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1.
Nursing ; 49(10): 49-52, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31568083

RESUMO

Urethral characterization can be difficult for patients and providers alike. This article describes an evidence-based protocol for difficult urethral catheter insertions in male patients.


Assuntos
Prática Clínica Baseada em Evidências , Guias de Prática Clínica como Assunto , Cateterismo Urinário/enfermagem , Algoritmos , Humanos , Masculino , Segurança do Paciente , Risco , Uretra/anatomia & histologia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos
3.
Urology ; 133: 72-77, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31465791

RESUMO

OBJECTIVE: To assess whether intraurethral anesthesia decreased voiding efficiency (VE), reduced catheterization pain, and impacted urodynamic parameters in healthy adult females. METHODS: In a randomized, double-blind, placebo-controlled trial, participants received two 5 mL doses of either intraurethral aqueous gel or 4% lidocaine gel. The primary outcome was VE during randomized condition uroflow, defined as voided volume/(voided volume + residual volume). The secondary outcomes were pain during catheterization and to confirm previously reported pressure-flow changes. A sample size of 10 per group was planned to detect a clinically significant decrease in VE with a power (1-ß) of 0.99. RESULTS: From October to December 2018, 23 women were screened and 18 were randomized to receive placebo (n = 10) or lidocaine (n = 8). Baseline uroflow VE was similar between the placebo and lidocaine groups (88 ± 6.6% vs 91 ± 5.8%, P = .33). After study drug administration, the changes in VE (post-pre) were similar between placebo and lidocaine groups (-5.4 ± 14% vs 1.7 ± 6.4%, P = .21). Visual analog scores were similar following catheterizations (26.7 ± 12.8 mm vs 36.9 ± 26.8 mm, P = .34). The lidocaine group exhibited lower average flow rates per voided volume (0.04 ± 0.02 s-1 vs 0.02 ± 0.01 s-1, P = .04). CONCLUSION: Intraurethral administration of 4% lidocaine did not decrease VE compared to placebo and did not change pain scores following catheterization. In the lidocaine group, the average flow rate per voided volume was lower. The decrease in flow rate after local anesthesia to the urethra may indicate that urethral sensory feedback contributes to voiding in human micturition.


Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Dor/prevenção & controle , Cateterismo Urinário , Micção/efeitos dos fármacos , Urodinâmica/efeitos dos fármacos , Administração Tópica , Adulto , Anestésicos Locais/farmacologia , Método Duplo-Cego , Feminino , Humanos , Lidocaína/farmacologia , Uretra , Cateterismo Urinário/efeitos adversos
4.
Int J Colorectal Dis ; 34(8): 1431-1443, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31280352

RESUMO

PURPOSE: Postoperative urinary retention is a common adverse effect after rectal surgery. Current methods for assessing postoperative urinary retention (residual urine volume) are inaccurate and unable to predict long-term retention. Voiding efficiency is an effective indicator of postoperative urinary retention in urological and gynaecological fields, but not in colorectal surgery. We aimed to determine whether voiding efficiency in the initial 24 h after urinary catheter removal was more effective in predicting the incidence of postoperative urinary retention than residual urine volume. METHODS: In this retrospective, observational study using prospectively collected data from patients who visited the colorectal department of a single institution, 549 patients who underwent rectal cancer surgery between April 2012 and May 2016 were initially enrolled, of which 46 were excluded and 503 finally included. RESULTS: The incidence of postoperative urinary retention was 18.5% (93/503). Multivariable logistic regression analyses revealed that the association of postoperative urinary retention with voiding efficiency < 50% was stronger than that with residual urine volume > 100 mL (odds ratio, 38.30 (residual urine volume) and 138.0 (voiding efficiency)). Voiding efficiency was significantly lower in patients with long-term than in those with short-term postoperative urinary retention (adjusted p value = 0.02), whereas residual urine volume was not different between the two groups. Multivariable logistic regression analysis for long-term postoperative urinary retention showed the strongest association with voiding efficiency < 20% (odds ratio, 25.70). CONCLUSIONS: Voiding efficiency is a more effective predictor of postoperative urinary retention than residual urine volume in rectal cancer patients.


