Choice Of Catheter Research Articles

318 - Examining the Impact of Intermittent Self-Catheterization on Quality of Life and Catheter Choice Preferences: Insights from the Continence Care Registry

318 - Examining the Impact of Intermittent Self-Catheterization on Quality of Life and Catheter Choice Preferences: Insights from the Continence Care Registry

Techniques to Optimize Radioembolization Tumor Coverage.

Yttrium-90 (Y90) radioembolization has become a major locoregional treatment option for several primary and secondary liver cancers. Understanding the various factors that contribute to optimal tumor coverage including sphere count, embolization techniques, and catheter choice is important for all interventional radiologists while planning Y90 dosimetry and delivery. Here, we review these factors and the evidence supporting current practice paradigms.

Hemodialysis Catheter Choice in Acute Kidney Injury Patients

Hemodialysis Catheter Choice in Acute Kidney Injury Patients

Abstract 15220: The Thermal Characteristics to Phrenic and Esophageal Injuries During Ablation of QDOTMICRO (50w-Qmode and 90w/4sec-Qmode+) vs 50w-TactiCath SE vs 50w-Thermocool Smart Touch: Findings From an In-Vivo Porcine Study

Introduction: Recently, there have been numerous strategies for treating atrial fibrillation, including the choice of catheters However, the thermal characteristics of each catheter, particularly in terms of safety, have not been fully understood. Hypothesis: Our aim was to characterize the thermal damage to collateral tissues during 50W-HPSD ablation and 90W/4sec-vHPSD ablation using three different ablation catheters. Methods: In 28 pigs, we implanted thermocouples on the superior vena cava, close to the phrenic nerve, and on the esophageal, close to the inferior vena cava. We performed endocardial ablation near the fiducial markers of the thermocouples using three different RF catheters: ablation index (AI)-guided HPSD (Qmode) and vHPSD ablation (Qmode+) with QDOTMICRO, lesion size index-guided HPSD ablation (targeting 5.0) with TactiCath Sensor Enabled (Tacti), and AI-guided HPSD ablation (targeting 400) with Thermocool Smart Touch (STSF). We measured tissue temperatures during ablation, including maximum tissue temperature (Tmax), time to maximum tissue temperature (t-Tmax), time to achieve a lethal temperature of 50°C (t-50°C), and time to return to baseline from Tmax (t-Tbase). Results: In terms of the frequency of esophageal injury, there were no significant differences among the different catheters. However, the depth of esophageal injury from the adventitia showed a significant difference. In terms of phrenic nerve injury, Tacti had the highest frequency compared to the other catheters (100%, p=0.0012). Tmax, t-Tmax, t-50°C, and t-Tbase showed significant differences, as shown in figure. Conclusions: The thermal effects on collateral tissues differ among the three different catheters and settings. STSF and Qmode result in a gradual increase in tissue temperature, while Tacti and Qmode+ lead to a rapid temperature increase. These distinct thermal distributions may contribute to the risk of phrenic nerve and esophageal injuries.

Abstract 13492: Optimal Fluoroscopy Views and Catheter Selection for Coronary Angiography in Porcine Models

Coronary angiography is the gold standard for the diagnosis and treatment of epicardial coronary artery disease. Further, it is an essential tool for conduction of translational cardiac research on large animal models, in the development of novel cardiac therapies. While in humans coronary angiography has an exceedingly low mortality rate; in pigs, procedural mortality has been reported as high as 15%, likely due to unsuitable variations in angiographic techniques. Porcine models are used due to the resemblance of cardiac function and anatomy to humans. However, procedural guidelines delineating proper equipment to be used for angiography in this model has yet to be systematically assessed. Aims: To evaluate clinically common catheters for their utility in the safe engagement of the coronary vessels in pigs. Establish optimal workflow and fluoroscopy views for safe coronary artery engagement and angiography. Method/Results: Percutaneous superficial femoral artery access was acquired via ultrasound guidance and subsequent cardiac catheterization was performed in sus domesticus weighing 35-50 kg. Catheters that were tested included the JL 2.5, JL3.0, JR 3.0, AR1, AL1, MPA1, Champ1, 3DRC, hockey stick and RCB (5-7 french) operated over a standard .035 J tip wire. AP views were optimum to engage both the left and right coronary vessels. Only AR1, 3DRC, and hockey stick catheters successfully engaged the RCA, while all catheters tested could successfully engage the LCA. AR1 was noted to be the best for RCA engagement and AL1 for Left system engagement. AR1 was also the most succesful in engagement of both LM and RCA in same pig. AL1 provided the most stable engagement for Left coronary system. AR1/JL were better for LAD intervensions. AL1 is best for LCX intervensions Conclusion: We present a systematic description of percutaneous coronary angiographic procedures highlighting that AL for the LCA and AR for the RCA are the best choice of catheters for fastest and safest engagement of the coronary arteries limiting both radiation time and contrast use. While variations in anatomy can mandate changes in angiographic angles and catheter techniques, AP visualization and use of AL and AR catheters provided the most consistent and effective approach for porcine angiography.

