Procedure: Male Seldinger catheter

Procedure, instructions and discussion

Difficult male catheters

Using the Seldinger technique for failed male catheter insertion

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Instructions

Indications

• Failed male catheter insertion

Contraindications (ABSOLUTE/relative)

• Trauma with suspected urethral injury
• Recent urological surgery

Alternatives

• No catheter (measure urine, MSU collection, skin care)
• Suprapubic catheter

Informed consent

VERBAL – IF HAS CAPACITY

• Simple procedure with a low risk of complications

NOT REQUIRED – IF LACKS CAPACITY

• Emergency procedure to prevent pain and distress
• Brief verbal explanation of the procedure is still recommended.

Potential complications

• Pain
• Failure (including creation of a false passage)
• Allergy
• Urethral trauma and haemorrhage
• Paraphimosis
• Pressure injury around insertion site
• Urinary tract infection
• Urethral stricture

Infection control

• Standard precautions
• PPE: sterile gloves, apron, protective eyewear/shield

MAINTAINING AN ASEPTIC FIELD THROUGHOUT CATHETERISATION REQUIRES PRACTICE AND GOOD TECHNIQUE

Area

• Private bed space with good lighting

Staff

• Procedural clinician
• Assistant

Equipment

• A prepared department catheterisation trolley is preferred
• 14-18 G IV cannula
• Straight hydrophobic guidewire
• Example guidewires:
• HiWire (Cook Medical)
• Radifocus (Terumo)
• ZIPwire (Boston Scientific)

plus

STANDARD CATHETERIZASTION EQUIPMENT

• Absorbent towel under patient
• Sterile tray, gauze squares, cotton balls (cleaning tray)
• 0.9% sodium chloride (for cleaning)
• Forceps for application
• Extra sterile tray (drainage tray)
• Fenestrated drape
• Lubricant (lignocaine gel)
• 16-18G urethral catheters (non-latex)
• Luer lock syringe (10ml)
• Sterile water for injection
• Catheter drainage bag
• Catheter securing device

Positioning

• Supine

Medication

• 5ml of 2% lignocaine gel (lubricant)

Sequence (Seldinger Catheterisation)

• The guidewire is lubricated with 10 mL sterile water using a sterile syringe
• Gel is injected down the inner length of the IDC for lubrication
• A 14–18 G cannula is passed through the side port to puncture the tip of the IDC
• The needle is removed leaving the plastic cannula in the IDC
• The guidewire is inserted through the penile urethra into the bladder with 50% of the wire (75–100 cm) inserted
• The end of the guidewire is passed through the cannula
• The cannula is removed.
• The guidewire is passed down the main port and advanced down the length of the IDC
• The guidewire is held straight whilst advancing the IDC
• The guidewire is removed once the IDC is in position.
• The IDC is confirmed to be in the bladder by aspirating with a syringe until urine flows.

Post-procedure care

DOCUMENT PROCEDURE

• Completion
• Size of catheter
• Residual volumes
• Number of attempts
• Immediate complications
• Document management plan for catheter

Tips

• Wire placement is proven safe and highly unlikely to cause false passage
• Failure of wire placement will result of curling of the wire out of the urethral meatus

Discussion

We recommend Seldinger catheterisation as the next step for any difficult male catheterization in the emergency department. The evidence shows Seldinger technique is has greater than 90% success at overcoming difficult IDC in the emergency department and that the skill is easily mastered by junior clinicians with little experience.

The hydrophilic guidewire has not been shown to cause damage to the urethra. In unsuccessful attempts to pass the wire into the bladder the guidewire invariably curls back to the external urethral meatus and has not been shows to create a false passage.

This is true even in cases where urethral injury and possible false passage formation are suspected by blood in the urethral meatus after initial catheterisation attempt. Additionally, blood in the meatus has not been shown to be predictive of failure of the Seldinger technique and is not a contraindication.

We recommend early use the Seldinger technique rather than attempting to force urinary catheters, which can have a high risk of urethral injury and false passage formation. Alternative options such as Coude tip catheters or introducers both carry risk of urethral trauma and false passage creation and are not recommended for inexperienced clinicians.

References

• Cadogan M. Seldinger Technique. LITFL
• Cadogan M. coudé or Coudé…that is the question. LITFL
• Yuminaga Y, Kam J, Louie-Johnsun M. Multi-centre, prospective evaluation of the Seldinger technique for difficult male urethral catheter insertions by non-urology trained doctors. BJU Int. 2017 Nov;120 Suppl 3:21-27
• NSW Ministry of Health. Adult urethral catheterisation for acute care settings. Sydney: NSW Health; 2015. GL2015_16. Available from: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2015_016.pdf
• NSW Agency for Clinical Innovation. Male indwelling urinary catheterisation (IUC) – adult. Sydney: ACI; 2014. Available from: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0020/256133/ACI_Male_IUCv3.pdf
• Catheterisation: indwelling catheters in adults – urethral and suprapubic. 2012. Arnhem: European Association of Urology Nurses; 2012. Available from: https://nurses.uroweb.org/guideline/catheterisation-indwelling-catheters-in-adults-urethral-and-suprapubic/
• Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges’ clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.
• Schaeffer AJ. Placement and management of urinary bladder catheters in adults. In: UpToDate. Waltham (MA): UpToDate. 2019 July 2. Available from: https://www.uptodate.com/contents/placement-and-management-of-urinary-bladder-catheters-in-adults
• Sliwinski A, D’Arcy FT, Sultana R, Lawrentschuk N. Acute urinary retention and the difficult catheterization: current emergency management. Eur J Emerg Med. 2016 Apr;23(2):80-8.

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