SPC insertion

Technique

• Guidewire and Seldinger
  • USS prior to confirm bladder location
  • LA to skin, fascia and retropubic space
  • Prep skin
  • Small incision in skin
  • USS guidance
  • Approx 19G needle advanced vertically until urine is returned (can use long spinal needle). Avoid going into peritoneal cavity.
  • Remove needle and place a super-stiff guidewire into the bladder
  • Advance catheter over guidewire and fill balloon
• Open
  • Incision 2cm above pubic symphysis
  • Dissect down to fascia and divide it to enter space of Retzius
  • Identify bladder with stay sutures on either side
  • Modest incision in bladder dome, place catheter inside, purse-string suture
  • Close in layers

Difficult situations

• Large apron
  • Assistant to pull to the side
  • Consider cut-down