Page 70 - PJ MED OPS Handbook 8th Ed

Suprapubic Needle Cystotomy

Indications:
1. Unable to catheterize patient and bladder becomes distended (may be visible, or evident by dull
percussion sounds extending more than midway from the pubic bone to the umbilicus).
2. Severe genital trauma, extended care setting, or evac more than 3 hours.
Equipment Needed:
1. 18 gauge IV cannula, or
14 gauge 3.25 inch IV catheter
2. 25 gauge needle
3. Betadine
4. 4 × 4 gauze
5. sterile gloves
6. 5cc syringe
7. tape
8. 30 inch IV extension tube
9. urine collection container
10. Lidocaine
Procedure:
1. Clean area 1–2cm superior to symphysis pubis (pubic bone) with betadine (6 to 8 inches). Repeat
3 times.
2. Don gloves and drape area.
3. Anesthetize area where 18 gauge needle will be inserted.
4. Insert 18 gauge needle directly (must be EXACTLY) in midline on the upper edge of pubic bone.
5. Keep needle at 90° angle to the skin. Insert slowly while pulling gently on plunger of the syringe.
Stop insertion when urine begins to flow into the syringe.
6. Continue negative pressure until syringe is filled. Remove syringe and needle leaving catheter in
place. Secure catheter in place with tape.
7. Attach 30 inch IV tubing to catheter and drain urine into container.
8. After urine flow ceases, clamp off the IV tubing, and suture the catheter in place.
9. Unclamp the IV tubing and drain the bladder every 3–6 hours or as needed.

PJ PEARL:
A simpler option is to use sterile technique and drain the bladder every 3 hours or as judged
needed with a new angiocath (such as for ND) and not leave a tube. Administer Ertapenem
if not already done.

68 n Pararescue Medical Operations Handbook / 8th Edition