Assuntos
Remoção de Dispositivo , Neoplasias Retais/fisiopatologia , Neoplasias Retais/cirurgia , Cateterismo Urinário/efeitos adversos , Retenção Urinária/etiologia , Retenção Urinária/fisiopatologia , Micção , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC
5.
Rev Esc Enferm USP ; 53: e03452, 2019 May 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31166534

RESUMO

OBJECTIVE: To identify factors related to the occurrence of urinary tract infection associated with urinary catheter use. METHOD: A longitudinal, retrospective cohort study carried out by analyzing the electronic medical records of patients admitted to an intensive care unit of a high-complexity hospital from July 2016 to June 2017. Demographic and clinical data were analyzed by descriptive and analytical analysis. RESULTS: The incidence density of urinary tract infection related to urinary catheter use was 4.8 per 1000 catheters/day, the majority (80.6%) with no indication for catheter use, and there was no prescription for insertion and/or maintenance in 86.7%. The mean time between catheter insertion and infection diagnosis was 11.3 ± 6.3 days (6 to 28 days). Statistically significant factors (p < 0.001) related to urinary infection linked to catheter use were hospitalization time in the unit (16.7 ± 9 days), catheter permanence time (12.7 ± 6.9 days), and the use of antimicrobials in the intensive care unit (8.6 ± 6.3 days). CONCLUSION: The association of indication absence and the record of the need for maintenance possibly potentiated the occurrence of urinary tract infection associated to catheter use.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Unidades de Terapia Intensiva , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cateteres Urinários/efeitos adversos , Infecções Urinárias/etiologia
7.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 472-477, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31250535

RESUMO

OBJECTIVE: To determine the incidence of bacteriuria at the time of presentation and as a result of indwelling urethral catheterization in naturally occurring feline urethral obstruction (UO). DESIGN: Prospective observational study. SETTING: University teaching hospital. ANIMALS: A population of 34 male cats with UO admitted for standard medical care. INTERVENTIONS: A presenting urine sample was obtained by cystocentesis (precatheterization). After catheterization (performed under strict aseptic technique), a urine sample was obtained through the urinary catheter every 24 hours, as well as just prior to catheter removal. Urine was applied to culture media within 30 minutes of collection or refrigerated immediately at 4°C for subsequent culture the following morning. Samples positive for growth (defined as > 104 colony forming units/mL) had bacterial identification and susceptibility testing performed. MEASUREMENTS AND MAIN RESULTS: All 34 cats enrolled had initial culture performed. Of these, 1 patient died and 2 were euthanized within 24 hours and therefore subsequent cultures were obtained. The remaining 31 cats had median catheterization time of 42 hours (range 20-110 hours). No urine cultures yielded growth at presentation (0/34). A total of 4 of 31 patients (13%) subsequently had bacterial cultures that yielded growth. In these cases, all yielded growth by the 24-hour time point, and all had the same organism identified on subsequent cultures. Identified bacteria included Streptococcus spp. (3) and Pasteurella spp. (1). CONCLUSIONS: The male cats with UO in this study did not have bacteriuria at the time of presentation. The overall incidence of acquired bacteriuria was found to be 13% and could represent a transient bacterial population or true bacterial urinary tract infection. Based on these findings, empirical administration of antibiotics is not warranted in male cats with UO.


