A clever technique for placement of a urinary catheter over a wire

Abstract

Objective: The objective was to present a straightforward, step-by-step reproducible technique for placement of a guide-wire into any type of urethral catheter, thereby offering a means of access similar to that of a council-tip in a situation that may require a different type of catheter guided over a wire.

Materials and methods: Using a shielded intravenous catheter inserted into the eyelet of a urinary catheter and through the distal tip, a "counsel-tip" can be created in any size or type of catheter. Once transurethral bladder access has been achieved with a hydrophilic guide-wire, this technique will allow unrestricted use of catheters placed over a wire facilitating guided catheterization.

Results: Urethral catheters of different types and sizes are easily advanced into the bladder with wire-guidance; catheterization is improved in the setting of difficult urethral catheterization (DUC). Cost analysis demonstrates benefit overuse of traditional council-tip catheter.

Conclusion: Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system.

Keywords: Prostatic hyperplasia; urethral obstruction; urethral stricture; urinary bladder neck obstruction; urinary catheter; urinary retention.

Figure 1

Material list

Figure 2

(a) This technique may be performed with any style catheter and an 18 (or larger) gauge angiocath, (b) pass the angiocath through the lateral eyelet of the catheter, (c) advance the angiocath through the center tip of the catheter, (d) ensure the angiocath shaft as well as the needle pass through the tip of the catheter, (e) use the push-button needle shield to retract the needle leaving the angiocath in place, (f) after achieving distal glidewire placement into the bladder, advance the proximal end of the glidewire through the tip of the angiocath

Figure 3

(g) Pass the glidewire through the full extent of the angiocath, (h) remove the angiocath, (i) maintain the position of the glidewire through the tip of the catheter and out of the lateral eyelet, (j) slowly withdraw the glidewire until it enters back into the lateral eyelet of the catheter, (k) maintaining the glidewire's position within the central tip of the catheter, redirect it to advance through the catheter lumen, (l) with the catheter successfully positioned over the glidewire, guide the catheter into the bladder over the glidewire