Why Your Vet Clinic Needs Ultrasound for Safer Cystocentesis

Ultrasound Makes Cystocentesis Less Stressful for All

In veterinary medicine, minor improvements in technique can make a big difference.

One of those game-changing tools is ultrasound, particularly when it comes to performing safer, more reliable cystocentesis.

Suppose your practice doesn’t already use ultrasound for this everyday procedure. In that case, you may be missing an opportunity to improve diagnostic quality, reduce stress (for everyone involved), and elevate the standard of care you offer.

Here’s why it’s worth investing in — and how it can transform how you approach even routine diagnostics.

Cystocentesis Without Guesswork

If you’ve ever performed a blind cystocentesis on an obese dog, a wiggly cat, or a patient with a tiny, poorly palpable bladder, you know how tricky it can get.

Even with years of experience and skilled hands, there’s a level of uncertainty — are you truly in the bladder? Is it full enough? Are you avoiding other organs?

Ultrasound eliminates the guesswork

With real-time imaging, you can see exactly where the bladder is and guide your needle precisely, even when the bladder is small, displaced, or hidden by fat or intestines.

This not only improves your confidence but also makes the procedure faster and less stressful for the patient.

Let’s look at an example…

Take Blaze, for instance—a senior cat with chronic kidney disease who presents for a urine culture. On palpation, her bladder feels small and challenging to locate. With ultrasound, you can quickly find the small dorsal bladder and collect a sample without repeated attempts — a win for you, your patient, and the client.

Why Safer Matters — Beyond the Obvious

Of course, accuracy is essential, but safety is equally critical. Blind cystocentesis carries risks that can be mitigated with ultrasound:

• Puncturing the intestines or uterus by mistake

• Traumatizing bladder tumors or inflamed tissue

• Causing unnecessary discomfort with multiple unsuccessful attempts

With ultrasound, you can avoid these pitfalls by choosing the safest access point and observing the bladder’s walls and contents before you proceed.

It also builds trust with clients. Being able to explain, “We used ultrasound to guide our sample collection and avoid complications,” reassures pet owners that you’re providing the best care possible.

Unexpected Perks for Your Practice

Adding ultrasound for cystocentesis also brings less obvious benefits:

• Team empowerment: Veterinary technicians can be trained to perform ultrasound-guided cystocentesis under supervision, freeing doctors for more complex tasks.

• Time savings: Fewer failed attempts mean shorter appointments and happier patients.

• Professional pride: Offering a more advanced and refined approach sets your clinic apart, signaling to clients that you prioritize precision and patient comfort.

Overcoming Barriers to Getting Started

You might wonder: Isn’t ultrasound overkill for something as simple as cystocentesis?

Not anymore.

Modern ultrasound units are more affordable, portable, and user-friendly than ever — and they’re designed with veterinary needs in mind.

Training doesn’t have to be a hurdle, either. Many manufacturers offer resources to help you and your team get comfortable with the technology quickly.

And once you’re familiar with it, you’ll find yourself reaching for ultrasound not just for cystocentesis but for countless other applications — from pregnancy checks to identifying abdominal masses.

Ready to Upgrade Your Standard of Care?

By incorporating ultrasound into cystocentesis, your team can make this routine procedure safer, more precise, and less stressful for everyone involved.

From improving sample quality to reducing complications, ultrasound guidance offers clear benefits that elevate patient care and strengthen client trust.

It’s a simple-but-powerful way to advance the quality of medicine you provide every day.

Explore the ultrasound systems we offer:

• Vetus E7 Ultrasound System

• Vetus 9 Veterinary Ultrasound System

• Vetus EQ Ultrasound System

• Basic Bladder Scanner by Mindray

Mastering Cystocentesis: Benefits of Ultrasound Guidance in Veterinary Medicine

Top Benefits of Ultrasound-Guided Cystocentesis

Cystocentesis is a cornerstone diagnostic procedure in veterinary medicine; however, even for experienced teams, it can present its challenges.

Fortunately, ultrasound guidance has revolutionized how we perform this critical task, making it safer, more accurate, and more efficient.

Let’s take a moment to explore the benefits of ultrasound-guided cystocentesis and discuss common challenges — as well as how to overcome them — so your team can master this procedure with confidence.

Why Upgrade to an Ultrasound-Guided Cystocentesis Method?

