Overview of Suprapubic Aspiration

Suprapubic aspiration (SPA) is a clean and precise process utilized to get urine samples that are free from contamination. This method is widely recognized as the best approach and it is particularly used with young children. The American Academy of Pediatrics even recommends this technique for urine analysis when diagnosing urinary tract infections (UTIs) in children from 2 to 24 months old. This is especially so if they have fevers that can’t be linked to any known causes.

This procedure is not limited to only young children; it can be done on older children and adults too. SPA is especially helpful if the bladder opening (known as the bladder outlet) is blocked. But even though it is seen as the best approach because of its accuracy, SPA is not done often. This is mainly due to it being a bit invasive and can cause some level of discomfort. As a result, many doctors tend to lean towards urinary catheterization, which is a process of inserting a tube into the bladder to drain urine. Despite this preference, SPA is a crucial technique used by emergency doctors, pediatricians, and urologists. It’s particularly important when dealing with cases of a blocked bladder outlet or while placing a suprapubic catheter (a special tube that drains urine from the bladder).

Anatomy and Physiology of Suprapubic Aspiration

The Suprapubic Aspiration (SPA) procedure involves inserting a needle through the skin of your lower belly into your bladder (a sac-like organ that holds urine), in order to collect a sample of your urine. This procedure is done when there is a strong need to avoid getting any germs into the urine sample. Knowledge of the human body’s layout and how it functions is crucial for the doctor to do this procedure safely.

Your bladder is a hollow, muscular organ placed behind the pubic bone in your pelvic area. It is made up of three layers, with the innermost layer being closest to the urine it holds, followed by the muscular layer, and then the outermost layer of tissue. The bladder is covered by a lining called peritoneum, which moves away from the bladder as the bladder gets filled with urine in the lower part of your abdomen. This happens so that the bladder is less likely to get injured when the doctor performs the SPA.

For the SPA, it is important that your bladder is full. This is because a full bladder is easier to reach and makes it less likely for the surrounding organs to get injured when the needle goes in. When your bladder is full, it moves up into your belly, pushing the peritoneum away. This creates a safe path for the needle to go in without risking injury to the peritoneum or your bowels.

In the SPA procedure, a needle is inserted straight into your bladder through the skin, the fatty tissue under the skin, and the muscles of your abdomen. Once the needle is in the bladder, the urine is drawn out, providing a clean sample for testing. Since the bladder doesn’t have germs inside, the SPA method helps avoid any germs getting into the urine sample, making it the most reliable method for collecting urine for tests.

In babies and young children, the bladder is positioned higher up in the belly, behind and above the pubic bone. To ensure that the needle is inserted at the right spot for children, doctors imagine a line from the belly button to the border of the lower belly, and insert the needle at the middle of this line. The needle then goes through the skin, the layers of soft tissue, and the layers of the bladder.

In adults, the bladder is placed lower in the pelvis, behind the pubic bone. The main location that the doctors use to guide them for this procedure is the pubic bone. It is crucial to be careful of the area where the bladder lining attaches to the bladder top, as there is a risk of injuring, and even creating a hole in, the bladder or intestine. It is also important for the doctors to be aware of the large blood vessels on either side of the bladder, as they need to avoid them to prevent injury during the procedure.

The lower belly area, located just above the pubic bone, is relatively free of large blood vessels and nerves, making it safer to perform this procedure. The best spot to insert the needle is in the middle line of your lower belly, about 1 to 2 cm above the pubic bone, as that is where the bladder is closest to your skin.