70 Purpose-built Catheters for Minimally Invasive Surfactant Therapy – Experience from a Canadian Tertiary Level Neonatal Intensive Care Unit

Abstract Background Surfactant delivery via a thin endotracheal catheter during spontaneous breathing (a technique called minimally invasive surfactant therapy [MIST]), is an increasingly popular alternative to intubation and surfactant administration. Procedural details among different centres vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multiaccess catheters and vascular catheters for this purpose. Recently, purpose-built catheters for MIST received regulatory approval in Canada and became available for use. Procedural differences and user experiences between such catheters have not been described. Objectives The aim of this study was to describe procedural success, procedural adverse effects and user experience pertaining to two different types of purpose-build catheters (BLEScath™ and Surfcath™) for surfactant administration. Design/Methods This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit (NICU) in Southwestern Ontario. Neonates who received MIST using purpose-built catheters between January 1, 2021 and March 31, 2022 were included. Two types of purpose-built catheters were used in this time period: Surfcath™ and BLEScath™. Relevant baseline characteristics and data on procedural details (premedication, type of catheter) were collected. The procedural success, number of attempts and adverse effects among neonates who received MIST via Surfcath™ and those who received surfactant via BLEScath™ were compared, using chi-square tests or Fisher’s tests, as appropriate. User experience was described using an ease-of-use scale. Descriptive reports of user experience were collected and explored for themes/patterns. P-values <0.05 were considered statistically significant. Results 37 neonates met eligibility criteria; 22 received MIST via Surfcath™, whereas 15 received MIST via BLEScath™. Success rates were 91% in SurfCath™ and 93% in BLES-Cath (P> 0.994). Failed attempts were lower in Surfcath™ (23%) compared with BLEScath™ (33%), but the difference was not statistically significant (p=0.708). Upon analyzing ease-of-use by operators, we found that 90% of operators found Surfcath™ very easy or relatively easy to use, compared with 43% of users reflecting the same degree of use with BLEScath™ (P=.021). Users described difficulty in ‘maneuvering’ the BLEScath™ and reported it to be ‘pliable/ flimsy’. There was no difference in adverse events between groups. Conclusion This is the first study in Canada to report the experience of MIST with purpose-built catheters. Overall success rate was equally high for both catheters. Users subjectively reported higher ease of use with SurfCath™. Commercially available purpose-built catheters should facilitate universal adaptation of the MIST method. Our reports regarding operator experience may help with optimizing future product design to improve ease-of-use.

The effects of catheter choice on accessory pathway mapping efficiency

Abstract Funding Acknowledgements: Type of funding sources: None. Recent studies have assessed the use of a novel high density (HD) mapping catheter in pediatric patients, finding that the catheter is safe and effective in this population. However, there is a lack of understanding on use patterns of HD mapping technologies in this population and how these patterns affect intraprocedural workflows. The objective of this analysis was to assess the role of mapping catheter choice on the efficiency of accessory pathway localization and ablation in patients with structurally normal hearts treated in a pediatric EP setting. Acute data from 61 accessory pathway ablation cases in patients treated in a pediatric EP setting were prospectively collected from 14 hospitals in 6 countries in Europe and the US. Choice of mapping tools and strategy was left to physician discretion. Procedure data such as map collection duration and statistics were compared across three mapping catheter choices: Ablation Catheter (AC) (n=42), Linear Catheter (LC) (n=9), and HD Grid Catheter (HDC) (n=10). Of the 61 procedures, 16 cases were patients aged 0-12 years (26%), 34 aged 13-17 years (56%), and 5 aged 18+ years (18%). Distribution of catheter use was similar across age groups with HDC use of 13%, 15%, and 27%, respectively. Pathway location did not correlate with catheter choice. There was 0% incidence of congenital heart disease. Mean mapping times in the AC, LC, and HDC groups were 20.6±15.8, 18.8±12.9, and 14.2±13.8 minutes, respectively; differences in mapping times were not statistically significant but trended lower with higher density mapping. The mean number of mapping points used in each group was 44±46, 101±62, and 1521±908 points, respectively (p<.01). Ablation was attempted in 57 (93%) of cases with 100% acute success eliminating accessory pathway conduction. Ablation time was analyzed in patients receiving RF ablation (93% of treated; n=53); mean RF time was 526s in the AC group, 369s in the LC group, and 367s in the HDC group; differences were not statistically significant (p>.05). All groups had similar ablation target technique distributions including timing map and signal morphology. Mean procedure time was 2:11 (h:mm) in the AC group, 1:56 in the LC group, and 1:44 in the HDC group; differences were not statistically significant. Analysis of this cohort of pathways in a pediatric setting shows multipolar catheters may provide more mapping information in shorter times. RF ablation and procedure times also trend shorter in procedures with HD Grid used for mapping, regardless of anatomic location of pathway. Further analysis in a larger cohort may be warranted to validate these findings and explore use of open window mapping described elsewhere.