Traditionally, cystocentesis was done “blind,” using only palpation to locate the bladder. While this can work well in ideal patients — those who are lean, cooperative, and have a full bladder — not all patients fit that description.

Ultrasound-guided cystocentesis gives you:

• Precision: Visualize the bladder in real time and guide your needle directly into it, reducing the risk of accidental injury.

• Cleaner samples: Essential for urine cultures, especially when diagnosing infections or bladder disease.

• Improved safety: Paramount in patients with small bladders, obesity, or abdominal masses, where blind cystocentesis risks puncturing other organs.

• Confidence under challenging cases: For example, in a tense cat with hematuria, ultrasound helps you find and access even a small, hard-to-palpate bladder.

Let’s say Johnny, a middle-aged male cat, presents with straining and blood in his urine. On palpation, his bladder feels small and difficult to isolate. With ultrasound, you can see the partially contracted bladder nestled beneath intestinal loops, allowing you to confidently and safely obtain a diagnostic sample on the first attempt.

Tips and Best Practices for Success

Choose the proper probe:
A microconvex or linear transducer is ideal for small animal abdominal imaging because it offers good resolution and fits easily against the body wall.

Positioning matters:
Most patients do well in dorsal or lateral recumbency. Ensure the patient is calm — sometimes gentle sedation or a quiet room can make all the difference.

Scan before you poke:
Before inserting the needle, take a moment to thoroughly scan the bladder. Identify its borders, note any stones, masses, or unusual anatomy, and plan your needle path.

Use the in-plane approach:
Whenever possible, guide your needle within the ultrasound beam so you can watch its entire length — and the tip — enter the bladder.

Have an assistant help:
A trained veterinary technician can hold the probe steady while you guide the needle, keeping your hands free and maintaining a clear image.

Common Challenges and How to Overcome Them

Even with Ultrasound, you may encounter some hurdles. Let’s talk it through…

1. The bladder is too small: Some patients present after voiding or have a chronically small bladder (e.g., due to polyuria).
   Solution: If the sample isn’t urgent, wait and give the patient access to water. You can also use a fluid bolus and monitor until the bladder refills enough to access safely.

2. Obese or tense patients: In these patients, the bladder can be obscured by fat or muscle tension.
   Solution: Position them carefully to minimize pressure on the abdomen and consider mild sedation to relax abdominal muscles.

3. Needle not visible: If you can’t see the needle on the ultrasound screen, it’s likely off-plane.
   Solution: Adjust your angle and make small movements while watching the screen until the needle comes into view

4. Patient movement: Sudden movements can make it hard to keep the bladder in view and the needle steady.
   Solution: Enlist a skilled technician to hold the patient securely and calmly. In some cases, light sedation may be appropriate.

A Team Effort — And a Growth Opportunity

Ultrasound-guided cystocentesis isn’t just a skill for veterinarians — it’s also an excellent way for veterinary technicians to grow professionally. With appropriate training, technicians can perform this procedure competently, freeing up doctors for more complex tasks and improving overall hospital efficiency.

Invest in the Right Tools

Of course, mastering ultrasound-guided cystocentesis starts with the right equipment. High-quality imaging, ergonomic probes, and user-friendly interfaces make it easy for your team to perform accurate, confident diagnostics every day.

With the right equipment, a little practice, and teamwork, this procedure can become second nature — and a true diagnostic advantage!

Links to the systems we offer:

https://newvetequipment.com/vetus-e7-ultrasound

https://newvetequipment.com/vetus-9-veterinary-ultrasound-system

https://newvetequipment.com/vetus-eq-ultrasound-system

https://newvetequipment.com/basic-bladder-scanner-by-mindray

Ultrasound-Guided Cystocentesis: Pros & Cons for Veterinary

A cystocentesis offers advantages over other urine collection methods

If you work in a small animal veterinary practice, there’s a good chance you’ve performed, assisted with, ordered, or overseen a cystocentesis in many of your patients.

A cystocentesis offers advantages over other urine collection methods in that it provides a sterile sample, as opposed to free catch or even catheter methods that may contain contamination with pathogens or cells from the skin or urethra.

But how does an ultrasound-guided cystocentesis compare to a blind cystocentesis obtained via palpation or anatomical landmarks?

Your preference may depend on your practice style, experience, and patient needs. But here are a few things to consider…

Which Patients Are Good Candidates for Ultrasound-Guided Cystocentesis?