Assuntos
Bacteriúria/veterinária , Doenças do Gato/epidemiologia , Obstrução Uretral/veterinária , Cateterismo Urinário/veterinária , Infecções Urinárias/veterinária , Animais , Bacteriúria/epidemiologia , Doenças do Gato/etiologia , Doenças do Gato/microbiologia , Doenças do Gato/urina , Gatos , Hospitais Universitários , Incidência , Masculino , Ohio/epidemiologia , Estudos Prospectivos , Obstrução Uretral/terapia , Urinálise/veterinária , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia
8.
Br J Nurs ; 28(9): S4-S17, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31070971

RESUMO

More than 90 000 of the UK adult population are estimated to have a urinary catheter, with 24% likely to develop symptoms of catheter-associated urinary tract infection (CAUTI). The consequences of having a CAUTI are reduced quality of life, risk of hospitalisation and increased mortality. The authors undertook a literature review of primary research studies to identify how nurses could support patients to maintain effective catheter care to reduce the risk of CAUTI. Four themes emerged: education, knowledge, empowerment and communication. The authors therefore conclude that consistent knowledge, clear communication and treating patients as partners in the decision-making process can help build trust and allow empower patients. This will enable patients to make safe and healthy decisions about their catheter, particularly with regard to personal hygiene and optimal fluid intake, to reducing the risk of CAUTI.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora , Relações Enfermeiro-Paciente , Cateterismo Urinário/enfermagem , Infecções Urinárias/prevenção & controle , Cateteres de Demora/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/etiologia
9.
BMJ Case Rep ; 12(5)2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092490

RESUMO

We highlight the case of a woman who had elective gynaecological surgery with bilateral prophylactic ureteric catheterisation, indicated for the excision of a mucinous cystadenoma arising from the right ovary. Surgery was successful with no intraoperative complications. Anuria and subsequent acute kidney injury developed within 12 hours of surgery. A CT of the kidneys, ureters and bladder revealed mild bilateral hydronephrosis and perinephric stranding surrounding the left kidney with no discernible injury to the lower urinary tract. Further investigation did not reveal a clear cause for her anuric state. Management involved aggressive renal support, rigid cystoscopy and bilateral ureteric stenting. Diuresis and a prompt improvement in renal function ensued with no further complications. She was discharged a week after her initial operation, with a 6-week review for stent removal. We believe this to be a rare instance of reflex anuria due to ureteric spasm and encourage consideration of ureteric stenting as part of subsequent management.


Assuntos
Lesão Renal Aguda/etiologia , Anuria/etiologia , Cateterismo Urinário/efeitos adversos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico por imagem , Idoso de 80 Anos ou mais , Creatinina/sangue , Feminino , Humanos , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X
10.
J Urol ; 202(4): 757-762, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31120374

RESUMO

PURPOSE: We report long-term data on a large cohort of adults who underwent formation of a continent catheterizable channel for various indications. We examined outcomes according to the tissue used for channel formation. MATERIALS AND METHODS: We retrospectively reviewed the case notes of 176 consecutive adult patients in whom a continent catheterizable channel was created using the Mitrofanoff principle for a broad range of indications a median of 142 months (range 54 to 386) previously. We evaluated outcomes in terms of continued use and continence for each type of material used for channel formation. RESULTS: At the time of this review 165 of the 173 patients (95.4%) included in this study were alive. We included 114 women (65.9%) and 59 men (34.1%) who underwent surgery at a median age of 42 years (range 18 to 73) with a mean followup of 78.6 months (median 60, range 2 to 365). The rate of revision for all causes was higher in the ileal group than in the group with an appendiceal channel (channel stenosis rate 22.7% vs 17.2%, p = 0.39, and channel incontinence rate 36.0% vs 19.5%, p = 0.03). Although 38.7% of patients underwent major surgical revision of the channel at some point, 75.9% of channels continued to be used, of which 90.2% were continent. CONCLUSIONS: This study provides a pragmatic overview of the outcome of these challenging cases. Mitrofanoff channel formation represents a durable technique. Appendix and ileum are each a viable choice for tissue use. Tissue selection depends on availability and individual patient factors.


