Efficacy of Trauma Catheter and Mushroom Tip Catheter in Evacuation of Chronic Subdural Hematoma and Complications of Drain Placement.

Objective The aim of this study was to assess the efficacy and complications of trauma catheter versus mushroom tip catheter placement in the evacuation of chronic subdural hematoma via twist drill craniostomy with closed system drainage. Background Chronic subdural hematoma (cSDH) is one of the most frequent neurosurgical pathologies in patients >70 years of age with an estimated incidence of 8.2 per 100,000 people per year. The most common risk factors for cSDH are advanced age, alcohol abuse, seizures, cerebrospinal fluid (CSF) shunts, coagulopathies, blood thinners, and patients at risk for falling. Twist drill craniostomy can be performed at the bedside under local anesthesia, making it an attractive treatment option, especially in poly-morbid patients who are poor surgical candidates. A closed drainage system is placed at the time of surgery to allow continuous drainage and promote postoperative brain expansion. Despite the increasing prevalence, limited literature exists to guide surgical management, particularly in terms of drain management and selection of catheter.  Methods This is a retrospective review of 205 patients from January 2007 to May 2017 at two-level high volume centers for the evaluation and treatment of cSDH. Inclusion criteria include patients >18 years of age with the radiographic presence of a subdural hematoma for greater than three weeks. All patients were managed with either a trauma catheter or mushroom tip catheter. All patients received computed tomography (CT) of the head without contrast prior to subdural drain placement and within 24 hours after subdural drain removal. Exclusion criteria include patients <18 years of age and patients with depressed skull fractures, vascular malformations, subdural empyema, subdural hygroma, or who initially underwent open craniotomy or burr-hole craniotomy. Results Drain efficiency in evacuating the cSDH was assessed using both radiographic and clinical markers. Analysis of 205 patients treated by twist drill craniostomy and the subsequent closed system drainage utilizing either the mushroom tip catheter or trauma catheter revealed that neither catheter was superior in producing a statistically significant change in the maximum thickness of the cSDH (p = 0.35) and midline shift (p = 0.45). Furthermore, when assessing patients clinically via utilization of the Glasgow Coma Scale (GCS), both the trauma catheter and the mushroom catheter did not show a statistically significant difference in improving GCS after the evacuation of the cSDH (p = 0.35). Neither catheter was associated with an increased incidence of hemorrhage with drain placement requiring open surgery (p = 0.12), need for additional drain placement (p = 0.13) or decline in GCS with intervention (p = 0.065). Conclusion Analysis of the 205 patients treated by twist drill craniostomy with closed system drainage for the evacuation of chronic subdural hematoma utilizing either the mushroom tip or trauma catheters revealed that neither catheter was statistically significant in radiographic or clinical improvement in evacuating cSDH. Furthermore, neither catheter was found to be associated with an increased complication risk.

Impact of an aseptic procedure for breaking the integrity of the urinary drainage system on the development of catheter-associated urinary tract infections in the intensive care unit.

BACKGROUND: Catheter associated urinary tract infections (CAUTI) are a common complication in the hospital, especially in intensive care units (ICU). These infections are directly linked to the use of an indwelling urinary catheter. One commonly identified factor related to the development of CAUTI has been thought to be violating the integrity of the closed drainage system. However, a paucity of research exists to support or refute this practice. OBJECTIVE: The primary purpose of this observational study was to assess if there is a relationship between CAUTI incidence and breaking the closed drainage system using an aseptic procedure. METHOD: A process improvement effort was developed to ensure an aseptic technique was utilised when there was a need to break the integrity of the urinary drainage system. Because this was a new practice and not supported by the Centres for Disease Control (CDC) recommendations, this change in practice was evaluated as an observational study. RESULTS: In an eight month period there were 53 documented breaks in the urinary drainage system. There were 28 total cases of CAUTI overall during this same time period. Only four patients with a system break developed a CAUTI (7.5%). In almost 93% of the patients where aseptic technique was used for breaks in the drainage system, there was no occurrence of CAUTI. A follow-up evaluation was performed after a year of this practice in three adult ICUs. During this three month evaluation period, there were 47 documented cases of breaking this system using aseptic technique. Of the patients who had a documented break in their drainage system, none developed subsequent CAUTIs. CONCLUSION: One commonly identified factor related to the development of CAUTI has been thought to be violating the integrity of the closed drainage system. However, a paucity of research exists to support or refute this practice. This observational study found that utilising an aseptic technique to break the integrity system did not result in an associated increase in CAUTI.

Application of multi-function anti-reflux drainage connector in prevention from catheter-associated urinary infection / 中华护理杂志

Objective To evaluate the effects of a self-designed multi-function anti-reflux drainage connector on preventing catheter-associated urinary infection in patients with long-term indwelling catheters.Methods A total of 100 elderly males with indwelling catheters from 10 nursing homes in our city were selected and randomly divided into the control group (n=50) and the experimental group (n=50) from January 2013 to December 2015.The patients in the control group were indwelled with Foley catheters and connected with an ordinary disposable drainage bags;the patients in the experimental group were indwelled the same catheters and connected to disposable drainage bags with an multi-function anti-reflux drainage connector.Patients' urine in catheters and drainage bags from two groups were collected for urine culture on 7th,14th,21st,28th days.The cases of catheter plugging on the 7th,14th,21st,28th days and the cases of catheter encrustation on 28th day in two groups were recorded.Results The cases of bacteriuria on the 7th,14th,21st,28th days in the experimental group were significantly less than those in the control group (P＜0.05),and were also significantly less than those in the drainage bags in the same group (P＜0.05).The cases of catheter plugging on the 7th,14th,21st,28th days were not significantly different between two groups(P＞0.05).The cases of catheter encrustation on the 28th day in the experimental group were significantly less than those in the control group (P＜0.05).Conclusion Multi-function anti-reflux drainage connector can safely and effectively prevent catheter-associated urinary infection,reducing bacteria ascending with reflux of urine as well as catheter encrustation.

Application of one-time anti-reflux multi-function drainage bag in clinic / 中国实用护理杂志

Objective To investigate the effect of one-time anti reflux multi-function drainage bag in clinical application.Methods A total of 125 cases of benign prostate hyperplasis (BPH) were treated with transurethral resection of prostate (TURP) from October 2012 to March 2013 at our hospital of uropoiesis surgical department.All the cases were randomly divided into the control group (63 cases) and the experimental group(62 cases).The three cavities balloon catheter was connected with common drainage bag in the control group,and with one-time anti-reflux multi-function drainage bag in the experimental group.The urine in catheters and drainage bag of 3,5,7 days postoperatively in two groups was sampled for urine culture.The cases of daily urine tube plugging and daily drainage bag reflux in two groups were observed respectively.Results The cases of bacilluria significantly reduced in catheters of the experimental group compared with the control group and the drainage bag of the experimental group,respectively.The cases of bacilluria was significantly reduced in drainage bag compared with the control group.The cases of drainage bag reflux was significantly reduced compared with the control group.The cases of bacilluria in catheter and drainage bag had no significant difference in the control group.The cases of catheter plugging had no significant difference between two groups.Conclusions One-time anti reflux multi-function urine drainage bag can effectively prevent bacteria and reflux,and make the drainage system in a closed state.It has obvious advantage to prevent the happening of the retrograde infection compared with the common drainage bag.