Impact of the lack of community urinary catheter care services on the Emergency Department.

OBJECTIVES: To conduct an audit of patients presenting with long-term urinary catheter (LTC)-associated problems to our Emergency Department (ED) and to assess the availability of community nursing support for their LTC. We also estimated the cost implication to the health service and the potential solutions to this issue, as although catheter care is provided by community nurses, LTC problems are common presentations to the ED and are often significant burdens to the services. PATIENTS AND METHODS: A study was carried out of all patients presenting to the ED with a urinary catheter problem, specifically studying LTCs and the reason for presentation, district nurses' involvement, and the intervention received. RESULTS: In all, 78 patients with a urinary catheter problem presented to the ED over a 69-day period, of whom 59 (68%) had a LTC. In all, 33 patients (42%) attended during normal working hours between 0900 and 1700 h. The mean (range) age was 74 (42-93) years and the duration the LTC had been in situ was 11 (1-120) months. The most common reasons for attendance were blocked catheter (37 patients, 47%) and catheter-bypass (18, 23%). Only 28 patients (36%) were known to district nursing services, and 14% were referred by a district nurse. Most of the remaining patients self-referred to the ED. No patient had any documented contact with their general practitioner. In addition, 64 patients (82%) had their catheter issues addressed adequately by ED nurses or doctors, without any urology involvement. CONCLUSIONS: The high morbidity of LTCs causes a considerable demand on ED services, and has heavy cost implications to the health system. Most patients had minimal community nurse support, and their catheter problems were easily dealt with by ED nurses and doctors.

Using no-rinse skin wipes to treat incontinence-associated dermatitis.

Individuals who suffer with incontinence, especially in relation to faeces, will often be at risk of skin breakdown and develop incontinence-associated dermatitis (IAD) which, if left untreated, can lead to pressure ulcer formation ( Gray, 2004 ). IAD is caused by increased, unrelieved moisture against the skin, usually from liquid faeces and urine, which can then weaken the skin integrity. The integrity of the skin in this area is also at risk of pressure ulcers caused by shear or friction ( Beeckman et al, 2010a ). Treatment and prevention of IAD lesions involves a three-step process used in post-incontinence episodes, which includes cleansing, moisturisation and protection of the skin ( Beeckman et al, 2011a ). Using a wipe covers all of these steps immediately following incontinence episodes ( Rönner et al, 2010 ). This reduces the need to gather a number of different items required for post-incontinence skin care, which usually includes a dry wipe to be soaked in soapy water to wash the skin, a moisturiser to replace lost moisture and a skin protectant to prevent moisture from direct contact with the skin ( Foxley and Baadjies, 2009 ). This article will give some examples of the use of a particular continence and cleansing wipe in clinical practice.

Use of near infrared spectroscopy as an alternative to videourodynamics to detect detrusor overactivity in women with the overactive bladder syndrome.

OBJECTIVE: To evaluate near infrared spectroscopy as a noninvasive alternative to cystometry for detecting detrusor overactivity in women with overactive bladder (OAB). Although cystometry is considered the "gold standard" investigation for the lower urinary tract, it is invasive. Recently, a noninvasive form of assessment of the lower urinary tract has been introduced using near infrared spectroscopy. METHODS: This was a prospective pilot study. Women with symptoms of OAB, referred to a tertiary referral one-stop urodynamics clinic were studied. A urodynamic diagnosis was made according to the International Continence Society guidelines. The near infrared spectroscopy monitoring results were analyzed by an independent near infrared spectroscopy Clinical Research Assessor. Both the urodynamics and near infrared spectroscopy assessors reported whether detrusor overactivity was present. Primary outcome measurement was the performance of near infrared spectroscopy as a new diagnostic test. We evaluated the performance of this by calculating the sensitivity and specificity. The clinical usefulness of near infrared spectroscopy was evaluated using positive and negative predictive values. RESULTS: One hundred patients were recruited of whom 95 had traces that could be interpreted. Thirty-one patients were found to have detrusor overactivity on cystometry. Twenty-five of these patients (26%) had detrusor overactivity on near infrared spectroscopy analysis. In 6% of these cases, no near infrared spectroscopy changes identified as suggestive of detrusor overactivity were seen. No detrusor overactivity was detected by cystometry in 64 patients, and in 19% of cases by near infrared spectroscopy. Forty-six patients (48%) had near infrared spectroscopy monitoring events identified as detrusor overactivity but no cystometry changes diagnostic of detrusor overactivity. CONCLUSION: The results of our study suggest that near infrared spectroscopy is an unreliable method for detecting detrusor overactivity in women with OAB symptoms.