Background

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.

Methods

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].

Figure 1

Figure 1: Suprapubic Foleys catheter introducing set' (Mediplus Ltd, High Wycombe, UK)

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].

Figure 2

Figure 2: The 0.035 inch floppy-tip guidewire being passed through a 18 gauge needle into the Bladder.

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].

Figure 3

Figure 3: Dilatation of the Suprapubic established tract over the 0.035 inch floppy-tip using the Seldinger technique.

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].

Figure 4

Table 1: Ratings by 6 observers of their assessment of the new device compared to standard trochar placement. The rating scale ranged from -100% to + 100%.

Conclusion

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.

Acknowledgment