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for more than several days, pre-treat the patient with cystitis antibiotic regimen (Septra DS bid) the
day before catheter removal and monitor the patient for signs of infection within the rst week after
catheter removal.
What Not To Do:
In men, do not inflate the balloon unless urine flows through the catheter, and the catheter flange is at the
meatus. If this is not done, the balloon may be inflated in the prostatic urethra.
Do not make more than two attempts to pass the catheter if there is injury to the urethra. Allow the patient
to try to void. Consider a suprapubic catheter and evacuation.
Do not use saline to inflate the balloon if the catheter is to be left more than a day. Use sterile waterto
inflate the balloon. Saline may crystallize in the balloon port resulting in inability to deflate the balloon.
Do not leave catheters in for more than one month without changing them.
Do not forget to always pull the foreskin of an uncircumcised male back down over the glans to prevent
development of paraphimosis.
Procedure: Suprapubic Bladder Aspiration (Tap)
CAPT Leo Kusuda, MC, USNWhat: Insert a needle into the bladder to drain the bladder.
When: Bladder is palpable above pubic bone, patient cannot void and the urethra is injured so Foley
catheterization not indicated. Indicated for anuric patients prior to transport.
What You Need: Long spinal needle, if available (if not, use a 2 inch or longer needle for adults; 1 1⁄2 inch
for children), antisetic skin prep, 10cc syringe , 60 cc syringe, stopcock and IV tubing (desirable), 10 cc of
1% lidocaine local anesthetic (optional), Kelly clamp (optional)
What To Do:
- Confirm bladder is full:
a. Palpate abdomen above pubic bone. If there is a midline mass above the pubic bone, confirm that
this is the bladder by pressing on the mass. If there is increased urge to void, this suggests that the
mass is the bladder. Then percuss abdomen above pubis. If the mass is dull and firm, this also suggests
the mass is the bladder.
b. Do a bimanual rectal or vaginal exam to feel for an enlarged bladder
WARNING: IF YOU CANNOT PALPATE THE BLADDER, DO NOT ATTEMPT A TAP. IF THE BLADDER IS
NOT FULL, YOU MAY INJURE THE BOWEL. - Prep the skin, an area about the size of your hand, centered around a spot in the midline 1-2 finger-widths
above the pubic bone with alcohol prep pads or Betadine. - If you have lidocaine, fill the 10 cc syringe and anesthetize the skin as described below. This is about as
painful as the tap will be, but the patient will be less likely to move during the procedure. - Attach the spinal needle (or appropriate length needle) to the lidocaine syringe and infiltrate the skin
in the midline about 1-2 finger-widths above the pubic bone. Infiltrate the tough fascia below the skin and
subcutaneous fat. Direct the needle straight down, perpendicular to the long axis of the body. Do not
angle up toward the head or down toward the feet. You may infiltrate below the fascia. - If you are using a large 18 gauge needle, now insert the supplied obturator (wire that goes inside the
needle) with the needle. If the needle is smaller, you may use a syringe to aspirate in place of the
obturator. Attach the stopcock, tubing and 60 cc syringe (if available) to siphon out the urine. - Pass the needle in the area that was anesthetized. Again direct the needle straight down.
- The bladder should be encountered within 1 inch below after going through the fascia (tough layer below
the skin). If you do not get urine back, slowly withdraw the needle while aspirating. - Once urine is encountered, advance the needle about 1⁄2 inch. A Kelly clamp or other large clamp may be