Iowa Neonatology Handbook: Procedures

Suprapubic Bladder Tap

Iowa Neonatology Fellows
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I. Indications: bladder aspiration is performed to obtain sterile urine for culture. A suprapubic bladder tap is not necessary for Group B strep latex antigen studies (i.e., a bag specimen is adequate).

II. Be certain that voiding has not occurred within the previous hour so that the bladder has an adequate amount of urine. The infant is restrained in the frog leg position. The pubic area is prepped 3 times with an alcohol swab. A 25-gauge needle attached to a 3-ml syringe is directed perpendicularly to the skin just superior (0.5 cm) to the symphysis in midline and advanced to its hub. Full-term infants sometimes require a 22-gauge needle (which need not be inserted to the hub). The needle is withdrawn, slowly, with slight pressure pulling back on the syringe.

III. A minimal amount of hematuria may be seen after an attempt, but otherwise the risks are minimal. Rare complications include bladder wall hematoma, lacerated vessel on anterior bladder wall, perforation of hollow viscus, osteomyelitis of pubic bone or abdominal wall abscess.

IV. If no urine is obtained, the infant should have a U-BagR placed with repeat attempt in 1 hour. If unable to obtain a specimen, a catheterized specimen may need to be obtained but this procedure is more difficult to perform and may be riskier.

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