Assuntos
Apêndice/transplante , Íleo/transplante , Cateterismo Urinário/métodos , Coletores de Urina , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Transtornos Urinários/etiologia , Transtornos Urinários/cirurgia , Adulto Jovem
12.
Int J Nurs Stud ; 95: 1-6, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30981953

RESUMO

BACKGROUND: In pre-continent children, collection bags are frequently used as a first-line option to obtain a urine specimen. This practice, acknowledged by several guidelines for the step of UTI screening, is driven by a perception of the technique as being more convenient and less painful. However, our own experience led us to consider bag removal as a painful experience. OBJECTIVE: Our aim was to determine whether the use of an oleo-calcareous liniment to aid bag removal reduced the acute pain expressed by young children. METHODS: This prospective, randomized, controlled, single blind study was carried out in two emergency pediatrics departments. Pre-continent children aged 0-36 months admitted with an indication for urine testing were eligible for the study. Urine for dipstick test screening was obtained using a collection bag. At micturition, the patients were randomized into bag removal with (intervention group) or without (control group) liniment. Bag removal was recorded on video in such a manner as to permit independent assessments of pain by two evaluators blinded to group allocation. Pain was assessed using the FLACC scale. FINDINGS: 135 patients were analyzed: 70 in the intervention group and 65 in the control group. The median FLACC scores [interquartile range] for the intervention and control groups, respectively 4.0 [2.0-7.0] and 4.0 [3.0-7.0], did not differ significantly (p = 0.5). A FLACC score ≥4 was obtained for 56% of the patients and a score ≥7 for 28%. CONCLUSION: Removal of urine collection bags caused moderate to severe pain in half of the children included. The use of an oleo-calcareous liniment did not reduce this induced pain.


Assuntos
Dor/etiologia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Coleta de Urina/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Método Simples-Cego
13.
East Mediterr Health J ; 25(2): 90-97, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-30942472

RESUMO

Background: Surveillance of health care-associated infections (HCAIs) is an integral part of infection control programmes, especially in intensive care units (ICUs). Device-associated infections (DAIs) are a major threat to patient safety. Aim: To measure DAI rates in ICUs. Methods: Central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter- associated urinary tract infection (CAUTI) were assessed in the ICUs of 4 tertiary-care teaching hospitals in Tehran, Islamic Republic of Iran. Results: The incidence rate of CLABSI, VAP and CAUTI was 10.20, 21.08 and 7.42 per 1000 device-days, respectively. The utilization ratio for central lines, ventilators and urinary catheters was 0.62, 0.47, and 0.84, respectively. The most common organisms were Acinetobacter (33.5 %) and Klebsiella (19.0 %). Sixty to eighty percent of Enterobacteriaceae were extended- spectrum beta-lactamase producing. About half of Pseudomonas aeruginosa isolates were resistant to piperacillin/ tazobactam and carbapenem. Acinetobacter resistance rate to ampicillin/sulbactam and carbapenem was 70-80 %. The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus was 84.6 % and 83.3 %, respectively. Conclusions: This study showed high incidence rates of DAIs and resistant organisms, and appropriate interventions are necessary to reduce these rates.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Hospitais de Ensino/estatística & dados numéricos , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/etiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/etiologia , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Irã (Geográfico)/epidemiologia , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/etiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/etiologia , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia , Cateterismo Urinário/efeitos adversos
14.
Medicine (Baltimore) ; 98(8): e14417, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813142

