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CONTRAINDICATIONS

■ Avoid placing in patients whose bladder is not full enough to visualize or is

not definable due to previous surgery or radiation. Ultrasound is useful in

determining bladder position.

TECHNIQUE

■ Use sterile technique and local anesthesia. If necessary, conscious sedation

should be provided.

■ The needle is placed approximately 2–3 cm above the pubic symphysis

directed toward the pelvis and advanced slowly while aspirating until urine

is easily aspirated (see Figure 19.13).

■ Once the bladder is located, the Foley is placed over a guidewire and sheath.

COMPLICATIONS

■ Bowel perforation, intraperitoneal/extraperitoneal extravasation, infection,

obstruction of tubing, tubing comes out, ureteral catheterization

INTERPRETATION OFRESULTS

■ Aspiration of urine from the catheter confirms placement.

ABSCESS INCISION AND DRAINAGE (I+D)

INDICATIONS

■ Definitive treatment of a soft tissue abscess (antibiotics alone are ineffective)

CONTRAINDICATIONS

■ Incision prior to localization of pus (may extend infection)

PROCEDURES AND SKILLS

FIGURE 19.13. Insertion site of catheter during suprapubic catheterization.

(Reproduced, with permission, from Stone CK, Humphries RL. Current Emergency Diagnosis &

Treatment. 5th ed. New York: McGraw-Hill, 2004:128.)

Patients with pelvic fractures

and either a high-riding

prostate or blood at the

urethral meatus should have a

retrograde urethrogram

(RUG) for evaluation of

urethral injury. If present,

place a suprapubic catheter.