• 
  

  • Diagnostic evaluation of urine in an infant.

Absolute

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  • Neutropenia.

  
  

  • Thrombocytopenia and bleeding disorders.

  
  

  • Cellulitis and infection at puncture site.

  
  

  • Age greater than 2 years.

Relative

• 
  

  • Urogenital anomalies.

  
  

  • Recent urologic or lower abdominal surgery.

• 
  

  • 22-gauge, 2–3-cm needle.

  
  

  • 3-mL or 5-mL syringe.

  
  

  • Sterile collection cup.

  
  

  • 10% povidone-iodine (or equivalent).

  
  

  • Sterile gloves, drapes, gauze.

  
  

  • Topical anesthetic or buffered 1% lidocaine solution, or both.

• 
  

  • Infection (rare).

  
  

  • Intestinal perforation (very rare).

  
  

  • Failure to obtain urine (success rates vary widely but less successful than catheterization).

  
  

  • Psychological stress (common, as child is restrained for procedure).

  
  

  • Pain (certain; can be limited somewhat with anesthesia).

  
  

  • Hematuria.

  
  
  
  
  • 
    

    • Microscopic is very common.

    
    

    • Macroscopic is uncommon.

• 
  

  • Appropriate patient restraint is critical to the success of the procedure.

  
  

  • More than 2 or 3 attempts do not add to success rates.

  
  

  • Ultrasonography has been reported to increase success rates in some studies.

  
  

  • Because spontaneous voiding may occur during skin preparation or as the procedure is initiated, have a sterile container available to collect the urine.