RESUMO

BACKGROUND: Removing an indwelling urinary catheter as soon as possible is the cornerstone of catheter-associated urinary tract infections (CAUTI) prevention. However, implementing this measure may be challenging in clinical settings. To evaluate the impact of implementing a healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications among critical patients on the incidence of CAUTI. METHODS: This was a quasi-experimental study performed in a general intensive care unit of a tertiary-care hospital over a 12 years period, from January 1, 2005 to December 31, 2016. Rates of urinary catheter use and incidence density of CAUTI were monthly evaluated following the Centers for Disease Control and Prevention (CDC) criteria throughout the study period. Phase I (2005-2006) was the pre-intervention period. In phase II (2007-2010), HCWs routine training on CAUTI prevention was performed twice-a-year. In phase III (2011-2014), we implemented a daily checklist for indwelling urinary catheter indications, in addition to the biannual training. In phase IV, (2015-2016) the biannual training was replaced by training only newly hired HCWs and the daily checklist was maintained. RESULTS: The mean rate of urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). Similarly, the incidence density of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively). CONCLUSIONS: HCWs education and daily evaluation of indwelling urinary catheter indications were highly effective in reducing the rates of catheter utilization as well as the incidence density of CAUTI.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Pessoal de Saúde/educação , Controle de Infecções/métodos , Cateteres Urinários/efeitos adversos , Infecções Urinárias/prevenção & controle , Brasil , Infecções Relacionadas a Cateter/epidemiologia , Lista de Checagem/métodos , Estado Terminal/terapia , Humanos , Incidência , Unidades de Terapia Intensiva/normas , Ensaios Clínicos Controlados não Aleatórios como Assunto , Avaliação de Programas e Projetos de Saúde/métodos , Cateterismo Urinário/efeitos adversos , Cateteres Urinários/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
15.
Obstet Gynecol ; 133(4): 675-682, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870290

RESUMO

OBJECTIVE: To estimate whether the urinary force of stream method is noninferior to a standard fill voiding trial for rate of catheterization within 6 weeks after apical prolapse surgery in those discharged without a catheter. METHODS: A noninferiority randomized controlled trial was conducted in postoperative women comparing force of stream with standard fill voiding trials after vaginal, abdominal, or laparoscopic-robotic apical pelvic organ prolapse (POP) surgery. Before discharge, women in both groups were backfilled with 300 mL normal saline. Successful voiding criteria in the force of stream group was subjective force of stream of at least 50 using a visual analog scale; reporting less than 50 prompted a bladder scan. Successful voiding was defined as a postvoid residual volume of less than 500 mL. For the standard fill voiding trial group, voiding two thirds of the instilled amount indicated success. The primary outcome was the rate of catheterization within the 6-week postoperative period after surgical repair of apical prolapse among those discharged without a urinary catheter. Secondary endpoints included trial of void failure rates. A sample size of 59 patients per group who passed trial of void at discharge was needed to achieve 80% power using a noninferiority margin (delta of 10%). Total enrollment of 169 patients was necessary to account for an estimated 30% trial of void failure rate. RESULTS: From April 2016 and April 2017, 184 patients were enrolled (six enrolled before the trial registration date), with the first patient enrolled on April 1, 2016. One hundred seventy-four patients were randomized (86 in the force of stream group and 88 in the standard fill voiding trial group). No differences were observed in demographic or perioperative characteristics, except for stage 2 apical prolapse (52% in the force of stream group vs 36% in the standard fill voiding trial group). For the primary outcome, similar rates were found in those patients who passed their trial of void but subsequently needed catheterization for voiding dysfunction (force of stream 2.8% [2/71] vs standard fill voiding trial 3.1% [2/64]; difference -0.3%, 95% CI -8.69% to 8.08%). The incidence of trial of void failures at discharge was similar (force of stream 17.4% [15/86] vs standard fill voiding trial 26.4% [23/87]; risk ratio 0.65, 95% CI 0.37-1.18, P=nonsignificant). CONCLUSION: Force of stream was noninferior to standard fill voiding trial when comparing the rate of catheter insertion during the 6-week postoperative period after apical POP surgery in those discharged without a catheter. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02753920.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Cateterismo Urinário/estatística & dados numéricos , Transtornos Urinários/diagnóstico , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Slings Suburetrais/efeitos adversos , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Micção , Transtornos Urinários/terapia , Urina , Procedimentos Cirúrgicos Urogenitais/efeitos adversos
16.
BMC Anesthesiol ; 19(1): 37, 2019 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885134