Why do People Need Suprapubic Aspiration

Suprapubic aspiration (SPA), also known as taking a sample of urine directly from the bladder, is done in several situations:

– When a child, aged between 2 to 24 months, has a fever but it’s unclear where the fever is coming from.
– When a healthcare professional needs to get a clean urine sample but cannot use the urethra (the tube that carries urine from the bladder out of the body). This could be due to:
– Labial adhesions (when the lips of the vagina stick together)
– Labial edema (swelling of the vaginal lips)
– Phimosis (tight foreskin in boys that cannot be pulled back)
– If the child had surgery in the urethra or vagina.
– To help diagnose an issue with backward ejaculation (when semen enters the bladder instead of coming out through the penis). SPA can help tell the difference between genuine backward ejaculation and semen that stayed in the urethra.
– For bladder outlet obstruction which is when the flow of urine is blocked. This can happen due to several reasons like a narrow urethra, an injury, cancer, prostate infection, or enlarged prostate. SPA is mostly done when inserting a catheter (a thin tube) into the urethra isn’t possible.

SPA is also done:

– As part of placing a tube into the bladder via the lower abdomen, right above the pubic area (suprapubic tube placement).
– For patients with a spinal cord injury who can’t urinate on their own.
– Sometimes, a healthcare professional might use SPA to poke a hole in a catheter balloon that isn’t deflating. This is usually done with the help of ultrasound.

When a Person Should Avoid Suprapubic Aspiration

There are certain conditions that may prevent a patient from undergoing Suprapubic Aspiration (SPA), a procedure where a needle is used to remove urine directly from the bladder. Here are some of these conditions:

1. Having a swollen belly.
2. Having scars or injuries on the skin around the belly.
3. Having a blood disorder that makes bleeding hard to stop, such as having a low platelet count (thrombocytopenia) or Hemophilia, a condition that affects the body’s ability to control blood clotting.
4. A high international normalized ratio (a measurement used to determine how quickly your blood clots).
5. Any signs of problems with the bowel or intestines.
6. Severe abnormalities of the urinary system.
7. If the bladder can’t be felt or the patient has urinated within an hour before the procedure.
8. Having bladder cancer.
9. Abnormally large organs (organomegaly) or other abnormal conditions inside the belly.
10. Having infections in the tissue of the belly wall.
11. If the patient is not able to cooperate.
12. Severe fluid accumulation inside the belly (ascites) or excessive body weight (morbid obesity).

Equipment used for Suprapubic Aspiration

To perform a Suprapubic Aspiration (SPA, a procedure where a needle is used to get urine from the bladder), a doctor typically needs the following:

– An antiseptic solution, like povidone-iodine, chlorhexidine, or alcohol, to clean the area
– Sterile gloves for the doctor’s hands to ensure no germs are transferred
– A sterile drape or towel, which is placed on the patient to help keep the area clean
– Optional topical anesthetic cream to numb the area[9]
– 1% lidocaine, a type of medicine used to numb the area further
– A 5-mL syringe for the anesthetic solution, which is a small tube to inject the numbing medicine
– A 10-mL syringe to pull out and collect the urine sample
– In younger children, a 1.5- to 3-inch (or longer), 22-gauge or spinal needle is used to draw out the urine
– In older children and adults, a 3-inch (or longer) 22-gauge or spinal needle is used to draw out the urine
– If the doctor plans to leave a guide wire in place for suprapubic tube placement (a method to drain the bladder), a larger 18-gauge needle is needed to allow a 0.035″ guidewire to pass through.
– A 25 gauge needle is used to draw up the anesthetic solution
– A sterilized urine collection container to store the collected urine
– Sterile gauze, which is a type of bandage used to cover the area after the procedure
– A basic bandage to protect the area

If the doctor plans to use an ultrasound for this, they will also need:
– A portable ultrasound machine to view the bladder in real-time
– Sterile ultrasound gel, which is used to help the ultrasound image be more clear
– A sterile cover for the ultrasound probe to ensure no germs are transferred.

Who is needed to perform Suprapubic Aspiration?

SPA, or suprapubic aspiration, is a straightforward and safe procedure that’s usually done by an emergency doctor, a child’s doctor (pediatrician), or a doctor who specializes in the urinary system (urologist). Generally, nurses don’t do this procedure. Since suprapubic aspiration is most often done in children younger than two, it’s recommended that another medical professional assist during the procedure to help make it more successful.

