Comparison of the efficacy of three topical antiseptic solutions for the prevention of catheter colonization: a multicenter randomized controlled study.

BACKGROUND: To compare the efficacy of three antiseptic solutions [0.5%, and 1.0% alcohol/chlorhexidine gluconate (CHG), and 10% aqueous povidone-iodine (PVI)] for the prevention of intravascular catheter colonization, we conducted a randomized controlled trial in patients from 16 intensive care units in Japan. METHODS: Adult patients undergoing central venous or arterial catheter insertions were randomized to have one of three antiseptic solutions applied during catheter insertion and dressing changes. The primary endpoint was the incidence of catheter colonization, and the secondary endpoint was the incidence of catheter-related bloodstream infections (CRBSI). RESULTS: Of 1132 catheters randomized, 796 (70%) were included in the full analysis set. Catheter-tip colonization incidence was 3.7, 3.9, and 10.5 events per 1000 catheter-days in 0.5% CHG, 1% CHG, and PVI groups, respectively (p = 0.03). Pairwise comparisons of catheter colonization between groups showed a significantly higher catheter colonization risk in the PVI group (0.5% CHG vs. PVI: hazard ratio, HR 0.33 [95% confidence interval, CI 0.12-0.95], p = 0.04; 1.0% CHG vs. PVI: HR 0.35 [95% CI 0.13-0.93], p = 0.04). Sensitivity analyses including all patients by multiple imputations showed consistent quantitative conclusions (0.5% CHG vs. PVI: HR 0.34, p = 0.03; 1.0% CHG vs. PVI: HR 0.35, p = 0.04). No significant differences were observed in the incidence of CRBSI between groups. CONCLUSIONS: Both 0.5% and 1.0% alcohol CHG are superior to 10% aqueous PVI for the prevention of intravascular catheter colonization. TRIAL REGISTRATION: Japanese Primary Registries Network; No.: UMIN000008725 Registered on 1 September 2012.

Povidone-Iodine, 0.05% Chlorhexidine Gluconate, or Water for Periurethral Cleaning Before Indwelling Urinary Catheterization in a Pediatric Intensive Care: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to evaluate the efficacy of periurethral cleaning with 10% povidone-iodine, 0.05% chlorhexidine gluconate, or sterile water in preventing catheter-associated urinary tract infections (CAUTIs) prior to indwelling urinary catheter insertion in a pediatric intensive care unit. A secondary aim was to identify pathogens resulting in CAUTIs in this group. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: One hundred twenty-two patients cared for in a pediatric intensive care unit of a university hospital between September 2012 and December 2013 participated in the study. METHODS: Subjects were randomly allocated to 1 of 3 groups: periurethral cleansing with 0.05% chlorhexidine; 10% povidone-iodine; or sterile water. The patients in each group were cleansed 3 times using different sterile pads and assigned cleansing solutions for as long as the patients were observed or until the urinary catheter was removed. Daily monitoring forms, which included physiologic and physical parameters and catheter-related infections, were completed for all patients. We used Centers for Disease Control and Prevention/National Health and Safety Network criteria to determine the presence of a CAUTI. RESULTS: CAUTIs occurred in 6 patients (15%) allocated to periurethral cleansing with povidone-iodine, 2 (4.8%) in the chlorhexidine gluconate group, and 3 (7.5%) in the sterile water group. Although more patients in the povidone-iodine group had CAUTI than in the other 2 groups, differences were not statistically significant (P > .05). CONCLUSION: We found no statistically significant differences in CAUTI rates in the 3 groups. Further investigation with a larger study group is needed to more definitively identify any difference in CAUTI occurrences based on periurethral cleansing solution.

The female experience of ISC with a silicone catheter.

Intermittent self-catheterisation (ISC) is a safe and effective treatment in the management of neuropathic bladder, voiding dysfunction and urinary incontinence in women. ISC has been shown to improve quality of life when used appropriately. It provides freedom for individuals who require bladder drainage as they can choose where and when to catheterise to empty the bladder. ISC requires minimum equipment, is a more discreet solution than an indwelling catheter and is relatively easy to teach in one patient visit. There are a range of different ISC catheters available on prescription. Many have been designed specifically for women and patient choice regarding product selection is an important consideration. This article describes a UK patient-satisfaction survey evaluating the female patient's perspective of learning ISC using a silicone intermittent catheter called HydroSil Go™ that is manufactured by C.R. Bard, Inc.

Multicenter cohort study to assess the impact of a silver-alloy and hydrogel-coated urinary catheter on symptomatic catheter-associated urinary tract infections.

