SUPRAPUBIC BLADDER ASPIRATION VERSUS URETHRAL CATHETERIZATION IN ILL INFANTS - SUCCESS, EFFICIENCY, AND COMPLICATION RATES

Study objective: To compare success rates, complications, and efficien cy of suprapubic bladder aspiration with urethral catheterization in i ll infants. Design: Prospective, randomized clinical study. Setting: T he pediatric emergency department at the University of Mississippi Med ical Center in Jackson. Participants: Convenience sample of infants un der 6 months of age requiring an uncontaminated urine specimen for the evaluation of febrile illness, suspected urinary tract infection, or sepsis. Infants with wet diapers were excluded. Interventions: Patient s were randomized to undergo timed suprapubic bladder aspiration (perf ormed by a physician and a nurse) or urethral catheterization (perform ed by two nurses). If suprapubic bladder aspiration was unsuccessful, urethral catheterization was performed immediately and the bladder was drained; emptying volume was recorded. All patients had a next-void ' 'bag'' urinalysis performed for post-procedure hematuria. Results: Fif ty patients underwent primary suprapubic bladder aspiration. The succe ss rate (defined by obtaining at least 2 mL of urine) was 46%. Mean +/ - SD time per successful suprapubic bladder aspiration was 16.73 +/- 7 .73 seconds. Fifty patients underwent primary urethral catheterization . The success rate was 100%; the mean time required was 80.70 +/- 46.5 2 seconds. After failed suprapubic bladder aspiration, urethral cathet erization was 100% successful, with a mean draining volume of 2.95 +/- 2.38 mLD. No immediate problems were identified among any instrumente d patients; later complications (next-void hematuria after either proc edure, other visceral injury with suprapubic bladder aspiration) were not detected. Conclusion: Both suprapubic bladder aspiration and ureth ral catheterization afford the emergency physician low-risk access to uncontaminated urine in ill infants. Suprapubic bladder aspiration is less efficient in that it requires physician participation and failure rates are higher. These data suggest that successful suprapubic bladd er aspiration is primarily dependent on the volume of urine in the bla dder; thus, in the ill or febrile ED infant who may be dehydrated, the likelihood of success decreases. The authors recommend that ED nursin g and physician staff become comfortable with performing urethral cath eterization on infants.