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How To Do Suprapubic Aspiration of the Bladder in a Child

ByKeara N. DeCotiis, MD, Nemours/Alfred I. duPont Hospital for Children
Michael SD Agus, MD, Harvard Medical School
Reviewed/Revised Modified Jul 2025
v48991166
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Suprapubic aspiration refers to a procedure used to obtain a urine sample directly from the bladder through the abdominal wall. It is performed to obtain urine samples in infants or young children when other collection methods may be challenging.

Topic Resources

(See also How To Catheterize the Bladder in a Female Child, How To Catheterize the Bladder in a Male Child, Bladder Catheterization, How To Do Urethral Catheterization in a Female, How To Do Urethral Catheterization in a Male, and Urinary Tract Infection in Children.)

Indications for Suprapubic Aspiration in a Child

Suprapubic aspiration is done when a clean-catch urine sample cannot be obtained and transurethral bladder catheterization was unsuccessful or not possible. This procedure is performed most often in children but can also be done in adults.

The main indication for suprapubic aspiration in children is to:

  • Obtain a sterile urine sample for testing (eg, urinalysis, urine culture) in very young children who cannot void on command

The American Academy of Pediatrics recommends bladder catheterization or suprapubic aspiration for obtaining urine specimens for urinalysis and culture in febrile infants aged 8 to 60 days when a urinary tract infection (UTI) is suspected because the diagnosis of urinary infection cannot be reliably achieved using bagged specimens (1); either procedure should be performed before initiating antimicrobial therapy.

Suprapubic aspiration of the bladder is the preferred method of obtaining uncontaminated urine to diagnose a UTI in the following children under 24 months of age: males with moderate to severe phimosis and females with tight labial adhesions.

A suprapubic catheter may be placed when an indwelling catheter is needed. This procedure is not discussed further here.

Indications reference

  1. 1. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610. doi:10.1542/peds.2011-1330

Contraindications for Suprapubic Aspiration in a Child

Absolute contraindications

  • Skin or soft tissue infection* of the abdominal wall over the bladder

* Cellulitis or significant abdominal wall infection, not diaper rash or eczema.

Relative contraindications

  • Empty bladder

  • Major genitourinary abnormalities

  • Bleeding diathesis

  • Massive hepatosplenomegaly

  • Previous abdominal surgery

Complications of Suprapubic Aspiration in a Child

Suprapubic aspiration is typically safe. Possible complications include:

  • Bleeding

  • Infection

  • Bowel perforation (Rare, usually occurs in patients with bowel distention resulting from a gastrointestinal disorder. In these patients, ultrasound guidance can reduce the risk of bowel perforation.)

Equipment for Suprapubic Aspiration in a Child

Required equipment typically includes:

  • Sterile drapes and gloves

  • An absorbent underpad

  • Antiseptic solution (eg, povidone-iodine, chlorhexidine) with applicator sticks, cotton balls, or gauze padsAntiseptic solution (eg, povidone-iodine, chlorhexidine) with applicator sticks, cotton balls, or gauze pads

  • Lidocaine (1% with or without epinephrine), 25-gauge needle, and 5-mL syringeLidocaine (1% with or without epinephrine), 25-gauge needle, and 5-mL syringe

  • For aspiration, a 5-mL syringe, 22-gauge 1.5-inch needle

  • Sterile cup for collecting the urine specimen

  • Washcloth for removing antiseptic solution after the procedure

  • Sterile bandage

Additional Considerations for Suprapubic Aspiration in a Child

  • The bladder should be relatively full (confirmed by physical examination and/or ultrasound).

  • Urology consultation may be considered in complicated cases, such as children with known or suspected anatomic abnormalities, prior pelvic surgery, or failed attempts.

Relevant Anatomy for Suprapubic Aspiration in a Child

  • The bladder lies posterior to the pubic bone and anterior to the uterus in girls and anterior to the rectum in boys.

Female Genital Organs

Male Genitourinary Tract Anatomy

Positioning for Suprapubic Aspiration in a Child

  • Place the patient in a supine, frog position (hips and knees partially flexed, heels on the bed, hips adequately abducted to allow access).

Step-by-Step Description of Suprapubic Aspiration in a Child

  • Locate the bladder by percussion and palpation or using ultrasound guidance.

  • Locate the point of entry, which is 1 to 2 cm cephalad to the superior edge of the symphysis pubis in the midline.

  • Place the absorbent underpad with the plastic side down beneath the buttocks.

  • Remove diaper if present and clean the area with a wet washcloth using soap and water. Dry the area with a dry towel. Then wash your hands with soap and water.

  • Put on gloves using sterile technique (ensuring hands are clean, opening the glove package without contamination, and donning the gloves without touching the outer surfaces).

  • Cleanse the area from the pubic symphysis to the umbilicus with antiseptic solution. Begin at the planned entry site and use a circular motion outward. If using povidone-iodine, cleanse 3 times and allow the area to dry then remove the Cleanse the area from the pubic symphysis to the umbilicus with antiseptic solution. Begin at the planned entry site and use a circular motion outward. If using povidone-iodine, cleanse 3 times and allow the area to dry then remove thepovidone-iodine with an alcohol swab.

  • Place sterile drapes around the sterile area or use a fenestrated sterile drape.

  • Inject local anesthetic subcutaneously and into the dermis at the planned entry site.

  • Insert the 22-gauge needle attached to a 5-mL syringe into the entry site vertically into the abdominal wall about the breadth of 2 fingers above the pubic bone in the midline. (This is typically pointing 10 to 20° caudally from the true vertical because the abdominal wall in children slopes down to the symphysis pubis.)

  • Aspirate while advancing. Urine will appear in the syringe.

  • If urine is not obtained, withdraw the needle to the subcutaneous tissue but do not withdraw completely. Then redirect the needle closer to the pubic bone caudally.

  • If ultrasound-guided insertion is planned, place a sterile cover on the ultrasound probe. Place the probe on the abdominal wall just inferior to the planned needle-insertion site. Follow the needle as it advances through the anterior abdominal wall and into the bladder. When the needle is visualized in the bladder, aspirate the urine.

  • After collecting adequate urine, withdraw the syringe and needle.

Aftercare for Suprapubic Aspiration in a Child

  • Remove the drapes.

  • Place a bandage over the insertion site.

Warning and Common Errors for Suprapubic Aspiration in a Child

  • Microscopic hematuria is common after the procedure; gross hematuria is uncommon.

Tips and Tricks for Suprapubic Aspiration in a Child

  • Frequently, the child may spontaneously urinate having been stimulated by the procedure. Be prepared to collect this urine in a sterile container.

  • During pre-procedure examination or ultrasound-guided bladder visualization, apply minimal pressure to the abdominal wall to avoid triggering urination.

  • If the bladder appears on ultrasound as a hypoechoic area 2 cm in each dimension, it is possible to obtain approximately 2 mL of urine.

  • If the bladder cannot be visualized with ultrasound, there is probably not enough urine due to dehydration or recent voiding. Provide hydration if permitted by the patient's clinical condition and repeat the ultrasound after a few minutes.

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