Trends in Urinary Catheter Use by Indication in US Emergency Departments, 2002-2019.

This retrospective study examines trends in urinary catheter use in US emergency departments between 2002 and 2019.

Role of noble metal-coated catheters for short-term urinary catheterization of adults: a meta-analysis.

OBJECTIVE: To evaluate the efficacy of noble-metal coated catheters in reducing catheter-associated urinary tract infections (CAUTI) in adult patients requiring short term catheterization. METHODS: An electronic literature search of PubMed, BioMed Central, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar was carried out from inception to 10th October 2019. Any prospective study or randomized controlled trial (RCT) on adult patients comparing noble-metal coated urinary catheters with any standard catheter and evaluating the incidence of CAUTI or bacteriuria was included. RESULTS: A total of 13 studies were included in the systematic review. 12 were RCTs and one was a prospective cross-over trial. Catheters employed in the study group were grouped into two sub-groups: Silver alloy coated or Noble metal alloy-coated (Gold, Silver, and Palladium) catheters. Bacteriuria was the most commonly studied outcome variable across trials. Meta-analysis indicated that silver alloy-coated catheters (RR 0.63, 95%CI 0.44-0.90, P = 0.01; I2 = 72%) and noble metal alloy catheters (RR 0.58, 95%CI 0.41-0.81, P = 0.001; I2 = 0%) significantly reduce the risk of bacteriuria. Sub-group analysis based on the duration of catheterization demonstrated that silver alloy catheters reduce the risk of bacteriuria with >1week of catheterization (RR 0.46, 95%CI 0.26-0.81, P = 0.007; I2 = 63%). Symptomatic CAUTI was evaluated only in four studies with variable results. The quality of the included studies was not high. CONCLUSIONS: Our review indicates that bacteriuria may be reduced with the use of noble metal-coated catheters during short-term catheterization of adults, however, the quality of evidence is not high. It is not clear if these catheters reduce the risk of symptomatic CAUTI. Further homogenous RCTs are needed to provide clarity.

Effectiveness of silver alloy-coated silicone urinary catheters in patients with acute traumatic cervical spinal cord injury: Results of a quality improvement initiative.

Patients with acute traumatic cervical spinal cord injury (ATCSCI) have an increased risk of catheter-associated urinary tract infection (CAUTI). The effectiveness of silver alloy-coated silicone urinary catheters (SACC) in preventing CAUTI in ATCSCI is unknown and was the objective of this study. We performed a quality improvement initiative in an attempt to reduce CAUTI in patients undergoing spine surgery at a single quaternary center. Prior to July 2015, all patients received a latex indwelling catheter (LIC). All patients with ATCSCI with limited hand function (AIS A,B, or C) received a SACC. Incidence of CAUTI, microbiology, duration of infection, antibiotic susceptibility, and catheter-associated adverse events were recorded prospectively. We studied 3081 consecutive patients over the three years, of whom 302 (9.8%) had ATCSCI; 63% of ATCSCI patients were ASIA Impairment Scale (AIS) A or B. The overall rate of CAUTI was 19% (585/3081), and was 38% (116/302) in patients with ATCSCI. Of 178 ATCSCI patients with LIC, 100 (56%) developed a CAUTI compared with 28 of 124 (23%) patients with SACC (p < 0.05). Poly-microbial and gram-positive infection was more common in LIC than in SACC (p < 0.05). Median duration of infection was 9 days in SACC group and 12 days in LIC group (p = 0.08). Resistance to trimethoprim (p < 0.001) and ciprofloxacin (p < 0.05) were more common in LIC group. There was no difference in catheter-associated adverse events or length of stay between the groups. This quality improvement initiative illustrates the effectiveness of antiseptic silver alloy-coated silicone urinary catheters in patients with ATCSCI. In our population, the use of SACC reduces the incidence and the complexity of CAUTI.

Efficacy and Safety of Ureteral Catheter Use During Arteriovenous Fistula in End-Stage Renal Disease Patients with Poor Vascular Status.