Preparing for Suprapubic Aspiration

Before performing a Single-port Appendectomy (SPA), which is a type of surgery to remove appendix, there are few important steps that need to be taken:

First, it’s crucial that the medical team gets your permission, or ‘informed consent’, to perform the operation. This means that you or a family member or guardian in the case of a child, have been fully informed about the surgery and agree to it.

During the operation, the team will take steps to make sure the area they are working on is clean to prevent infection. They will apply a special cleaning liquid, called an antiseptic solution, to the lower part of your belly, from your belly button down to the pubic bone. This is the area where they will make the surgical incision.

Next, they will place sterile drapes over your lower abdomen. The sterile drapes serve to create a clean and germ-free environment for the operation.

Lastly, pain management is a crucial part of any operation. Your surgical team may use medications to ensure you are comfortable and partially or fully unaware of what is going on around you. This is called sedation. Depending on your condition and the complexity of your surgery, the team will decide the appropriate level of sedation.

How is Suprapubic Aspiration performed

While you’re laying flat on your back, a assistant might help hold your legs in a special position to help with the procedure. This is same for both children and adults.

The first step of the procedure is making sure that your bladder is full. This is done because it can greatly improve the chances of the procedure being done successfully. If you are dehydrated and your bladder isn’t full, the procedure might not be as effective. The doctor can confirm the fullness of your bladder by gently pressing on your belly, tapping it, or using ultrasound. An ultrasound will help the doctor see exactly how full your bladder is and increases the likelihood of the procedure going well.

Once your bladder is confirmed to be full, the doctor will find the right spot on your lower abdomen for the needle to go in. The spot is generally a little above your pubic bone, in the lower part of your belly. To help prevent infections, the doctor will disinfect this area with a special antiseptic.

Your doctor might also give you a local anesthetic in this area. This is optional and primarily used to help numb the area and reduce any discomfort you might feel. However, this step is sometimes skipped in children because the pain caused by the anesthetic can be similar to the discomfort of the procedure itself.

The doctor will then insert a special needle to collect a urine sample from your bladder. In children, this needle is inserted a little above the midline of the pubic bone, at a slight upward angle. In adults, the needle is inserted slightly above the pubic bone, at a slight downward angle. If an ultrasound is used, it can help guide the needle to the right spot in the bladder. After the urine is collected, the needle is carefully removed and a dressing is applied to the area to prevent any bleeding.

After the procedure, your doctor will check your belly to make sure there are no signs of inflammation or infection. If you’re going home immediately after the procedure, you’ll be told to return or follow up with your doctor if you feel too much discomfort, have a fever and inflammation around the procedure site, or if a child is inconsolable. The doctor might even suggest an over-the-counter pain medication for any discomfort you might feel after the procedure is done.

Possible Complications of Suprapubic Aspiration

Complications from a medical procedure called suprapubic aspiration, which uses a needle to remove urine from the bladder, are quite rare, especially when the doctor uses real-time ultrasound to guide the needle. Sometimes minor issues can occur, such as mild bleeding in the urine or some bruising. However, there could be more serious problems like damage to the bowel wall, skin infections, heavy bleeding in the urine, blood in the abdomen, or other bleeding. If the doctor suspects the bowel wall has been damaged during the procedure, they will remove the needle and use a fresh one to finish. Usually, this type of injury to the bowel is not a serious problem. In rare cases, an abscess, or a collection of pus, might develop in the suprapubic area (the area just above the pubic bone).

What Else Should I Know About Suprapubic Aspiration?

When a child is suspected of having a urinary tract infection or UTI, it’s important to diagnose it correctly, and that often involves getting a urine sample. For infants and young children who cannot use the toilet yet, the best way to get a urine sample is called Suprapubic Aspiration (SPA). This method is also recommended for children aged 2 to 24 months who have a fever that can’t be explained, as it avoids the risk of contaminating the urine sample.

