CYSTOCENTESIS

Siew Zen Yii B04168003

Lee Kae Chyi B04168006
Zharief A B04168011
Vanitha B B04168012
Michele E.R B04168013
Mhaturi B04168016
 Cystocentesis
• A veterinary procedure where a needle is placed into the urinary
bladder of an animal and a sample of urine is removed
• Diagnostic cystocentesis: used to prevent the sample taken
for urinalysis from being contaminated with bacteria, cells and debris
from the lower urogenital tract
• Therapeutic cystocentesis: to relieve pressure buildup due to urethral
obstruction
• Therapeutic cystocentesis is typically last resort ➡️ greatly distended
bladder more likely to rupture when punctured.
 Indication

A cystocentesis is performed to obtain a rapid

and sterile urine sample for urinalysis and
bacterial culture in cats with the following
conditions:
 Cystitis
 Urinary tract infections
 Bladder infection
 Urinary obstruction (to relieve bladder
distension)
Moe..
Name: Ginger
Age: 1
Species: Domestic
Weight: 3.8 kg
Gender: Male
Sterilization: Not Sterilized
Temperament: Good

Present Status
Temperature: 39.3 ºC
Heart rate: 232/min
Respiratory Rate: 56/min
Advantages & Disadvantages
Advantages
• urine is not contaminated
by miscellaneous debris
from the lower urinary Disadvantages
passage • more invasive method
• Risk of urinary tear
• May have blood
contamination
• Must have sufficient amount
of urine in bladder
 Pre-Operative
Preparation
Operator Surgical Sterilization Pack (30 minutes at 60ºC)
• Surgical gown • Gloves
• Towels • Hair Cap
• Brush • Face mask

Surgical Tools Sterilization Pack (15 minutes at 121ºC or 100ºC for

60 minutes)
• Wrap, instrument box, lister bandage scissor (1), needle
holder(1), curved rat tooth hemostat tissue forcep (1), curved
hemostat tissue forceps (2), straight rat tooth hemostat tissue
forceps (2), straight hemostat tissue forceps (4), curved
blunt/blunt mayo scissor (1), curved sharp/blunt mayo scissor
(1), curved sharp/sharp mayo scissor (1), straight blunt/blunt
mayo scissor (1), straight sharp/blunt mayo scissor (1), straight
sharp/sharp mayo scissor (1), rat tooth thumb tissue forcep (1),
dressing thumb tissue forcep (1), scalpel handle, towel clamps
(4).
 Pre-Operative
Preparation II
Operator and Ass. Operator Preparation
• Operator and ass. operator sterile condition.
• Hands are washed.
• Hair cap and mask are worn.
• Hands up to elbow are washed and scrubbed
using a pair of brush for each hand.
• Drying with a pair of sterilized towels each
side for one arm.
• Sterilized surgical gown was worn.
• Sterilized gloves are worn and hands are
lifted upwards to prevent contaminations
 Pre-Operative Preparation III
Patient Preparation
• Patient showered 1 day before operation.
• Complete physical examination done 1 day before operation
and 1 hour before operation
• Patient fasted for 10 hours prior to operation.
• Premedication of Atropine Sulphate (SC),
• A mix of sedative and anesthesia (Xylazine and Ketamine)
administered 10 minutes after premedication.
• The surgical site was shaved, cleaned and sterilized using a
hair clipper, razor blade, soap, alcohol and
betadine/povidone iodine.
• The cat is ready for operation
 Pre-Operative Preparation V

Induction of Restrained and ready

Shaving and cleaning of surgical site
anesthesia to be operated
 Anesthesia
Premedication: Atropine sulfate
Route: Subcutaneous
Dosage: 0.025mg/kg
Concentration: 0.25mg/ml
Body Weight: 3.8 kg

Volume: 3.8 𝑘𝑔 × 0.025 𝑚𝑔/𝑘𝑔

= 0.38 ml
𝒎𝒈 0.25𝑚𝑔/𝑚𝑙
𝒃𝒐𝒅𝒚 𝒘𝒆𝒊𝒈𝒉𝒕 𝒌𝒈 𝒙 𝒅𝒐𝒔𝒂𝒈𝒆 ( )
𝒌𝒈
𝒎𝒈
𝒄𝒐𝒏𝒄𝒆𝒏𝒕𝒓𝒂𝒕𝒊𝒐𝒏 ( )
𝒎𝒍
Anesthesia II
Induction: Xylazine + Ketamine
Route: Intramuscular
Dosage: Xylazine: 2 mg/kg
Ketamine: 10 mg/ kg
Concentration: Xylazine: 20 mg/ml
Ketamine: 100 mg/ml
Body Weight: 3.8 kg
Volume: Xylazine: 3.8𝑘𝑔 𝑥 2𝑚𝑔/𝑘𝑔 = 0.38 ml
20𝑚𝑔/𝑚𝑙