BACKGROUND The aim of this study was to evaluate the efficacy and safety of use of a ureteral catheter during arteriovenous fistula in end-stage renal disease patients with poor vascular status. MATERIAL AND METHODS Fifty patients with standard arteriovenous fistulas at Sir Run Run Hospital of Nanjing Medical University from April 2018 to April 2019 were included. Based on the use of ureteral catheter exploration and tourniquet hydraulic dilatation, patients were divided into study and control groups. The operative success rate, inner diameter of cephalic vein 1 day post-operatively, blood flow in the internal fistula, patency rate and blood flow in the internal fistula 3 months post-operatively, and complications 6 months post-operatively were compared between the 2 groups. RESULTS There were 25 cases in each group, with no significant differences in sex or age between the 2 groups. The operative success rate in the study group was higher than in the control group (96% vs. 88%) (F=1.087, P=0.297). The patency rates at 3 and 6 months post-operatively in the study group were higher than in the control group. The inner diameter of the cephalic vein 1 day post-operatively, the blood flow in the internal fistula, and the complications 6 months post-operatively in the study group were significantly superior to those of the control group (P=0.002). CONCLUSIONS In standard arteriovenous fistula, especially vascular catheter exploration of unhealthy vessels, the application of a ureteral catheter can improve the operative success rate and promote internal fistula maturity, with low cost and ease of use.

Male External Catheter in Adults: a glance at nursing care practice.

OBJECTIVE: to describe the patients care in the use of the Male External Catheter in Adults in a clinical-surgical hospitalization unit. METHOD: a cross-sectional study. Evaluation of 30 patients hospitalized in clinical-surgical units to collect items related to the specific care provided. RESULTS: 100% had no reference to the use of external catheter in the evolution of the nurse; 43.3% of the assistants or technicians recorded; 36.6% presented skin lesions; 100% had a latex device attached with adhesive tape; 90% were not submitted to hair removal; 96.7% had daily genital hygiene; 70% received no guidance at all. CONCLUSION: no individualized evaluation was observed for the use of the device, nursing records did not include prescription and description of installation and care, latex device and micropore paper adhesive tape were predominant; skin lesions were prevalent, hygiene and exchange were adequate, few patients were advised regarding the use of the device.

Male External Catheter in Adults: a glance at nursing care practice / Cateter Urinario Externo Masculino: una mirada sobre la práctica asistencial de la Enfermería / Cateter Urinário Externo Masculino: um olhar sobre a prática assistencial da Enfermagem

ABSTRACT Objective: to describe the patients care in the use of the Male External Catheter in Adults in a clinical-surgical hospitalization unit. Method: a cross-sectional study. Evaluation of 30 patients hospitalized in clinical-surgical units to collect items related to the specific care provided. Results: 100% had no reference to the use of external catheter in the evolution of the nurse; 43.3% of the assistants or technicians recorded; 36.6% presented skin lesions; 100% had a latex device attached with adhesive tape; 90% were not submitted to hair removal; 96.7% had daily genital hygiene; 70% received no guidance at all. Conclusion: no individualized evaluation was observed for the use of the device, nursing records did not include prescription and description of installation and care, latex device and micropore paper adhesive tape were predominant; skin lesions were prevalent, hygiene and exchange were adequate, few patients were advised regarding the use of the device.

RESUMEN Objetivo: describir la asistencia a los pacientes en uso del Cateter Urinario Externo Masculino en una unidad de internación clínico-quirúrgica. Método: estudio transversal. Evaluación de 30 pacientes internados en unidades clínico-quirúrgicas para el levantamiento de ítems relacionados al cuidado específico prestado. Resultados: el 100% no tuvo referencia del uso de catéter externo en la evolución del enfermero; el 43,3% de los auxiliares o técnicos realizaron anotaciones; el 36,6% presentó lesión de la piel; el 100% estaba con dispositivo de látex fijado con cinta adhesiva; el 90% no fue sometido a la remoción de los pelos; el 96,7% realizó higiene genital diariamente; el 70% no recibió ningún tipo de orientación. Conclusión: no se observó una evaluación individualizada para el uso del dispositivo, los registros de Enfermería no contemplaron prescripción y descripción de instalación y cuidados; el dispositivo de látex y la cinta adhesiva microporosa fueron predominantes; las lesiones de la piel fueron prevalentes, la higiene y el cambio fueron adecuados, y pocos pacientes fueron orientados en cuanto al uso del dispositivo.