RESUMO

BACKGROUND: Catheter-related bladder discomfort (CRBD) frequently occurs during recovery in patients who undergo intra-operative urinary catheterization. We conducted this study to compare the effect of intravenous lidocaine and dexmedetomidine infusion for preventing CRBD. METHODS: 120 patients undergoing elective open abdominal hysterectomy or hysteromyomectomy requiring urinary bladder catheterization were randomly allocated into three groups of 40 each. Group L received a 2 mg/kg lidocaine bolus followed by infusion of 1.5 mg/kg/h; Group D received a 0.5 µg/kg dexmedetomidine bolus followed by infusion of 0.4 µg/kg/h; Group C received a bolus and infusion of normal saline of equivalent volume. The incidence and different severity (mild, moderate, and severe) of CRBD were assessed on arrival in the postanaesthesia care unit at 0, 1, 2, and 6 h postoperatively. RESULTS: The incidence of CRBD was significantly lower in Group L and Group D compared with Group C at 0, 1, and 2 h. However, there was no significant difference among the three groups regarding the different severity of CRBD at all time points. The requirement of rescue tramadol for CRBD was lower in group L and group D than in group C. The incidence of sedation was significantly higher in Group D compared to Group L and Group C, though no difference in other adverse effects was observed. CONCLUSIONS: Intravenous lidocaine and dexmedetomidine infusion reduced the incidence of CRBD as well as the additional tramadol requirement for CRBD, but had no effect on the different severity of CRBD. TRIAL REGISTRATION: ChiCTR-INR-16009162 . Registered on 5 September 2016.


Assuntos
Dexmedetomidina/administração & dosagem , Lidocaína/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Cateteres Urinários/efeitos adversos , Adulto , Analgésicos não Entorpecentes/administração & dosagem , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Histerectomia/métodos , Infusões Intravenosas , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Tramadol/administração & dosagem , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos
17.
Hu Li Za Zhi ; 66(2): 77-84, 2019 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-30924517

RESUMO

BACKGROUND & PROBLEMS: Urinary tract infection (UTI), the most common type of healthcare-associated infection, may result from negligence of care regardless of the presence or absence of catheterization. The UTI rate in our unit was .069%, which was the highest among all of the wards in the hospital. PURPOSE: This project aimed to reduce the UTI rate to 0.37%. METHODS: In order to achieve this goal, we amended the SOPs and audit table of catheterization, enhanced access to catheterization and perineal-wash-related instructional videos using quick response (QR) codes, encouraged and reminded patients to drink plenty of water, maintained the urinary drainage system free to avoid the growth of bacterial colonies, revised related healthcare education pamphlets and posters, and organized on-the-job training sessions for nursing staff. RESULTS: The UTI rate fell from .069% to 0.030%. Moreover, patients and their families responded well to the QR code method of accessing relevant videos, which enhanced technical knowledge and made the new information easy to learn. CONCLUSIONS: The use of QR code scanning enabled patients and their families to easily and conveniently watch videos on catheterization and perineal washing on demand. Nurses may employ QR codes in health education more frequently in order to provide higher quality nursing care.


Assuntos
Tecnologia Biomédica , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Infecções Urinárias/prevenção & controle , Infecções Relacionadas a Cateter/etiologia , Infecção Hospitalar/etiologia , Hospitais , Humanos , Pesquisa em Avaliação de Enfermagem , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/etiologia
18.
Dan Med J ; 66(4)2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30910003