Here are a few factors that may determine if an ultrasound-guided cystocentesis is a good option for any particular patient…

• Large or overweight patients. A blind (or non-ultrasound assisted) cystocentesis may be straightforward on cats, and even small dogs, who are not overweight. In these patients, it is often possible to palpate the urinary bladder and to easily reach the bladder with a standard-length needle. 

However, difficulties arise in patients who are overweight, which makes it more challenging to feel and reach the bladder. Additionally, an ultrasound can help guide your needle with large dogs.

• Patients with “hard to stick” bladders. Maybe your patient’s bladder is thickened due to chronic cystitis or another condition. Or, maybe the patient’s bladder is small. 

Either way, an ultrasound provides additional direction (and visualization) of partially-full or otherwise difficult-to-obtain-a-sample-from bladders.

• Patients whose bladders could use a visual evaluation. If you’re obtaining a cystocentesis because the patient has urinary symptoms, a quick scan can provide more information about any obvious lesions. 

Use this for your own peace of mind (i.e., there’s no bladder tumor present at the time of the cysto), or create a charge for urinary ultrasound evaluation packaged together with other diagnostics.

Which Patients Are NOT Good Candidates for Ultrasound-Guided Cystocentesis?

• Thin cats with big bladders. Depending on your practice style and preference, you may find it’s easier to do a blind cystocentesis on a cat with an easily palpable bladder, especially for routine health checks. 

Although it may still be worth doing an ultrasound if the cat presented for urinary symptoms, so you can look at the bladder.

• Patients with bladder masses or tumors. If a patient has transitional cell carcinoma, placing a needle into the bladder may “seed” tumor cells into the abdomen as the needle is withdrawn. 

So any time a mass is present or suspected, it’s good to be cautious and skip the cysto (with or without ultrasound).

• Fractious or wiggly patients. These patients may not be good candidates for either ultrasound-guided or blind cystocentesis, since it wouldn’t be good for them to move around while the needle is inserted.

However, sedation may make the procedure possible for these dogs and cats.

PROS of Ultrasound-Guided Cystocentesis Versus Blind Cystocentesis 

Advantages include…

• Quick and easy. If you’re new to ultrasound-guided cystocentesis, it may take some practice. But soon it becomes a habit and may even be faster than a blind cysto.

• Visualization of the bladder. You know exactly where the needle is heading, and therefore you have an improved likelihood of getting a sample from a small or partially-full bladder. 

Plus, you may want to do a quick bladder evaluation to look for things like uroliths, sludge, or bladder masses, as this could change your recommended course of treatment.

• Safety. Supporters of ultrasound-guided cystocentesis point out that if you can see where the needle is going, there’s less risk of accidental puncture of other organs or blood vessels. 

CONS of Ultrasound-Guided Cystocentesis Versus Blind Cystocentesis 

• Training and practice are needed. It may take a little time for your team to become comfortable with this new method. Fortunately, it’s simple and straightforward to learn.

• Creating a charge for the service. This isn’t necessarily a bad thing—after all, you should be paid for your time and expertise when you provide a service.

However, there are differing opinions from practice to practice as to when and how to charge.

• For example, will you charge for all ultrasound-guided cystocentesis?

• Or only charge as part of a package with other diagnostics (urine analysis, urine culture and sensitivity, and quick ultrasound evaluation of the bladder, for example) in patients who are symptomatic?

• And how much will you charge?

• Small risk of side effects. The most common side effect is hematuria, which is mild and transient. Other risks do exist, such as bladder rupture or injury, organ or blood vessel puncture, urine leakage into the abdomen, the spread of bladder cancer, or vagal reactions (retching, panting, hypersalivation, collapse). 

While these effects are quite rare, it’s always worth considering the risks of any procedure before performing it, especially in patients who may be at higher risk due to underlying health conditions.

Investing in Ultrasound Training

In addition to teaching your team members to do an ultrasound-guided cystocentesis, it’s worth considering training in ultrasound examinations for you or one of your DVM associates.

There are plenty of other uses, including but not limited to abdominal evaluation for organs, masses, ascites, or even pregnancy, and cardiac or pericardial evaluations.

By maximizing your ultrasound usage, you can offer more diagnostics to your patients, while also getting the best ROI on your equipment investment—a win-win.

Disclaimer: This article is for general informational purposes only, and not intended as a guide to the medical treatment of any specific animal.

Written by: Dr. Tammy Powell, DVM