RESUMO Objetivo: descrever a assistência aos pacientes em uso do Cateter Urinário Externo Masculino em unidade de internação clínico-cirúrgica. Método: estudo transversal. Avaliação de 30 pacientes internados em unidades clínico-cirúrgicas para levantamento de itens relacionados ao cuidado específico prestado. Resultados: 100% não teve referência do uso de cateter externo na evolução do enfermeiro; 43,3% dos auxiliares ou técnicos realizaram anotação; 36,6% apresentaram lesão de pele; 100% estava com dispositivo de látex fixado com fita adesiva; 90% não foram submetidos à remoção dos pelos; 96,7% tiveram higiene genital diariamente; 70% não receberam nenhum tipo de orientação. Conclusão: não se observou avaliação individualizada para uso do dispositivo, os registros de enfermagem não contemplaram prescrição e descrição de instalação e cuidados, dispositivo de látex e fita adesiva microporosa foram predominantes; lesões de pele foram prevalentes, higiene e troca foram adequadas, poucos pacientes foram orientados quanto ao uso do dispositivo.

Ins and outs of urinary catheters

BACKGROUND: Inserting an indwelling catheter (IDC) is a common medical procedure that is often performed poorly and inappropriately, and can lead to significant morbidity. Although most catheterisations are performed by nursing staff, medical personnel need to be aware of the procedure, products and common IDC complications. OBJECTIVE: Current guidelines and literature were reviewed to outline catheterisation indications, catheter types and provide a general understanding of complications associated with IDCs for the general practitioner (GP). DISCUSSION: There is evidence that IDCs are often used when not indicated and improperly managed when inserted. IDCs can cause significant morbidity, prolong hospital stay and increase healthcare costs. Infection and traumatic insertion are common complications; advances in catheter design have helped to limit these complications. Most complications are avoidable, do not require specialist input and can be managed by community nurses or GPs. Reviewing indications, adopting proper technique for insertion and defining management strategies can limit complications.

Suprapubic tube versus urethral catheter drainage after robot-assisted radical prostatectomy: a systematic review and meta-analysis.

BACKGROUND: Prostate cancer is one of the most common cancers in the elderly population. The standard treatment is radical prostatectomy (RARP). However, urologists do not have consents on the postoperative urine drainage management (suprapubic tube (ST)/ urethral catheter (UC)). Thus, we try to compare ST drainage to UC drainage after robot-assisted radical prostatectomy regarding to comfort, recovery rate and continence using the method of meta-analysis. METHODS: A systematic search was performed in Dec. 2017 on PubMed, Medline, Embase and Cochrane Library databases. The authors independently reviewed the records to identify studies comparing ST with UC of patients underwent RARP. Meta-analysis was performed using the extracted data from the selected studies. RESULTS: Seven studies, including 3 RCTs, with a total of 946 patients met the inclusion criteria and were included in our meta-analysis. Though there was no significant difference between the ST group and the UC group on postoperative pain (RR1.73, P 0.20), our study showed a significant improvement on bother or discomfort, defined as trouble in hygiene and sleep, caused by catheter when compared two groups at postoperative day (POD) 7 in ST group (RR2.05, P 0.006). There was no significant difference between the ST group and UC group on urinary continence (RR0.98, P 0.74) and emergency department visit (RR0.61, P 0.11). The rates of bladder neck contracture and other complications were very low in both groups. CONCLUSION: Compared to UC, ST showed a weak advantage. So it might be a good choice to choose ST over RARP.

Effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury.

