A Revised Guide-Wire Technique for Urethral Catheter Insertion

BACKGROUND

A common call to an SHO/registrar covering urology is the inability to pass a urethral catheter, either to relieve urinary obstruction, or occasionally for intensive care monitoring of urine output. Often, several attempts have been made and additional techniques may be required. Flexible cystoscopy with insertion of a guide wire and rail-roading of a catheter over the guide wire is an easy and effective technique that is often employed to overcome this problem.^1,2

TECHNIQUE

In order for the urethral catheter to be rail-roaded, the end of the catheter has to be cut to allow the guide wire to pass through. This needs to be done in such a way as to prevent any disruption to the balloon mechanism. It has been our experience that operators cut the end of the catheter transversely. This results in a sharp edge, which produces difficulty when trying to advance the catheter and causes additional trauma. If the tip of the catheter is cut longitudinally (Fig. 1), the guide wire can be passed through the catheter and the natural manufactured shape of the catheter with a smooth edge is maintained (Fig. 2), thereby allowing easy atraumatic advancement.

Figure 1.

Photograph showing the urinary catheter being cut longitudinally which is correct.

Figure 2.

Photograph demonstrating the smooth shape of the catheter tip with a guide-wire after a longitudinal incision.

DISCUSSION

It is important to document in the notes that the end of the catheter is cut so that when the catheter needs replacement, a guide wire can simply be inserted before removing the catheter thereby allowing a new catheter to be rail-roaded over the guide wire again. If this is managed correctly, repeated flexible cystoscopy should not be required to re-introduce a guide wire every time the catheter needs to be changed.