RESUMO

INTRODUCTION: Routine use of perioperative indwelling urinary catheterisation in fast-track total hip arthroplasty (THA) and total knee arthroplasty (TKA) is still debatable, as urinary catheterisation may cause complications. The aim of this study was to describe the incidence of re-catheterisa-tion and urologic complications during the initial 30 days following THA and TKA fast-track surgery. METHODS: We conducted a prospective, observational study of 795 patients ≥ 50 years of age who had undergone elective fast-track THA or TKA with perioperative indwelling urinary catheterisation until the first post-operative morning. Primary outcomes were number of patients keeping their catheter the first post-operative morning and the incidence of re-catheterisations before discharge. Follow-up on post-discharge complications was done by phone 30 days after surgery. RESULTS: A total of 784 of 795 included patients (98.6%) were analysed for the primary outcomes, and follow-up data were available for 760 patients (95.6%). Three patients (0.4%) kept their catheter after the first post-operative morning and 25 patients (3.2%) were re-catheterised before discharge. The median length of stay was two days (interquartile range: 1-2). The incidence of post-operative urinary tract infections (UTI) was 4.2%, and about 30% of the patients experienced pre-to-post-operative aggravation of their lower urinary tract symptoms. CONCLUSIONS: Routine use of perioperative indwelling urinary catheterisation in fast-track THA and TKA may increase the risk of post-operative UTI and does not eliminate the need for subsequent re-catheterisation. These findings speak against routine use of perioperative indwelling catheterisation. FUNDING: The study was supported by the Lundbeck Foundation and registered with clinicaltrials.gov. TRIAL REGISTRATION: clinicaltrials.gov 8 April 2014 (NCT02133768).


Assuntos
Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/epidemiologia , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
19.
Ont Health Technol Assess Ser ; 19(1): 1-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30847008

RESUMO

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.


Assuntos
Cateteres , Cateterismo Urinário/métodos , Retenção Urinária/terapia , Assistência Ambulatorial/economia , Cateteres/efeitos adversos , Cateteres/economia , Doença Crônica , Materiais Revestidos Biocompatíveis/uso terapêutico , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
20.
Pediatr Int ; 61(7): 706-711, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30779413

RESUMO

BACKGROUND: Overnight catheter drainage (OCD) is introduced to avoid overdistention of the bladder at night-time when clean intermittent catheterization proves ineffective for daytime management of neurogenic bladder. We adopted OCD using disposable silicone no-balloon (DSnB) catheters, with the distal end outside the body opening into diapers. OCD using DSnB catheter, however, had risks of retrograde bacterial contamination. Therefore, in this study, the validity of equipping DSnB catheters with check valves to prevent retrograde bacterial contamination was examined. METHODS: For the in vitro study, excised saline-filled swine bladders were drained using DSnB catheters with or without check valves, and the time required for intravesical pressure to reach 5 cmH2 O was measured. For the in vivo study, in cross-over experiments comparing DSnB catheters with and without check valves, OCD using DSnB catheters for 10 h was performed in rabbits under analgesia. Bacterial growth from urine samples before and after OCD and residual urine volume were examined. RESULTS: For the in vitro experiment, the median drainage time was 368.2 s (range, 88-1,085 s) and 344.7 s (range, 28-840 s) with and without check valves, respectively (n = 6), which was not significantly different. For the in vivo experiment, in cross-over experiments (n = 8) new bacterial growth rates after OCD did not differ, and median residual urine volume was 17.1 mL (range, 0-75 mL) and 1.2 mL (range, 0-5 mL) with and without check valves, respectively (P = 0.055). CONCLUSIONS: Installing a check valve in the DSnB catheter did not decrease new bacterial growth, while tending to increase residual urine volume. DSnB catheters without check valves appear to be better for continuous drainage of urine from bladder.


Assuntos
Equipamentos Descartáveis , Drenagem/instrumentação , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário/instrumentação , Cateteres Urinários , Animais , Estudos Cross-Over , Equipamentos Descartáveis/microbiologia , Drenagem/efeitos adversos , Drenagem/métodos , Técnicas In Vitro , Masculino , Coelhos , Distribuição Aleatória , Suínos , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos , Cateteres Urinários/efeitos adversos , Cateteres Urinários/microbiologia , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
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