STUDY DESIGN: A retrospective study. OBJECTIVES: To investigate the effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury (SCI). SETTING: Spinal center (Tokyo, Japan). METHODS: Imidafenacin was prescribed to 34 patients with SCI who had a low cystometric volume and/or detrusor compliance according to a urodynamic study. A low cystometric volume and detrusor compliance were defined as <200 ml and <20 ml cm-1 H2O, respectively. The urodynamic study was repeated 4 weeks after imidafenacin was prescribed. When the urodynamic parameters did not improve in the follow-up study, the dose of imidafenacin was increased twofold. Then the urodynamic study was repeated 4 weeks thereafter. We compared the urodynamic parameters before and after imidafenacin treatment. Complications such as vesico-urethral reflux (VUR) and autonomic dysreflexia (AD) were documented. RESULTS: Fifteen patients took 0.2 mg of imidafenacin daily, and 19 received 0.4 mg of imidafenacin daily. Imidafenacin increased the cystometric volume from 246.0 to 321.5 ml (median, P=0.002), detrusor compliance from 6.67 ml cm-1 H2O to 8.98 ml cm-1 H2O (median, P=0.012), and decreased the detrusor pressure from 37.0 cm H2O to 30.5 cm H2O (median, P=0.056). All three patients who had VUR fully recovered. Although 3 of 12 patients recovered from AD, 3 patients newly developed symptoms of AD. No patient withdrew from treatment due to adverse effects. CONCLUSION: Imidafenacin is a safe drug that may improve the urodynamic parameters of patients with SCI, and it possibly alleviates bladder complications.

Early removal of urinary catheter after surgery requiring thoracic epidural: a prospective trial.

OBJECTIVES: To prevent urinary retention, urinary catheters commonly are removed only after thoracic epidural discontinuation after thoracotomy. However, prolonged catheterization increases the risk of infection. The purpose of this study was to determine the rates of urinary retention and catheter-associated infection after early catheter removal. DESIGN: This study described a prospective trial instituting an early urinary catheter removal protocol compared with a historic control group of patients. SETTING: The protocol was instituted at a single, academic thoracic surgery unit. PARTICIPANTS: The study group was comprised of patients undergoing surgery requiring thoracotomy who received an intraoperative epidural for postoperative pain control. INTERVENTIONS: An early urinary catheter removal protocol was instituted prospectively, with all catheters removed on or before postoperative day 2. Urinary retention was determined by bladder ultrasound and treated with recatheterization. MEASUREMENTS AND MAIN RESULTS: The primary outcomes were urinary retention rate, defined as bladder volume>400 mL, and urinary tract infection rate. Results were compared with a retrospective cohort of 210 consecutive patients who underwent surgery before protocol initiation. Among the 101 prospectively enrolled patients, urinary retention rate was higher (26.7% v 12.4%, p = 0.003), while urinary tract infection rate improved moderately (1% v 3.8%, p = 0.280). CONCLUSIONS: Early removal of urinary catheters with thoracic epidurals in place is associated with a high incidence of urinary retention. However, an early catheter removal protocol may play a role in a multifaceted approach to reducing the incidence of catheter-associated urinary tract infections.

Cost effectiveness of antimicrobial catheters for adults requiring short-term catheterisation in hospital.

Catheter-associated urinary tract infection (CAUTI) is the second most common cause of hospital-acquired infection. A number of strategies have been put forward to prevent CAUTI, including the use of antimicrobial catheters. We aimed to assess whether the use of either a nitrofurazone-impregnated or a silver alloy-coated catheter was cost-effective compared with standard polytetrafluoroethylene (PTFE)-coated catheters. A decision-analytic model using data from a clinical trial conducted in the United Kingdom was used to calculate the incremental cost per quality-adjusted life-year (QALY). We assumed that differences in costs and QALYs were driven by difference in risk of acquiring a CAUTI. Routine use of nitrofurazone-impregnated catheters was, on average, £7 (€9) less costly than use of the standard catheter over 6 wk. There was a >70% chance that use of nitrofurazone catheters would be cost saving and an 84% chance that the incremental cost per QALY would be less than £30 000 (€36 851; a commonly used threshold for society's willingness to pay). Silver alloy-coated catheters were very unlikely to be cost-effective. The model's prediction, although associated with uncertainty, was that nitrofurazone-impregnated catheters may be cost-effective in the UK National Health System or a similar setting.