Percutaneous suprapubic catheter placement

Percutaneous suprapubic catheters are placed using sterile technique with local anesthesia and sedation if needed. Ultrasound is used to verify full bladder distension prior to the procedure. The lower abdominal skin is prepared and lidocaine is injected in the midline, 2 centimeters above the symphysis pubis. The catheter is placed through a small skin incision into the bladder either with a direct puncture or Seldinger technique. For the direct puncture technique, a mushroom catheter is straightened with a stylet and advanced into the bladder. Once the catheter is confirmed within the bladder, the stylet is removed. For the Seldinger technique, a needle is inserted until urine is aspirated. A guidewire is placed through the needle into the bladder, and the needle is removed. A dilator is advanced over the wire enlarging the tract. The dilator is then replaced with a sheath, the guidewire removed, and the catheter placed through the sheath, which is then peeled away. The catheter balloon is inflated and the catheter gently withdrawn until slight tension is felt. The catheter is then connected to the catheter drainage system and secured to the patient.