𝒎𝒈 3.8𝑘𝑔 𝑥 10𝑚𝑔/𝑘𝑔
𝒃𝒐𝒅𝒚 𝒘𝒆𝒊𝒈𝒉𝒕 𝒌𝒈 𝒙 𝒅𝒐𝒔𝒂𝒈𝒆 (
𝒌𝒈
) Ketamine: 100𝑚𝑔/𝑚𝑙 = 0.38 ml
𝒎𝒈
𝒄𝒐𝒏𝒄𝒆𝒏𝒕𝒓𝒂𝒕𝒊𝒐𝒏 ( ) Xylazine + ketamine = 0.76ml
𝒎𝒍
 Anesthesia III
Maintenance Anesthesia: Ketamine (2x)
Lidocaine (2x)
Route: Ketamine: Intramuscular
Lidocaine: Topical
Dosage: Ketamine: 10 mg/kg
Since ½ of dosage = 5 mg / kg
Concentration: Ketamine:100 mg/ml
Lidocaine: 20 mg/ml
Body Weight: 3.8 kg

Volume: 3.8𝑘𝑔 𝑥 5𝑚𝑔/𝑘𝑔

Ketamine: 100𝑚𝑔/𝑚𝑙 = 0.19 ml
𝒎𝒈
𝒃𝒐𝒅𝒚 𝒘𝒆𝒊𝒈𝒉𝒕 𝒌𝒈 𝒙 𝒅𝒐𝒔𝒂𝒈𝒆 ( )
𝒌𝒈
𝒎𝒈
𝒄𝒐𝒏𝒄𝒆𝒏𝒕𝒓𝒂𝒕𝒊𝒐𝒏 ( )
𝒎𝒍
 OPERATION PROCEDURE
1.
• Skin was incised using scalpel
blade.
• 3 cm caudal to umbilical, 4cm
long.

2.
• Stay suture was used to fixate the
skin for retraction to minimized
trauma, using silk suture.

3.
• Linea alba was incised by scalpel,
then further cut open using
sharp/blunt scissors.
 4.
• Stay suture was used to fixate the
muscle for retraction to minimized
trauma, using silk suture

5.
• One finger was inserted into the
abdominal cavity to isolate the
urinary bladder

6.
• Urinary bladder was isolated
using square dressing gauze (wet
with NaCl 0.9%).
• VU was inverted 180 degree to
expose the dorsal side of VU.
7.
• Sterile syringe+needle was used to
puncture and aspirate the urine.
• A hemostat was used to hold and
stabilize the needle.
8.
• 0.2ml of antibiotic was given into the VU.
• Needle was then pulled out, a round tampoon
was used to apply pressure.
• Penicillin was given to the punctured site.

9.
• VU was returned back to its original
position.
• Urine was yellow, clear, volume= 3
ml.
 10.
• Penicillin was given before closure.
• Linea alba was sutured (3-0 chromic
cat gut, simple interrupted)

11.
• Penicillin was given to muscle layer.
• Skin was sutured (silk, simple
interrupted)

12.
• Perubalsem was
given
• Gurita and e-
collar were put
on.
 Monitoring

Respiratory Rate
60

Respiratory Rate (x/min) 56 56 56

45 52 52 52

30 36

15 24

0
0: 15 0:30 0:45 1:00 1:15 1:30 1:45 2:00
Time in hours and minutes (hr:min)
 Monitoring

Heart Rate
225
Heart Rate (x/min)
180
180 180 180
135160 160
120 130
90
100
45

0
0:15 0:30 0:45 1:00 1:15 1:30 1:45 2:00
Time in hours and minutes (hr:min)
 Monitoring

Temperature (ºC)
40

38.75 40
39
Temperature (ºC)
39 39
37.5 38
38
36.25
37
35
35
33.75

32.5
0:15 0:30 0:45 1:00 1:15 1:30 1:45 2:00
Time in hours and minutes (hr:min)
 Post operation
• Ginger was monitored for 5 days, these are:
1. Breathing rate
2. Heart rate
3. Temperature

• The monitoring that has been done in 3 different

timings:
1. Morning 7am
2. Noon 12pm
3. Evening at 5pm.
 Post operative PE result
450

400
248

350 212
200

152 148 168

300 168
160
176
160
192
250 140

128
200

84
120 120
150 108
100 104 104
92 92
72 72
100 64
48 48
28
50
34 35.2 39.9 38.2 39 38 37.6 38 38 37.6 37.7 38.8 38.8 38.8

0
D1 D1 D2 D2 D2 evening D3 D3 D3 evening D4 D4 D4 evening D5 D5 D5 evening
afternoon evening morning afternoon morning afternoon morning afternoon morning afternoon
Temperature °C Respiration Rate, rpm Heart rate, bpm
 Post operation
• Throughout post – operation
1. Normal excretion
2. Slightly dry defecation for the first few days, score 3
3. Normal eating
4. Normal drinking
5. Diarrhea started 3 days after surgery
 Post operation Therapy

1. Amoxicillin: 3.8 ml x2/day (morning & evening)

2. Bandage and Gurita change x1/day
3. Loperamide: 1.5 ml on 3rd Day x2/day
4. Bioplacenton applied on wound
5. Vitamin A
THANK YOU