SUPRAPUBIC ASPIRATION OF URINE NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. This guideline applies to all hospital staff responsible for the collection of a neonatal urine specimen via supra pubic aspiration 2. The Guidance 2.1 Indications: Obtain uncontaminated urine for microbiological culture, when clean catch has been unsuccessful. 2.2 Contraindications: Thrombocytopenia, infection or abdominal distension and dilated loops of bowel. 2.3 Anatomy: As the bladder fills in infants it will rise up behind the pubic bone, and it will lie directly behind the muscle layer of the abdominal wall. 2.4 Procedure. Prior to aspiration: Ensure that the parents understand the procedure and have had full eplanation. A full bladder is essential for success of the procedure and avoidance of complications, therefore palpate or ideally scan immediately prior to procedure. Figure 1. Anatomical landmarks when considering Suprapubic Aspiration. Umbilicus Syringe perpendicular to skin Bladder Pubis symphysis Uterus Rectum Illustration: Kim Smith Supre-pubic aspiration of urine - Neonatal clnical Guideline Page 1 of 7
2.5 Equipment: Sucrose analgesia, 5ml syringe, 23 gauge (blue) needle Sterile gloves, Unisept sachet Sterile gauze. 2.6 Method: 1. Lay the baby on his back, etend the legs and hold still to stabilise the pelvis. 2. Wash hands, clean skin area and put on sterile gloves, give sucrose. 3. Locate landmarks; palpate the top of the pubic bone; the needle should pass through the abdominal wall about 1.0cm above this in the midline. Clean with Unisept sachets and dry with gauze. (Be prepared as baby may spontaneous urinate at this point). Give sucrose. 4. Advance the needle vertically 2 to 3cm, no more than 3cm. aspirating as you advance. If you do not obtain urine then withdraw the needle whilst still aspirating. 5. Once procedure complete, remove needle, apply gentle pressure over puncture site with sterile gauze send specimen to lab 6. Ensure baby is comforted 7. Document all attempts, sample obtained, and how baby tolerated the procedure. Supre-pubic aspiration of urine - Neonatal clnical Guideline Page 2 of 7
3. Monitoring compliance and effectiveness This part must provide information on the processes and methodology for monitoring compliance with, and effectiveness of, the policy using the table below. Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Key Changes to practice Dr. Paul Munyard Audit As dictated by audit findings Child Health Directorate Audit and Neonatal clinical Guidelines Group Dr. Paul Munyard. Consultant Paediatrician and Neonatologist. Required changes to practice will be identified and actioned within 3 months. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website. 4.2. Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendi 2. Supre-pubic aspiration of urine - Neonatal clnical Guideline Page 3 of 7
Appendi 1. Governance Information Document Title Date Issued/Approved: November 2015 Supra-pubic aspiration of urine Neonatal Clinical Guideline Date Valid From: January 2016 Date Valid To: January 2016 Directorate / Department responsible (author/owner): Dr Munyard. Consultant Paediatrician and Neonatologist Contact details: (01872) 252667 Brief summary of contents This guideline outlines the management of infants requiring supra pubic aspiration of urine Suggested Keywords: Target Audience Eecutive Director responsible for Policy: Urine. Supra-pubic Aspiration (SPA). Neonatal RCHT PCH CFT KCCG Eecutive Director Date revised: 11:11:2016 This document replaces (eact title of previous version): Approval route (names of committees)/consultation: New Document Consultant approval. Child Health Directorate Audit. Neonatal Clinical Guidelines Group Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Eecutive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key eternal standards Sheena Wallace Not Required {Original Copy Signed} Internet & Intranet Intranet Only Neonatal. Midwifery. Child Health. Clinical None Supre-pubic aspiration of urine - Neonatal clnical Guideline Page 4 of 7
Related Documents: Reference Macdonald, M.G.(Ed) (2013) Procedures in Neonatology, Philadelphia, Lipincott, Williams & Wilkins. Rennie, J.M. (2005) Roberton s tetbook of Neonatology, Fourth Edition, Elsevier publications, Philadelphia. Training Need Identified? No Version Control Table Date Versio n No Summary of Changes 01:10:15 V1.0 Initial Issue and Formatting. Changes Made by (Name and Job Title) Author: Sarah Tabrett. Advanced Neonatal Nurse Practitioner Formatter: Kim Smith. Staff Nurse. 11:11:2016 V1.0 Approved at neonatal Guidelines meeting All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of epiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the epress permission of the author or their Line Manager. Supre-pubic aspiration of urine - Neonatal clnical Guideline Page 5 of 7
Appendi 2. Initial Equality Impact Assessment Form Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): Supra-pubic aspiration of urine Neonatal Clinical Guideline Directorate and service area: Child and Is this a new or eisting Policy? New Womens Health. Neonatal Name of individual completing Telephone: (01872) 252667 assessment: Dr. Paul Munyard. 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? 2. Policy Objectives* As above This guideline is aimed at clinical staff responsible for the supra-pubic aspiration of urine from a neonate within the hospital setting 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? Audit Audit Patients. Staff involved in the procedure No. Consultant led, Neonatal Guidelines Group approved document. b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Eisting Evidence Age Supre-pubic aspiration of urine - Neonatal clnical Guideline Page 6 of 7
Se (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Seual Orientation, Biseual, Gay, heteroseual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this ecludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. No 9. If you are not recommending a Full Impact assessment please eplain why. No area indicated Signature of policy developer / lead manager / director Dr Paul Munyard Date of completion and submission 14:01:2016 Names and signatures of members carrying out the Screening Assessment 1. 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Kim Smith Date 14:01:2016 Supre-pubic aspiration of urine - Neonatal clnical Guideline Page 7 of 7