PURPOSE: The purpose of this study was to determine the effect of a silver-alloy hydrogel catheter on symptomatic catheter-associated urinary tract infections (CAUTIs). DESIGN: Multicenter before-after non-randomized cohort study. SUBJECTS AND SETTING: Seven acute care hospitals ranging in size from 124 to 607 beds participated in this study. The study population included adult patients with a positive urine culture 2 or more days after admission, who underwent Foley catheterization. METHODS: Catheter-associated urinary tract infection surveillance was conducted at each hospital for at least 3 months during the use of a standard catheter and 3 months during the use of the silver-alloy hydrogel catheter. Both the National Healthcare Safety Network (NHSN) surveillance and a clinical definition of CAUTI were used for rate calculation. RESULTS: A 47% relative reduction in the CAUTI rate was observed with the silver-alloy hydrogel catheter compared to the standard catheter when both infection definitions were used (0.945/1000 patient days vs 0.498/1000 patient days) (odds ratio = 0.53; P < .0001; 95% CI: 0.45-0.62). When only NHSN-defined CAUTIs were considered, a 58% relative reduction occurred in the silver-alloy hydrogel period (0.60/1000 patient days vs 0.25/1000 patient days) (odds ratio = 0.42; P < .0001; 95% CI: 0.34-0.53). Antimicrobial days for CAUTIs decreased from 1165 (standard catheter period) to 406 (silver-alloy hydrogel period). CONCLUSIONS: Use of a silver-alloy hydrogel urinary catheter reduced symptomatic CAUTI occurrences as defined by both NHSN and clinical criteria.

In vitro analysis of balloon cuffing phenomenon: inherent biophysical properties of catheter material or mechanics of catheter balloon deflation?

AIM: To investigates the different methods of balloon deflation, types of urinary catheters and exposure to urine media in catheter balloon cuffing. MATERIALS AND METHODS: Bardex®, Bard-Lubri-Sil®, Argyle®, Releen® and Biocath® were tested in sterile and E.Coli inoculated urine at 0, 14 and 28 days. Catheter deflation was performed with active deflation; passive deflation; passive auto-deflation; and excision of the balloon inflow channel. Balloon cuffing was assessed objectively by running the deflated balloon over a plate of agar and subjectively by 3 independent observers. RESULTS: Bardex®, Argyle® and Biocath® showed greater degree of catheter balloon cuffing (p < 0.01). Active balloon deflation was the worst method (p < 0.01). The presence of infected urine media also contributed to greater balloon cuffing (p > 0.05). Linear regression model analysis confirmed time as the most significant factor. CONCLUSION: The duration of catheters exposure, different deflation methods and types of catheters tested contributed significantly to catheter balloon cuffing (p < 0.01).

[Placement of a shape-memory alloy intraurethral catheter (Memokath) using transrectal ultrasonography and fluoroscopy].

Intraurethral catheters are effective in the treatment of elderly patients with benign prostate hyperplasia (BPH) who have severe complications. However, it is not easy to measure the length of the prostatic urethra and to determine an appropriate location for the urethral catheter using only fluoroscopy, especially in patient with severe mid-lobe enlargement. We attempted to place a shape-memory alloy intraurethral catheter (MEMOKATH) by transrectal ultrasonography and fluoroscopy to measure the precise length of the prostatic urethra and to determine an appropriate location for an intraurethral catheter placement. Patients were given urethral infiltration anesthesia with 2% lidocaine hydrochloride jelly and placed in the supine position. Both transrectal ultrasonography and fluoroscopy were performed to observe the bladder neck, the apex of the prostate gland, and the prostatic urethra. Transrectal ultrasonography was shown to depict them more clearly than fluoroscopy. Transrectal ultrasonography was also shown to be more suitable than fluoroscopy for measuring the prostatic urethra length, as well as for accurately positioning the MEMOKATH stent, especially in cases of BPH with mid-lobe enlargement. The MEMOKATH stent was placed in 7 patients with BPH. Urethral catheters had been put in place in 6 of these patients because of urinary retention, and large amounts of residual urine were found in the remaining patient. Three patients had severe mid-lobe enlargement. All patients were able to urinate without much residual urine after the procedure. No severe complications were noted. Transrectal ultrasonography is useful for accurately placing the MEMOKATH stent, as it provides more objective and detailed anatomical findings than fluoroscopy.

Intermittent Catheters for Chronic Urinary Retention: A Health Technology Assessment.

