Glidewire-assisted Foley catheter placement: a simple and safe technique for difficult male catheterization

Difficulty in Foley catheter placement is a frequently encountered problem.We describe a simple and safe technique for this condition.Rather than using force, which may lead to the formation of a false passage, one should place a glidewire into the bladder through the area of resistance, followed by the placement of a Foley catheter over the glidewire.This is a very easy procedure and can be taught to nurses and nurse practitioners to avoid an unnecessary call for a urologist in the emergency department. RésuméIl arrive fréquemment que des difficultés surviennent durant l'installation d'une sonde de Foley.Nous décrivons ici une technique simple et sûre pour remédier à la situation.Plutôt que d'utiliser la force, qui peut entraîner la formation d'un faux passage, nous conseillons d'insérer un fil-guide dans la vessie par la zone de résistance suivi de l'installation de la sonde de Foley par-dessus le fil-guide.Cette intervention est très facile à réaliser et peut être enseignée aux infirmières et aux infirmières praticiennes en cas de difficulté lors de l'insertion de la sonde et ainsi éviter de devoir faire venir un urologue à la salle d'urgence.We describe a simple and safe technique that we have taught to several nurse practitioners, urology nurses and non-urology specialized physicians to successfully place Foley catheters in difficult cases.This technique can help avoid unnecessary emergency department visits for urologists.This technique has been used in more than 150 cases of difficult catheterization without any complications. TechniqueWhen encountering difficulty in placing a Foley catheter in a male patient, one should ensure that the urethra is lubricated adequately.This can be better achieved by instilling lubricants into the urethra rather than solely dipping the tip of the catheter in the lubricant.If the patient experiences substantial pain during a Foley catheter placement, the intraurethral instillation of topical anesthetics (2% xylocaine jelly) is also helpful.This alleviates pain and decreases sphincter contraction that creates resistance to the catheter placement.If, after these manoeuvres, one cannot place the Foley catheter, then a glidewire-assisted technique should be used rather than forcefully pushing the Foley catheter.Examples of such a glidewire are the angled tip, 0.038 inches, 150 cm, No. 630-103 wire (Boston Scientific Inc.) or the straight tip, 0.038 inches, 150 cm, No. HW-038150 Hi-wire (Cook Medical Inc.).Glidewires and Hi-wires are hydrophilic coated smooth surface wires that have very soft ends, which makes it safe to pass through a strictured or distorted urethra with minimal risk of injury.When a hydrophilic glidewire comes in contact with water it becomes slippery and the Foley catheter can easily be slid around it because of its smooth and wet surface.The glidewire comes in different sizes and lengths.We commonly use a 0.038-inch glidewire with 150 cm length for this technique.After moisturizing the glidewire with sterile water by injecting water into the plastic sheath that contains the glidewire and then using a wet sponge to keep the glidewire moist during use, the soft floppy end of the glidewire or Hi-wire (not the stiff end of the wire) should be placed into Can

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