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Cystocentesis: Feline

Views: 17078 - Comments: 17

Megan Brashear, CVT, VTS (ECC), shows you how to obtain a sterile urine sample from a cat via manual cystocentesis.

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Megan Brashear's picture
Megan Brashear

CVT VTS(ECC)

Enrolled: 07/2011

Meredith Rose's picture
Meredith Rose

CVT VTS(ECC)

Enrolled: 08/2011

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Comments

Megan Brashear's picture

How many of you are using an ultrasound to guide all of your cystocentisis procedures? Any interest in having us make that a procedure video as well?

Amie Brunagan's picture

Our facility uses an ultrasound for when technicians obtain a cysto sample. There is a designated (cheaper) ultrasound for the technicians to use. We utilize the u/s not only to be accurate and obtain a good sample, but it also allows us to potentially notice any abnormalities within the structure of the bladder (i.e. small bladder, wall thickness, stones, TCC) in which case we notify the DVM and forgo obtaining a sample until told otherwise (or the DVM obtains themselves). We also do not charge the client for the use of the u/s in obtaining a sample; it is more-so incorporated in the cost for a urinalysis as it is just another means of urine collection. It would be great to see a video offered that instructs on how this is done.

Kris Keane's picture

Megan,
Have you considered that making the injection area wet with alcohol does not actually cleanthe area (unless you allow it to stay in contact much longer than demonstrated here) but may in reality provide a vehicle for surface bacteria to be drug into the bladder when you insert your needle?
You really should be doing one-handed needle recaps in a demo video if your goal is to teach good technique.

Megan Brashear's picture

Thanks Kris, the point about the alcohol is very valid. Sometimes you may need to clip and perform a scrub if the skin is grossly contaminated. The alcohol works to mat the hair down and hopefully prevent some contamination from running the needle through too much. And YES, those of you unfamiliar with one handed needle recaps, you can google it, in vet med we are often pretty lazy with needles (including myself in this video) but safety first! Thanks again Kris!

Morgan VanFleet's picture

My preference is to always use U/S guidance. It can be more costly for the client, so if money is an issue and the bladder is easily palpable, I might forego it. Still, I like being able to visualize my stick.

Anne Downes's picture

I have a few concerns about this video: It is not possible to reduce surface contamination with alcohol, the alcohol is useful though just to smooth the fur and mark the point of entry. The vertical angle of needle entry is less ideal that a 45 degree caudally directed angle as the tip of the needle is less likely to cause bladder injury as the size of the bladder decreases during the procedure. Lastly,the sample size is smaller than ideal (looks like only about 2 cc was obtained vs the standard 5 cc).

Megan Brashear's picture

Thank you Anne for your comments. I'm happy to see this generate comments as it allows all of us to discuss and point out the differences in how a procedure should be performed and ways to make us all better at what we do.

aura lee morse's picture

i also like using ultrasound (mostly because i am not very confident about my cysto skills), but i think it is good to show a low-tech way to do a cysto. not every clinic has the luxury of an ultrasound machine. we should all know how to perform essential tasks in the event technology fails or simply isn't available. that's why we all had to learn to calculate fluid rates by counting drops, even though most of us probably typically use fluid pumps.

Rachel Swithenbank-Duncan's picture

Thank you so much for sharing. I do have a question, even though I am a student and this video was assigned by my teacher to exam, I still feel I do not have enough information. I have been working in the field for six years and we have always taken samples through urinary tract, other then damage to the caudal area why would we want to do this risky procedure and not just use a catheter?

Megan Brashear's picture

Rachel S: While urinary catheters are usually a simple method when you need a sterile urine sample from a male dog they are just about impossible to place in cats and female dogs without a great deal of sedation and/or general anesthesia. Cystocentesis can be performed (in most cases) without drugs. Urinary catheter placement is also a notorious way to introduce bacteria (both from the lower urinary tract and from the outside environment) into the bladder so that is not without risk even when performed aseptically. Cystocentesis is the gold standard for obtaining a sterile sample for a urine culture. If the DVM does not specify that we need a sterile sample for culture we will use free catch urine to perform a routine urinalysis. With practice performing cystocentesis your confidence will improve, and if your hospital has an ultrasound that also helps tremendously and will decrease some of risk of hitting something other than the bladder. Thanks for asking, glad you're enjoying the site!

Melissa Klohn's picture

Great video! I think an ultrasound video would be beneficial as well. We usually use ultrasound and I feel more comfortable doing it that way. It was nice seeing how someone does it manually.

Megan Zalac's picture

Megan, I notice when doing this your needle goes straight in at a 90 degree angle and that's how i was originally taught but I notice some tech go in at a 45-60 degree angle. My concern is does the angle matter? Is this something that needs to be corrected?
Thanks!

Natalie Hamilton's picture

It may be more beneficial to rephrase the quiz question regarding when to apply pressure on the syringe during the procedure. Currently, the question is phrased as if asking for the release of syringe pressure rather than when syringe pressure should be applied.

Thanks again!

Beth Ann Fretz's picture

Hi Natalie,

Thanks for your feedback! I clarified the wording on the quiz question you are referring to. Thanks again for letting us know.

Beth Ann

Callan Hair's picture

Is this performed as part of the diagnostics for bladder stones? what will the urinalysis determine?

Rachel Medo's picture

Hi Callan,

I was able to check in with one of our technicians about your question!

A cystocentesis is only used to obtain urine for a urinalysis and/or culture. On the urinalysis, it will show if there is any crystal formation. And, if so, that could result in the evidence of stones. In order to determine if the patient does have bladder stones, a radiograph is usually taken.

Please let me know if I can answer any further questions!