Managing difficult catheterisation in nurse‐led catheterisation services: Does guidewire‐assisted urethral catheterisation make a difference?

The use of guidewires is well established in medical practice, but relatively new in nurse-led catheterisation services (NCS). We investigate the incidence of difficult urethral catheterisation and whether guidewire-assisted catheterisation reduces disrupted patient care. A retrospective Audit (September 2016-August 2017) recorded incidence and management of difficult catheterisation in two NCS. In NCS-A, nurses were familiar with improvised guidewire-assisted catheterisation, whereas in NCS-B nurses were not enabled and had to refer patients to urologists when they encountered problems. From September 2017 to August 2018, a National Institute for Health and Care Excellence (NICE)-approved urethral catheterisation device with integrated guidewire (Urethrotech UCD) was used in NCS-B for difficult urethral catheterisation. User and patient satisfaction was evaluated prospectively. Of 540 men attending NCS-A for trial without catheter (TWOC), 31% (169/540) were recatheterized, of whom 4%(6/169) required a guidewire-catheterisation technique to manage difficult catheterisation without problems. This was also done in 45 of 146 men attending for long-term catheter change with known history of difficult catheter change. Of 1002 men attending NCS-B for TWOC, 23% (226/1002) were recatheterized. This was difficult in 25% (57/226), of which 40% (23/57) suffered complications with bleeding from repeated catheterisation attempts and 10 men had to be admitted for specialist interventions to manage retention and catheterisation-associated urethral injury. During the prospective audit, 945 men attended the TWOC-clinic of NCS-B. In 11% (13/120), the UCD was used for failed Foley-catheterisation without complications. Patients and users were very satisfied because the difficult recatheterisation episode was managed successfully without patient harm and care delay. Difficult urethral catheterisation is a frequent occurrence in NCS with significant risk of urethral trauma. Catheterisation-associated urethral injury can be prevented with guidewire-assisted urethral catheterisation techniques. The NICE-approved UCD with integrated guidewire was easy to use with high user and patient satisfaction avoiding patient care delay and is supporting nurses to manage difficult urethral catheterisation safely making efficient use of specialist resources.