Procedure: Male Seldinger catheter
The Procedure
Hello again from the Emergency Procedures team. Next up…
Difficult male catheters
We recommend a Seldinger technique
Detailed written instructions and explanation are available in our Free App (iOS and Android). This video is hot off the press and we want your help improving it. Drop us a line with any suggestions
So, without further ado…here is the video
The rationale…
How useful is this?
Very useful, if you can get hold of the right wire.
This should probably be the standard method of insertion in ED after a failed attempt.
The most recent study showed over 90 percent success after an initial failed attempt. Most clinicians were junior doctors with little experience. Additionally, no false passages were created. All failed attempts result in the soft wire curling back out of the urethral meatus.
How does this compare to using an introducer or a coudé tip catheter?
Introducers have higher rates of urethral injury, false passage and failure and are reserved for urologists.
Coudé tip catheters are sometimes used in ED, but they also have higher potential for complications.
After a failed attempt we recommend using a guidewire, and if this fails contacting urology for support
What type of wire do I need to order for my department?
A Straight hydrophobic guidewire such as:
- HiWire (Cook Medical)
- Radifocus (Terumo)
- ZIPwire (Boston Scientific)
I’ve spotted an improvement that could be made to your video and guide?
Don’t be shy, let us know! Drop us a line
The App
References
- Cadogan M. Seldinger Technique. LITFL
- Cadogan M. coudé or Coudé…that is the question. LITFL
Emergency Procedures
Dr John Mackenzie MBChB FACEM Dip MSM. Staff Specialist Emergency Prince of Wales Hospital; Consultant Hyperbaric Therapy POW HBU. Lead author of Emergency Procedures App | Twitter | | YouTube |
Urological surgeon. Royal Perth Hospital, Perth, Western Australia
3 Comments
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Hello,
Great tip, thank you for the post/vid !
Just a little question : why do you need to puncture the IDC ? Can’t you pass the IDC directly into the wire ?
Thank you in advance.
Nicolas
Standard IDCs do not have a hole at the tip to pass a wire. Council tip catheters have a hole at the tip that would not require puncturing the tip. An alternative method is to cut the tip of the standard IDC with scissors. I would also add that if you puncture or cut the tip you should test the balloon before insertion (outside the body) as sometimes these can be compromised.
Good to know other trade names, I knew only “Glide wire.”
I’ve had success following failed attempts using the syringe technique https://bjui-journals.onlinelibrary.wiley.com/doi/10.1046/j.1464-410x.1998.00901.x which is another very safe alternative; minor disadvantage is that its easiest with a 2nd set of hands.
The other common mistake juniors make is position. Big patient, soft bed, consider something under the buttocks as one might for a difficult female IDC or VE. Most importantly, pj’s or strides get removed, not just pulled down to the knee which stops one from lowering the effluent end of the catheter when the prostate is reached…….