Here’s the typical case:
“Doctor, I’ve had a suprapubic in for some time and have been having it changed at home. I usually have a size 16, but last time they put in a 14. Today, they couldn’t change it and it’s been out all day. Can you please put a new one in?”
The patient is on the ambulance trolley and they are waiting for you to put it in, so the ambulance can take the patient back.
You try a 16, no go, a 14, no way, hey, a 12 won’t even go in.
What do you do now?
Well, it seems the Seldinger technique is to procedures what magnesium is to medicine. It can be used for everything.
Here is the solution:
You need to use a special guidewire for this purpose. ALWAYS put the soft tip of the guidewire in first. If it doesn’t go in, then stop, this patient needs to go to urology.
If you can pass the guidewire through then you can start. Then you need to put a 14G cannula through the tip of the catheter and feed the guidewire through it. This is the only way to get the wire up the middle of the catheter.
Then it’s simply a case of carefully pushing the catheter in, knowing that the guidewire will guide you into the bladder and using the catheter itself to dilate. Don’t push too hard.
The video of this procedure is in full on www.resustv.com.