BACKGROUND: People with chronic urinary retention typically require intermittent catheterization. This review evaluates the effectiveness, safety, patient preference, cost-effectiveness, and budget impact of different types of intermittent catheter (IC). Specifically, we compared prelubricated catheters (hydrophilic, gel reservoir) and noncoated catheters, as well as their single use versus reuse (multiple use). METHODS: We performed a systematic literature search and included randomized controlled trials, cohort, and case-control studies that examined any type of single-use versus multiple-use IC, hydrophilic single-use versus noncoated single-use, or gel reservoir single-use versus noncoated single-use. The outcomes of interest were symptomatic urinary tract infection (UTI), hematuria, other serious adverse events, and patient satisfaction. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also completed an economic evaluation, using the perspective of the Ontario Ministry of Health and Long-Term Care, to determine the cost-effectiveness of various intermittent catheters used in Ontario. We determined the budget impact of fully and partially funding various intermittent catheters for outpatients with chronic urinary retention. To understand patient experiences with intermittent catheterization, we interviewed 34 adults and parents of children affected by chronic urinary retention. RESULTS: We found 14 randomized controlled trials that met the inclusion criteria. When comparing any type of single-use or multiple-use IC, we found no difference in UTI (RR = 0.98, 95% CI 0.70-1.39), hematuria, or serious adverse events, and inconclusive evidence on patient satisfaction.Our meta-analysis of studies on people living in the community showed that hydrophilic ICs may result in fewer UTIs than single-use noncoated ICs, but given the nature of the studies, we were uncertain about this conclusion.The nature of the available evidence also did not allow us to make definitive conclusions regarding whether one type of catheter was likely to result in less hematuria, fewer serious adverse events, or greater patient satisfaction.Our economic evaluation found that owing to small differences in quality-adjusted life-years and moderate to large incremental cost differences, the lowest-cost ICs-noncoated multiple-use (using one catheter per week or one catheter per day)-have the highest probability of being cost-effective. In a subpopulation of those clinically advised not to reuse ICs, single-use noncoated ICs have the highest probability of being cost-effective. As current funding is limited in the outpatient setting, publicly funding noncoated multiple-use catheters (one per day) would result in a total additional cost of $93 million over the first 5 years. People who use ICs reported that the high ongoing cost of purchasing catheters was a financial burden. Almost all said they would prefer not to reuse catheters sold as "single use" but could not afford to do so. CONCLUSIONS: Given the overall low quality of evidence in available studies, we are uncertain whether any specific type of IC (coated or noncoated, single- or multiple-use) significantly reduces symptomatic UTI, hematuria, or other serious adverse clinical events, or whether a specific type improves patient satisfaction. Therefore, the lowest-cost IC is likely the most cost-effective.

Reducing the risk of catheter-related urinary tract infection.

Primum non nocere (first do no harm) is the ancient Latin phrase that reminds nurses that first principle of healthcare is not to harm those entrusted to our care. Yet, common healthcare interventions, such as urinary catheterization, have the potential to do patients great harm. The patient may even pay with his or her life if a urinary catheter is inserted without clinical indications or if the nurse fails to do his or her utmost to protect the patient from infection. Urinary tract infection (UTI) is the most common of healthcare-related infection. UTI in hospital inpatients normally occurs in people who have a urinary catheter inserted. Urinary catheterization is common and although the risks of catheter-associated UTI are small, the consequences or catheter-associated UTI can be life threatening. Urinary catheterization increases morbidity by a factor of three. Restricting catheterization to those who clinically require this invasive procedure can reduce the number of people who developed infection and life threatening bacteraemia. The use of silver-coated catheters can reduce the risks of infection. Evidence based practice can further reduce risks of catheterization. It is important that informed consent is obtained prior to catheterization. If a person lacks capacity the clinician must act in the person's best interests.

[Betadine as an antiseptic during replacement of suprapubic catheter in primary health care]. / Betadine como antiséptico para el recambio de sonda suprapública u,ia en Atención Primaria de Salud.

At times, a patient's capacity to store urine fails. When dealing with this circumstance, and bearing in mind Primary Health Care Center nurses' responsibilities, the elaboration of a protocol becomes justified, especially in light of the fact that virtually no Spanish bibliography on this topic exists. The aforementioned protocol will be revised in August 2013. This project won the Third Betadine Nursing Prize in 2008.

Efficacy and safety of urinary catheters with silver alloy coating in patients with spinal cord injury: a multicentric pragmatic randomized controlled trial. The ESCALE trial.

