slip to the
patient ID band using two patient identifiers as per UWHC Clinical Laboratory
Policy 1502.5.06 Specimen Acceptance.
L. Immediately transport the specimen to the lab.
M. Observe patient closely for any post-procedure complications which may include
peritoneal perforation with or without bowel perforation, infection (e.g. intra-
abdominal, bladder, skin or soft tissue), and hematuria (usually transient and
microscopic). Report any of these findings to the provider.
N. Documentation should include medications given, tolerance of procedure, and
urine output.

V. UW HEALTH CROSS REFERENCES

A. UW Health Clinical Policy 2.3.32, Operative, Invasive, and Other Procedures
B. UW Health Clinical Policy 2.5.2, Collecting a Urine Specimen
C. UW Health Clinical Policy 4.1.13, Hand Hygiene
D. UWHC Clinical Policy 4.17, Informed Consent
E. UWHC Clinical Laboratories Policy 1502.5.06, Acceptance Policy for Specimen
Identification
F. UWHC Clinical Laboratories Policy 1502.5.07, Specimen Rejection
G. UWHC Guidelines for Universal Protocol
H. UWHC Lab Test Directory available on U-Connect
I. UWHC Universal Protocol Flowsheet (in Health Link)
J. UW Health Universal Protocol Site Marking Guideline for Non-OR Setting
Procedures on U-Connect
K. UW Health Neonatal Analgesia-Neonatal-Inpatient/Ambulatory- Clinical Practice
Guideline
L. Pain Care Fast Facts: Sucrose Analgesia for Infants
M. Suprapubic Aspiration (Assisting with) Checklist

VI. REFERENCES

A. Gochman RF, Karasic RB, Heller MB. (1991). Use of portable ultrasound to
assist urine collection by suprapubic aspiration. Ann Emerg Med. Jun. 20(6): 631-
635.
B. Hardy JD, Fornell PM, Brumfitt HW. (1976). Comparison of sterile bag, clean
catch and suprapubic aspiration for the diagnosis of urinary infection in early
childhood. Br J Urol. 48(4): 279-83.
C. Martin JR, Shaikh N, Docimo SG, Hickey RW, Haberman A. (2014). Suprapubic
bladder aspiration. New England Journal of Medicine. 371: e13. Procedure video
available at http://www.nejm.org/doi/full/10.1056/NEJMvcm1209888.
D. Rosh AJ, Kim ED, Bolen KG, Van Laere J, Windle ML, Lovato LM, et al.

Page 4 of 4

(2015). Suprapubic aspiration. Medscape.
E. Tosif T, Baker A, Oakley E, Donath S, Babl FE. (2012). Contamination rates of
different urine collection methods for the diagnosis of urinary tract infections in
young children: An observational cohort study. J of Paediatrics and Child Health.
48. 659-664.
F. Wingerter S, Bachur R. (2011). Risk factors for contamination of catheterized
urine specimens in febrile children. Pediatr Emerg Care. Jan. 27(1): 1-4.

VII. WRITTEN BY

Clinical Nurse Specialist, Universal Care Unit & Float Team
Chair, Pediatric Department of Urology

VIII. REVIEWED BY

Pediatric CAUTI Prevention Workgroup
Nursing Patient Care Policy and Procedure Committee, October 2017

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive