#paeds see: [RCH sprapubic aspirate](https://www.rch.org.au/clinicalguide/guideline_index/Suprapubic_Aspirate_Guideline/) > [!key points] > - gold standard for urine specimens in children <2 ; any SPA specimen +ve growth is significant > - uss-guidance improves success ; can also help determine when NOT to do SPA # Indications - young infant with need for urine mcs as part of septic work up where abx administration should not be delayed while awaiting a clean catch urine - children with prior UTI and unusual or resistant organisms - children on ppx abx # contraindications - bleeding diathesis - abdominal distension - massive organomegaly - urogenital or gastrointestinal abnormality - overlying soft tissue infection # alternatives - catheter sample - do not delay treatment if unwell (eg give abx without sample) # complications - bowel perforation -- usually only wiht very distended abdomens. even when it occurs, no treatment needed and infection is very unlikely - infections around puncture site - microscopy haematuria transiently # equipment - need assistant to hold infant (preferably trained nurse not parent) - topical anaesthetic - bladder scanner or POCUS - sterile gloves - 5mL syringe - 23 gauge needle (25g for premature) - cleaning solution (alcohol swab or chlorhexidine 0.1%) - oral sucrose for infants <3 months of age # preparation - review anatomy of lower abdomen - restrain child in a frog-leg position - have all equipment nearby - patient should have not passed urine for 30 min prior to procedure / bladder should appear full on ultrasound # procedure 1. prepare area with topical anaesthetic unless procedure is urgent 2. be ready to catch an opportunistic midstream specimen during preparation 3. locate a spot ~1 cm cephalad of the pubic symphysis in the midline 4. use ultrasound to determine if bladder is full enough. if bladder diameter is 3.5 cm or if 10cm^3 of urine is present, procedure likely successful 5. insert needle at an angle approximately 10-20 deg cranially 6. provide constant back press of syringe 7. aspirate urine specimen, remove needle and place a small bandage on the site ![[Pasted image 20240302122845.png]]