BACKGROUND: Patients with spinal cord injury (SCI) who carry indwelling urinary catheters have an increased risk of urinary tract infection (UTI). Antiseptic silver alloy-coated (SAC) silicone urinary catheters prove to be a promising intervention to reduce UTIs; however, current evidence cannot be extrapolated to patients with SCI. PURPOSE: This study aimed to assess the efficacy of SAC urinary catheters for preventing catheter-associated urinary tract infections. DESIGN/SETTING: This is an open-label, multicenter (developed in Spain, Portugal, Chile, Turkey, and Italy), randomized clinical trial conducted in 14 hospitals from November 2012 to December 2015. PATIENT SAMPLE: Eligible patients were men or women with traumatic or medical SCI, aged ≥18 years, requiring an indwelling urinary catheter for at least 7 days. OUTCOME MEASURES: The primary outcome was the incidence of symptomatic UTIs. The secondary outcome included bacteremia in the urinary tract and adverse events. MATERIALS AND METHODS: Patients were randomized to receive a SAC urinary catheter (experimental group) or a standard catheter (control group) for at least 7 days. Data were compared using chi-squared test and also calculating the absolute risk difference with a 95% confidence interval. An adjusted analysis including different risk factors of UTI was performed. This study was mainly funded by La Marató de TV3 Foundation (grant number # 112210) and the European Clinical Research Infrastructures Network organization. The funders had no role in the interpretation or reporting of results. RESULTS: A total of 489 patients were included in the study, aged 55 years in the experimental group and aged 57 in the control group (p=.870); 72% were men; 43% were hospitalized patients, and 57% were outpatients (p=1.0). The most frequent cause of SCI was traumatic (73.75%), and the localization was mainly the cervical spine (42.74%). Most of the patients had an A score (complete spinal injury and no motor and sensory is preserved) on the ASIA scale (62.37%). The median time of urethral catheterization was 27 days in the experimental group and 28 days in the control group (p=.202). Eighteen patients (7.41%) in the experimental group and 19 in the control (7.72%) group had a symptomatic UTI (odds ratio [OR] 0.96 [0.49-1.87]). The adjusted analysis revealed no change in the results. Only three patients in the experimental group had bacteremia within the urinary tract. The experimental group presented more adverse events related to the use of a catheter than the control group (OR 0.03 [0.00-0.06]). CONCLUSIONS: The results of this study do not support the routine use of indwelling antiseptic SAC silicone urinary catheters in patients with SCI. However, UTIs associated to long-term urinary catheter use remain a challenge and further investigations are still needed.

New developments in ureteral stent design, materials and coatings.

Ureteral stents are used in a variety of urological diseases and procedures. The majority of patients with indwelling ureteral stents experience bothersome symptoms and are at increased risk for urinary tract infection. Stent encrustation and the associated complications can also result in significant patient morbidity. The development of new stent designs using novel biomaterials, stent coatings and drug-eluting technologies are being applied to reduce the disadvantageous features of ureteral stents.

Evidence for the use of silver-alloy-coated urethral catheters.

Catheter-associated urinary tract infections (CAUTIs) are a common occurrence and are associated with increased patient morbidity and mortality. In addition, they delay patient discharge from hospital, substantially increase hospital costs and promote the emergence of resistant organisms. Any intervention resulting in a decrease in the incidence of CAUTIs would have a significant impact on patient quality of life and hospital costs. By reviewing the current literature, it can be seen that the use of silver-alloy-coated hydrogel catheters can reduce CAUTIs by up to 45%. Despite reducing CAUTIs in most hospital situations, the greatest reduction is seen in postoperative patients, intensive care unit patients and burns patients.

Materials for urinary catheters: a review of their history and development in the UK.

The Foley catheter, introduced in the mid-1930s and originally manufactured from latex, is still the most commonly used device for the management of urinary incontinence (UI). Despite the passage of time, there are still problems associated with the use of these devices. It is currently estimated that the management and treatment of UI costs the UK National Health Service (NHS) in the order of 500 million pound per annum. Faced with the known demographic changes in the adult population these costs will continue to rise for the foreseeable future. This review examines the range of materials currently used to manufacture Foley catheters from both latex and silicone. It outlines the common problems associated with their clinical use-infection, encrustation and blockage. The main changes that have been made to the materials employed in response to these problems are analysed. In the first instance the use of controlled release glass and slow release polymers to introduce disinfectants and antibacterial agents is considered. Attempts to alter surface properties by using coatings based on silver, polytetrafluoroethylene (PTFE), hydrogels and silicone are then described. It can be seen that despite these approaches, problems remain with the design and materials currently used to manufacture catheters. The review concludes that changes to the materials currently used for the manufacture of commercially available catheters could potentially alleviate many of the existing problems. However, standards need to be developed in order to enable direct comparison of the mechanical and physical properties of existing and potential catheter designs to ensure their effective function in-service.

