Только, когда речь идет о совсем маленьких. Неинвазивный способ всегда предпочтительнее инвазивного.Ren_Yumi писал(а):Я так поняла, педиатры в Израиле предпочитают такой способ забора мочи.
UTI + evaluation for urinary tract abnormalites
Модераторы: Ren_Yumi, Alon, dr.Ira
Детей первых месяцев жизни. ( Хотя, по протокoлу показания к SPA - Urinalysis or urine culture in neonates or children younger than 2 years ). У них сложно получить мочу другим способом. Т.е. получить мочу, конечно, можно, но, вот, насколько этой моче можно доверять...? На практике, на самом деле, рутинно используют SPA только в больнице, у детей до 3-х месяцев при sepsis work up или, когда есть серьезные сомнения в результатах анализа у детишек постарше.Ren_Yumi писал(а):Кого ты называешь совсем маленькими, и почему их нужно пунктировать?
Делай, что должен, и будь, что будет.
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Алексей Живов
- Сообщения: 293
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- Откуда: Москва
Это зависит от врача, Артем. Подавляющему большинству наших лепил я бы тоже не доверил, а человеку, который образован, подготовлен и знает что делает - доверил бы безусловно. Вы ведь знаете что бывает, когда врачи доверяют некорректно выполненным анализам. Ну очень большие проблемы!Artem_Co писал(а):Никогда бы не разрешил своему ребенку делать пункцию из-за сомнений врача в анализе. По-моему, это неправильно.
Ну, во-первых, это достаточно безопасная процедура у маленьких детей ( даже я делала, когда работала в отделении 
).
А во-вторых, соглашусь с Алексеем. Лучше спунктировать и получить настоящий результат, чем лечить неизвестно что неизвестно чем неизвестно как.
Иногда одна пункция позволяет избежать огромного количества ненужных и гораздо более неприятных для организма малыша обследований и ненужного лечения отсутствующего заболевания.
).А во-вторых, соглашусь с Алексеем. Лучше спунктировать и получить настоящий результат, чем лечить неизвестно что неизвестно чем неизвестно как.
Иногда одна пункция позволяет избежать огромного количества ненужных и гораздо более неприятных для организма малыша обследований и ненужного лечения отсутствующего заболевания.
Делай, что должен, и будь, что будет.
Вот, например, Suprapubic aspirates are the gold standard for obtaining urine specimens for culture. Any growth of pathogenic bacteria in an SPA specimen is felt to be significant. It is a simple, safe, rapid and effective technique. http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5246 Там же Complications of suprapubic aspirates are uncommon (estimates of complications reported in the literature are ~0.2% (ie 1 in 500), most of which are benign).Artem_Co писал(а):Есть работы, показывающие дополнительную пользу для больного от SPA, в сравнение скажем со сбором мочи мочеприемником или катетером?
Или вот здесь If an infant or young child 2 months to 2 years of age with unexplained fever is assessed as being sufficiently ill to warrant immediate antimicrobial therapy, a urine specimen should be obtained by SPA or transurethral bladder catheterization; the diagnosis of UTI cannot be established by a culture of urine collected in a bag (strength of evidence: good). Urine obtained by SPA or transurethral catheterization is unlikely to be contaminated and therefore is the preferred specimen for documenting UTI. In a clinical setting in which the physician has determined that immediate antimicrobial therapy is appropriate, the use of a bag-collected urine specimen is insufficient to document the presence of UTI. http://aappolicy.aappublications.org/cg ... ;103/4/843
Для SPA, как и для любой другой инвазивной процедуры, существуют показания и техника выполнения. Наиболее широкие показания и наиболее простая техника выполнения у маленьких ( в силу их физиологических и анатомических особенностей.)
Делай, что должен, и будь, что будет.
A randomized controlled trial of two methods for collection of sterile urine in neonates.Tobiansky R, Evans N.
Department of Neonatal Medicine. Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW, Australia.
