Background
Small infant feeding tubes (5Fr and 6Fr) are commonly used in many institutions for catheterisation of neonates and infants. This is most likely because feeding tubes are cheaper, more flexible and more readily available than infant urinary catheters.1 Spontaneous intravesicular knotting of a feeding tube used for urethral catheterisation is a rare but documented complication.2 Removal of these intravesicular knots has been attempted in a number of ways such as use of a guidewire to untangle the knot, use of excess lubrication and traction with or without anaesthetic, and open or endoscopic removal via cystostomy. This method of removal using a cystoscope has not been described previously.
Technique
Our technique uses a well lubricated 7Fr cystoscope inserted urethrally alongside the feeding tube. Introduction of the cystoscope into the knot is possible as the knot is usually stuck at the bladder neck or posterior urethra. The knot is then further tightened by pulling on the distal end of the catheter. It is subsequently possible to remove the catheter on withdrawal of the cystoscope (Fig 1).
Figure 1.
Cystoscope in knot of catheter
Discussion
If standard methods of removal such as gentle traction or use of a guidewire are not successful in cases of a knotted catheter, this is a simple technique that can be employed. This method might avoid the use of more invasive procedures such as cystostomy.
References
- 1.Arena B, McGillivray D, Dougherty G. Urethral catheter knotting: be aware and minimize the risk. CJEM 2002; : 108–110. [DOI] [PubMed] [Google Scholar]
- 2.Foster H, Ritchey M, Bloom D. Adventitious knots in urethral catheters: report of 5 cases. J Urol 1992; : 1,496–1,498. [DOI] [PubMed] [Google Scholar]