N Vasdev, N Kachroo, S Mathur, R Pickard
novel technique, prevention of bladder injury, seldinger technique, suprapubic catheterisation
N Vasdev, N Kachroo, S Mathur, R Pickard. Suprapubic bladder catheterisation using the Seldinger technique. The Internet Journal of Urology. 2006 Volume 5 Number 1.
Suprapubic catheterisation is normally performed blindly or ultrasound guided. We present an evaluation of a new Seldinger technique for suprapubic catheterisation in our department describing the technique and post procedure results.
6 patients had suprapubic catheters introduced via the Seldinger technique using suprapubic Foley catheter introduction set, Mediplus Ltd, High Wycombe, UK. All clinicians completed a questioner at the end of the procedure rating their confidence in the new device compared to the standard technique across 5 domains using a simple scale.
Overall users of the device expressed greater confidence in application, patient comfort and safety of the new device compared to standard trochar placement. Given the current drive to minimise risk these devices appear to represent a significant advance over standard methods and merit consideration for routine use.
Suprapubic catherisation is currently performed using blind or ultrasound-guided percutaneous trochar puncture. Although usually straightforward it can be associated with bowel injury which may be fatal1,2. The safer Seldinger technique is now standard for vascular access and nephrostomy insertion and we now report its application to suprapubic catheterisation.
We evaluated patient safety and the clinician's perception of a new Seldinger technique for Suprapubic catheterisation using the ‘Suprapubic Foleys catheter introducing set' (Mediplus Ltd, High Wycombe, UK) [Figure 1].
We asked 6 members of the urology staff (SpR's and Consultants) to use it when they next needed to catheterise a patient suprapubically. All patients were consented prior to the procedure. Catheter placement was accomplished by puncture of the full bladder under local anaesthetic using a 18 gauge needle confirmed by aspiration, passage of a floppy-tip 0.035 inch guidewire through the needle [Figure 2].
A dilatation of the track over the guidewire was performed followed by removal of the needle and passage of a 14 Fr Foley catheter (Standard length of 43cm) through the peel-away sheath which is part of the dilator assembly [Figure 3].
At each use the clinician was asked to complete a short questionnaire rating their confidence in the new device compared to the standard technique across 5 domains using a simple scale [Table 1].
Overall users of the device expressed greater confidence in application, patient comfort and safety of the new device compared to standard trochar placement. This is in agreement with previous assessment of a similar device which, to our knowledge, has not been marketed in the UK3. Given the current drive to minimise risk these devices appear to represent a significant advance over standard methods and merit consideration for routine use.
Mr Jack Chalker and Mr James Urie, Mediplus Ltd for kindly providing permission to reproduce and publish figures 1,2 and 3.