Clinical skills: how to remove and change a suprapubic cathether.

Suprapubic catheterization is becoming more widely used to drain the urinary bladder either short or long term or is inserted where initial urethral or recatheterization is problematic. No matter where you work as a nurse, either in the hospital, community, hospice or nursing care home, sooner or later you will have to deal with a patient with a suprapubic catheter in situ. One of the concerns nurses encounter when changing the suprapubic catheter is what action to take when the catheter appears to have become stuck when removing it. The main cause of this problem is owing to a 'cuffing' effect occurring to the deflated catheter balloon, especially if using 100% silicone catheters. This article looks at the problem of removing a suprapubic catheter that has become stuck and how to change such catheters safely.

Minimum nephrostomy.

A new type of nephrostomy is described with the following main characteristics: it uses a small multiperforated Silastic tube; its crosswise location allows perfect drainage of all of the calyces and the pelvis; it does not become obstructed nor move from its position; and it causes minimum traumatization of the renal parenchyma. It has a double purpose: its serves as a drain and safety measures as well as being used for the treatment of renal infection.

Recording urethral pressure profile: comparison of methods and clinical implications.

Urodynamic evaluation of urethral sphincter efficiency can be carried out by constant carbon dioxide perfusion, constant water perfusion, or the use of membrane catheters. A comparison of these three techniques was made in in vitro and in vivo experiments. Results, and advantages and disadvantages of each method are discussed. From all factors considered in this study--responsiveness to pressure changes sensitivity to pressures at various levels along the urethra, and reproducibility and accuracy of the profile--the membrane catheter system was by far superior to either of the flow systems.

Biocarbon urinary conduit: laboratory experience and clinical applications.

A new urinary conduit utilizing pure vitreous carbon has been used successfully in dogs. Pure carbon appears to be inert with respect to urine and urothelium. Lack of urinary salt encrustation on the exposed surface provides a well-functioning urinary conduit for vesical drainage. Twenty-one vesicostomies were performed in dogs. Careful follow-up and histologic studies of removed specimens were done to establish the biocompatibility of pure carbon. All vesicostomies functioned well. A description of the device, protocol, and results of laboratory experimentation are outlined. The surgical procedure is explained in detail. Results encourage the clinical trial of these devices in humans. Indications include patients with neurogenic vesicla dysfunction and those with total urinary incontinence, both of which require permanent indwelling catheters.

Percutaneous antegrade dilatation of distal ureteral strictures and obstructions.

Since the first ureteral dilatations in experimental dogs were performed, the technique in human has been accepted and improved over the years. Balloon dilatation has been successful, but it has been very difficult or impossible to force the guide wires through long total strictures, especially those localized distally. In order to recanalize very narrow strictures or total occlusions located in the distal ureter, a modified angiographic technique was developed and tested in 12 ureters in 10 patients.

Bladder management in patients with pediatric onset neurogenic bladders.

Our objective was to determine which clean intermittent catheterization (CIC) methods and supplies were used by patients with pediatric onset neurogenic bladders and to relate methodology and materials to reported urinary tract infections. Data were collected via questionnaires distributed by mail and at clinic visits at our university tertiary care outpatient pediatric rehabilitation clinic. Questionnaires were given to 165 patients. Fifty-nine percent were returned (68 patients with myelomeningocele, 27 with pediatric onset spinal cord injury (SCI) and two with other diagnoses). Mean age was 12 years (range 1-27). Fifty-four percent of patients participated in their own CIC. Only two percent used sterile catheterization technique, whereas 98 percent used CIC. A sterile catheter was employed with clean technique by 22 percent. Catheters were reused by 76 percent. Subjects used a wide ranging number of catheters per month, with a median of 5.3. There was no correlation between the number of urinary tract infections (UTIs) per year and the type of catheter used or the use of prophylactic antibiotics. Compared with patients with myelomeningocele, subjects with SCI were significantly more likely to use sterile catheters (p = 0.04), > 10 catheters per month (p = 0.01) and gloves (p < 0.001). Subjects who used gloves or more catheters were more likely to experience UTI. These data suggest that clean reused supplies are not related to an increased likelihood of UTI and should be considered a way to lower costs in these populations.