Regular methods of collecting urine, like using a bag or asking the child to pee into a cup, can often get bacteria from the skin mixed in. This can lead to wrong test results, diagnosing a UTI when there isn’t one, which can then lead to unnecessary antibiotic treatment. SPA avoids this issue by taking the urine sample directly from the bladder, so any bacteria found in the sample is definitely from an infection.

A study found that when comparing SPA to regular urine collection methods for children under 2 years with a fever, regular methods often miss a potential diagnosis. Thus, even if a UTI is not found using regular methods in case of highly suspicious cases, SPA might still be recommended.

SPA also proves beneficial for children with physical disabilities, bladder issues, or those with a catheter inserted. Another benefit is for critically ill children, where inserting a catheter might increase their risk of infection.

Also, SPA helps in guiding appropriate antibiotic therapy due to its high accuracy, especially in cases of resistant bacteria or recurring urinary tract infections. Right diagnosis helps in avoiding unnecessary antibiotics helping in preventing the development of antibiotic resistance.

In adults, SPA can be used when there is some blockage at the bladder outlet, making it impossible to insert a catheter. It can not only help provide relief but also aid in diagnosing the underlying condition causing the obstruction.

Frequently asked questions

1. What is the purpose of the Suprapubic Aspiration (SPA) procedure? 2. How is the SPA procedure performed and what steps are taken to ensure safety and cleanliness? 3. Are there any conditions or factors that would prevent me from undergoing a Suprapubic Aspiration? 4. What equipment and materials are used during the SPA procedure? 5. What are the potential complications or risks associated with Suprapubic Aspiration?

Suprapubic Aspiration (SPA) is a procedure in which a needle is inserted through the skin into the bladder to collect a urine sample. It is done to avoid contamination of the sample with germs. The procedure is generally safe and does not have any major side effects, but it is important for the doctor to be knowledgeable about the anatomy of the body to perform it safely.

There are several reasons why someone may need Suprapubic Aspiration (SPA). Some of these reasons include having a swollen belly, scars or injuries on the skin around the belly, a blood disorder that makes bleeding hard to stop, a high international normalized ratio, signs of problems with the bowel or intestines, severe abnormalities of the urinary system, inability to feel the bladder or recent urination, bladder cancer, abnormally large organs or other abnormal conditions inside the belly, infections in the tissue of the belly wall, inability to cooperate, and severe fluid accumulation inside the belly or excessive body weight.

A person should not get Suprapubic Aspiration if they have conditions such as a swollen belly, scars or injuries on the skin around the belly, blood disorders that make bleeding hard to stop, problems with the bowel or intestines, severe abnormalities of the urinary system, bladder cancer, infections in the tissue of the belly wall, or if they are not able to cooperate. Additionally, having abnormally large organs or excessive body weight can also prevent someone from undergoing this procedure.

The text does not provide specific information about the recovery time for Suprapubic Aspiration.

To prepare for Suprapubic Aspiration, it is important to have a full bladder, as this makes it easier to reach and reduces the risk of injury to surrounding organs. The doctor will confirm the fullness of the bladder by pressing on the belly, tapping it, or using ultrasound. The area where the needle will be inserted will be cleaned with an antiseptic, and a local anesthetic may be given to numb the area and reduce discomfort.

The complications of Suprapubic Aspiration include mild bleeding in the urine, bruising, damage to the bowel wall, skin infections, heavy bleeding in the urine, blood in the abdomen, other bleeding, and the development of an abscess in the suprapubic area.

Symptoms that require Suprapubic Aspiration include fever in a child aged 2 to 24 months with an unclear source, the need for a clean urine sample when the urethra cannot be used, issues with backward ejaculation, bladder outlet obstruction, the need for suprapubic tube placement, inability to urinate due to a spinal cord injury, and the need to deflate a catheter balloon that isn't deflating.

There is no specific information provided in the given text about the safety of Suprapubic Aspiration (SPA) in pregnancy. Therefore, it is not possible to determine whether SPA is safe or not during pregnancy based on the given information. It is recommended to consult with a healthcare professional for specific advice regarding the safety and appropriateness of SPA during pregnancy.

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