OBJECTIVE: To test whether urethral catheterization (UC) is better than suprapubic bladder aspiration (SPA) as a method for collection of sterile urine in neonates. METHODS: Thirty-three babies, requiring sterile collection of urine, were randomly assigned to either urethral catheterization (n=16), median gestation 28+/-3.9 weeks, median birth weight 968 g (range 650-4100) or SPA (n=17), median gestation 26+/-5.6 weeks, median birth weight 926 g (range 771-4070). The primary outcome was success in obtaining urine. Secondary outcomes were complications and urine culture results. RESULTS: Some urine was obtained in 11 (64.7%) babies in the SPA group and in 13 (81.2%) babies in the catheter group. Sufficient urine for analysis (>0.5 ml) was obtained in 10 (58.8%) in the SPA group versus 5 (31.2%) babies in the catheter group. There were more contaminated specimens in the catheter group but this was not significant in this small study. CONCLUSIONS: In this small randomized controlled trial urethral catheterization offered no significant advantage over SPA.
http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum
Suprapubic bladder aspiration versus urethral catheterization in ill infants: success, efficiency and complication rates.Pollack CV Jr, Pollack ES, Andrew ME.
Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona.
STUDY OBJECTIVE: To compare success rates, complications, and efficiency of suprapubic bladder aspiration with urethral catheterization in ill infants. DESIGN: Prospective, randomized clinical study. SETTING: The pediatric emergency department at the University of Mississippi Medical Center in Jackson. PARTICIPANTS: Convenience sample of infants under 6 months of age requiring an uncontaminated urine specimen for the evaluation of febrile illness, suspected urinary tract infection, or sepsis. Infants with wet diapers were excluded. INTERVENTIONS: Patients were randomized to undergo timed suprapubic bladder aspiration (performed by a physician and a nurse) or urethral catheterization (performed by two nurses). If suprapubic bladder aspiration was unsuccessful, urethral catheterization was performed immediately and the bladder was drained; emptying volume was recorded. All patients had a next-void "bag" urinalysis performed for post-procedure hematuria. RESULTS: Fifty patients underwent primary suprapubic bladder aspiration. The success rate (defined by obtaining at least 2 mL of urine) was 46%. Mean +/- SD time per successful suprapubic bladder aspiration was 16.73 +/- 7.73 seconds. Fifty patients underwent primary urethral catheterization. The success rate was 100%; the mean time required was 80.70 +/- 46.52 seconds. After failed suprapubic bladder aspiration, urethral catheterization was 100% successful, with a mean draining volume of 2.95 +/- 2.38 mL. No immediate problems were identified among any instrumented patients; later complications (next-void hematuria after either procedure, other visceral injury with suprapubic bladder aspiration) were not detected. CONCLUSION: Both suprapubic bladder aspiration and urethral catheterization afford the emergency physician low-risk access to uncontaminated urine in ill infants. Suprapubic bladder aspiration is less efficient in that it requires physician participation and failure rates are higher. These data suggest that successful suprapubic bladder aspiration is primarily dependent on the volume of urine in the bladder; thus, in the ill or febrile ED infant who may be dehydrated, the likelihood of success decreases. The authors recommend that ED nursing and physician staff become comfortable with performing urethral catheterization on infants.
http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus
Не знаю, рутинно использовать SPA мне кажется чрезмерным. Даже в приемном покое госпиталя. Допустим поступил ребенок, провели SPA, исключили UTI, через 2 месяца опять поступает с подозрением, опять SPA? Так ведь заколоть можно.
Department of Neonatal Medicine. Royal Prince Alfred Hospital and University of Sydney, Camperdown, NSW, Australia.
OBJECTIVE: To test whether urethral catheterization (UC) is better than suprapubic bladder aspiration (SPA) as a method for collection of sterile urine in neonates. METHODS: Thirty-three babies, requiring sterile collection of urine, were randomly assigned to either urethral catheterization (n=16), median gestation 28+/-3.9 weeks, median birth weight 968 g (range 650-4100) or SPA (n=17), median gestation 26+/-5.6 weeks, median birth weight 926 g (range 771-4070). The primary outcome was success in obtaining urine. Secondary outcomes were complications and urine culture results. RESULTS: Some urine was obtained in 11 (64.7%) babies in the SPA group and in 13 (81.2%) babies in the catheter group. Sufficient urine for analysis (>0.5 ml) was obtained in 10 (58.8%) in the SPA group versus 5 (31.2%) babies in the catheter group. There were more contaminated specimens in the catheter group but this was not significant in this small study. CONCLUSIONS: In this small randomized controlled trial urethral catheterization offered no significant advantage over SPA.
http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum
Suprapubic bladder aspiration versus urethral catheterization in ill infants: success, efficiency and complication rates.Pollack CV Jr, Pollack ES, Andrew ME.
Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona.
STUDY OBJECTIVE: To compare success rates, complications, and efficiency of suprapubic bladder aspiration with urethral catheterization in ill infants. DESIGN: Prospective, randomized clinical study. SETTING: The pediatric emergency department at the University of Mississippi Medical Center in Jackson. PARTICIPANTS: Convenience sample of infants under 6 months of age requiring an uncontaminated urine specimen for the evaluation of febrile illness, suspected urinary tract infection, or sepsis. Infants with wet diapers were excluded. INTERVENTIONS: Patients were randomized to undergo timed suprapubic bladder aspiration (performed by a physician and a nurse) or urethral catheterization (performed by two nurses). If suprapubic bladder aspiration was unsuccessful, urethral catheterization was performed immediately and the bladder was drained; emptying volume was recorded. All patients had a next-void "bag" urinalysis performed for post-procedure hematuria. RESULTS: Fifty patients underwent primary suprapubic bladder aspiration. The success rate (defined by obtaining at least 2 mL of urine) was 46%. Mean +/- SD time per successful suprapubic bladder aspiration was 16.73 +/- 7.73 seconds. Fifty patients underwent primary urethral catheterization. The success rate was 100%; the mean time required was 80.70 +/- 46.52 seconds. After failed suprapubic bladder aspiration, urethral catheterization was 100% successful, with a mean draining volume of 2.95 +/- 2.38 mL. No immediate problems were identified among any instrumented patients; later complications (next-void hematuria after either procedure, other visceral injury with suprapubic bladder aspiration) were not detected. CONCLUSION: Both suprapubic bladder aspiration and urethral catheterization afford the emergency physician low-risk access to uncontaminated urine in ill infants. Suprapubic bladder aspiration is less efficient in that it requires physician participation and failure rates are higher. These data suggest that successful suprapubic bladder aspiration is primarily dependent on the volume of urine in the bladder; thus, in the ill or febrile ED infant who may be dehydrated, the likelihood of success decreases. The authors recommend that ED nursing and physician staff become comfortable with performing urethral catheterization on infants.
http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus
Не знаю, рутинно использовать SPA мне кажется чрезмерным. Даже в приемном покое госпиталя. Допустим поступил ребенок, провели SPA, исключили UTI, через 2 месяца опять поступает с подозрением, опять SPA? Так ведь заколоть можно.
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Igor Bulatov
- Сообщения: 1232
- Зарегистрирован: Сб апр 21, 2007 3:31 am
Pain in infants who are younger than 2 months during suprapubic aspiration and transurethral bladder catheterization: a randomized, controlled study.
http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus
http://www.ncbi.nlm.nih.gov/sites/entre ... stractPlus
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Igor Bulatov
- Сообщения: 1232
- Зарегистрирован: Сб апр 21, 2007 3:31 am
Ключевое слово в приведенном исследовании-резиденты.Как и в любой манипуляции,все зависит от того,кто ее делает.Катетеризация мочевого пузыря,даже в самых опытных руках,требует ассистента (для удержания ребенка) и занимает минимум 3-5 минут.SPA,с другой стороны,в достаточно опытных руках,не требует ассистента и занимает меньше минуты.Сам укол занимает десятую долю секунды плюс аспирация-около 30 секунд.Ультразвук-стандарт.Периферический венозный доступ (тоже необходимый для полноценного workup) на мой взгляд более болезненен.
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Igor Bulatov
- Сообщения: 1232
- Зарегистрирован: Сб апр 21, 2007 3:31 am
Так через 2 месяца ему уже на 2 месяца больше будетArtem_Co писал(а):
hДопустим поступил ребенок, провели SPA, исключили UTI, через 2 месяца опять поступает с подозрением, опять SPA?
. Может быть можно будет мочесборником обойтись ( у мальчиков проще ) или катетером ( у девочек проще ). Делай, что должен, и будь, что будет.