A review of techniques for difficult catheterisation and their costs

Abstract

Objective:

Awareness of departmental expenditure gives surgeons the ability to make cost-effective decisions. We reviewed the available techniques for difficult catheterisation and assessed the cost of each method.

Methods:

A literature search was undertaken using EMBASE and Medline databases. Seven techniques for difficult catheterisation were identified, and a cost analysis was performed. All items required for a technique were costed per unit, including VAT, and can be referenced to the NHS supply chain.

Results:

Techniques were divided into three broad categories: simple urethral techniques – increased lubrication with different catheter sizes (£5.05) or types (£8.83 Tiemann tip, £10.65 Coude tip); complex urethral techniques – blind hydrophilic guidewire (£27.31), S-dilators (£244.62) and flexible cystoscopy (£38.78); and percutaneous techniques – suprapubic catheterisation (£117.38).

Conclusion:

This paper demonstrates a progression in cost and specialist input required when moving from simple urethral techniques to complex and percutaneous techniques. It is clear that clinicians should consider these cost implications and exhaust all simple techniques before moving to the more complex options. We would advocate the use of a national evidence-based difficult catheter algorithm to guide management based on both effectiveness and cost.

Level of evidence:

Not applicable.