1. Suprapubic catheter insertion
Prepared by Shane barclay MD

2. Indications
1. Urethral injury 2. Urethral obstruction 3. Bladder neck masses 4. Benign prostatic hypertrophy resulting in obstruction.

3. Contraindications
1. Inability to palpate or visualize bladder on ultrasound. 2. Coagulopathy 3. Bowel adhesion to the bladder

4. Analgesia
If patient is awake it is highly recommended they receive IV procedural analgesia with or without sedation.

5. Equipment
There are many commercially available kits which contain all the equipment you will need. Refer to your local resources. The BARD suprapubic catheter will be reviewed here.

6. Technique
1. Patient supine Provide adequate analgesia +/- sedation Clean the lower abdominal wall 4. Shave area if necessary Palpate bladder and mark insertion 4-5 cm above pubic symphysis Better yet, visualize bladder with ultrasound and mark site.

7. Technique
7. Apply antiseptic solution from pubis to umbilicus 8. Apply sterile drapes 9. Using 10 cc syringe with local anesthesia infiltrate insertion site Then continue through the skin, SC tissue, rectus sheath and down while alternating injection and aspiration Eventually you should aspirate urine into the syringe.

8. Technique
11. Using #11 scalpel blade make small stab incision at insertion site. 12. Place your nondominant hand on the lower abdominal wall. Stabilize the unit between the thumb and index fingers. The dominant hand should be used to advance the unit. Insert the Bard catheter at a degree angle caudally towards the patient’s feet. You should feel the trocar ‘pop’ into the bladder.

9. Technique

10. Technique

11. Technique
13. Apply drain dressings around the catheter and secure the catheter with either tape or suture.

12. The END