Executive Summary
Reducing risk, reducing cost
Suprapubic catheterisation can now be undertaken using a new technique with a low risk of trauma and complications, and at a lower cost, with the availability of a new insertion kit that employs the Seldinger technique - a well-established procedure in clinical practice.
Our "How To, Why To Guide" provides a comprehensive introduction to the technology, with supporting clinical evidence, a business case, costing models and a road map for its implementation. Our How to Why To Guides are designed to save you time, improve performance and providing patients with a better experience.
We'll explain the benefits to adoption, and how they were overcome together with the benefits this technology can bring to your organisation from the lessons learnt at our three clinical implementation sites. The guide provides comprehensive, relevant information for clinicians, managers and other stakeholders on how to implement this technology. There's full information on procurement and key policy areas that this technology may impact on, a full business case, and costing model that can be tailored to your trust's requirements.
A new technique for safe introduction of Suprapubic Urinary Catheters
Suprapubic catheterisation (SPC) is a surgical procedure traditionally performed in the operating theatre and is routinely used in urology to decompress the bladder in patients who present as an emergency with bladder outlet obstruction (BOO) and where a urethral catheterisation is unsuccessful, or undesirable, because of an enlarged prostate or urethral stricture. It is also electively indicated in patients unable to tolerate a long-term urethral catheter due to bladder spasm/ discomfort/bypassing, and in patients with neurological diseases such as multiple sclerosis and spina bifida.
Although generally regarded as a safe procedure, initial insertion can carry a small but significant risk of bowel puncture, particularly in patients with a contracted bladder. Traditional methods are often daunting for both the surgeon and patient, due to the potential risks involved.
Mediplus Ltd and the BioMed Centre in Bristol have developed a new catheter insertion kit using the Seldinger technique - a well-established clinical procedure - to increase safety and reduce the number of insertions performed under general anaesthetic.
The Seldinger Suprapubic Catheter Kit consists of a long needle (16G), a guide wire, a trocar with an outer sheath and a choice of 14 or 16 French silicone catheters.
The anaesthetised tract is created in the normal way, but the needle is left in the patient. The guide wire is then inserted through the needle into the bladder. It will curl upon the posterior wall preventing the trocar from being pushed in too far. The needle can then be removed. The trocar is then inserted in a controlled manner, helping to reduce user anxiety and ensuring it enters the bladder.
Summary of clinical evidence
Suprapubic catheterisation has a number of advantages compared to urethral catheterisation. For example, the risk of urethral damage is eliminated, a suprapubic catheter is more patient-friendly, and bladder spasms occur less often because the suprapubic catheter does not irritate the outflow area of the bladder. What's more, suprapubic catheters are more sanitary because the catheter is away from the urethra/anal area, which can help reduce cases of urinary tract infections.
Traditional methods of suprapubic catheterisation are often daunting for both the surgeon and the patient. The new catheter insertion kit utilises the seldinger technique, already standard for vascular access and nephrostomy insertion, to safely place the catheter in the bladder.
For more detailed information about the clinical evidence - Click here
Key benefits of the technology
The Seldinger Suprapubic Catheter Kit offers a number of benefits for both clinical staff and patients:
- Greater control and accuracy. A high degree of control allows accurate placement.
- Reduced risk. Low risk of trauma and tissue damage for the patient. The catheter rarely needs to be inserted under general anaesthetic - reducing the associated risks in an elderly at risk group of patients.
- Greater confidence. The bladder may be located with an 18G hypodermic needle, giving more confidence in inserting the trocar into the bladder, as the track has already been secured by the guide wire.
- Improved insertion and removal. The safety guide wire improves insertion and removal, guaranteeing insertion of the trocar along the anaesthetised track.
- Reduces costs and hospital stay. The procedure rarely needs to be undertaken as an inpatient, under general anaesthetic or in an operating theatre - reducing hospital stay, as well as reducing overall costs.
- Frees up consultants time and enhances out of hours services. Enables non-consultant grade clinical staff and suitably trained nurse practitioners to perform the procedure after training, thereby freeing up consultant time and allowing suitably trained staff to safely insert catheters during out of hours.
Click here to view a summary of the Benefits 'v' the Barriers.
Impact on Key Policy Areas
Implementation of the Seldinger Suprapubic Catheter Kit will have a positive impact on the key policy areas such as patient safety, access, out of hours care, length of hospital stay and resource management.
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