Radiofrequency ablation of the great saphenous vein; does the choice of monopolar or bipolar catheters affect outcomes?

Radiofrequency-based procedure is one of the leading methods of endovenous thermal ablation. The most fundamental difference with regards to currently available radiofrequency ablation systems is the way of electric current flow given to the vein wall; bipolar segmental and monopolar ablation. This study aimed to compare the monopolar ablation method with conventional bipolar segmental endovenous radiofrequency ablation method for the management of incompetent saphenous veins. Between November 2019 and November 2021, 121 patients with incompetent varicose veins who were treated either with the F-Care/monopolar (N = 49) or ClosureFast/bipolar (N = 72) were included in the study. A single extremity of each patient with isolated great saphenous vein insufficiency was enrolled. The differences between the two groups in demographic parameters, disease severity, treated veins, peri- and postoperative complications, and treatment efficacy indicators were retrospectively evaluated. There was no statistically significant difference between the groups regarding demographic parameters, disease severity, and treated veins in preoperative period (p > 0,05). The average procedural time was 21.4 ± 4minutes in the monopolar group, while it was 17.1 ± 3minutes in the bipolar group. In both groups, the venous clinical severity scores declined significantly compared with the preoperative period, however; there was no difference between groups (p > 0,05). The occlusion rate of the saphenofemoral junction and proximal saphenous vein after 1year was 94.1% in the bipolar group and 91.8% in the monopolar group (p = 0.4) while there was a significant difference in the occlusion rate of the shaft and distal part of the saphenous vein (93.2% in the bipolar group and 80.4% in the monopolar group, p = 0.04). Postoperative complications (bruising and skin pigmentation) were slightly higher in the bipolar group (p = 0.02, p = 0.01). Both systems are effective in treating the venous insufficiency of the lower extremity. Monopolar system revealed a better early postoperative course with similar occlusion rate of the proximal part of saphenous vein compared with bipolar system, however; the occlusion of the lower half of the saphenous vein was significantly lower which may negatively affect long-term occlusion rates and recurrence of the disease.

PO-04-110 MAPPING TRENDS IN AVNRT ABLATION: AN INTERNATIONAL ANALYSIS

Electroanatomic mapping (EAM) in AVNRT procedures is an ongoing area of interest due to AVNRT prevalence and safety considerations, particularly in pediatric populations. The utility of voltage mapping to identify the slow pathway has been documented. However, use of mapping techniques differs widely across geographies, and trends in clinical practice of these techniques and the acute outcomes have not been quantified. To assess mapping patterns in AVNRT procedures by geography. Acute observational data from 484 AVNRT procedures were prospectively collected from 125 centers in 12 countries in North and South America, Europe, and Australia. Choice of mapping and ablation strategy was left to physician discretion. Procedure data (mapping approach, catheter choice, and number of Ablation lesions required Before Consolidation (ALBC)) were compared to analyze acute outcomes and regional use trends. There was a significant difference in EAM use in AVNRT cases in the US vs. OUS (89.5% vs. 64.5%, respectively, p<.05). Low voltage bridge (LVB) mapping was the most frequently used technique globally; 37.7% of US and 52.7% of OUS cases (p<.05). Wavefront collision mapping (WFC) and Local Activation Time (LAT) mapping applying isochronal late activation mapping concepts saw high use in the US (WFC: 28.2%, LAT: 22.3%) but infrequently OUS (7.5%, p<.05; 4.3%, p<.05). Fractionation mapping was uncommon in all regions (US 1.4%, OUS 0%; p>.05) (Figure 1). There was a significant decrease in ALBC between procedures that used EAM and those that did not (4.39±5.5 and 6.6±9.0 ablation lesions, respectively, p=.01). ALBC was also significantly different by mapping catheter choice, with cases that used HD Grid requiring fewer ablation lesions than cases that mapped with ablation or linear catheters (3.7±3.9, 5.4±7.1, and 6.0±6.8, respectively, p=.02). There was a significant difference in mapping catheter choice in the US vs. OUS (Table 1). In all regions analyzed, LVB mapping was the most common EAM technique and ablation catheters were the most commonly used mapping catheter. There were significant regional differences in the rate of EAM use and technique. Procedures that used EAM required fewer ALBC, an effect further amplified in the cases using HD Grid. Therefore, use of both EAM and HD Grid may help to minimize ALBC in AVNRT, an important safety and efficiency consideration. Further analysis exploring long-term efficacy by approach in a protocol-driven cohort may be warranted.Tabled 1Table 1.USOUSAblation Catheter54.0% (n=122)58.1% (n=111)HD Grid30.1% (n=68)34.6% (n=66)Linear Mapping Catheter16.0% (n=36)7.3% (n=14)Prevalence of mapping catheter choices compared between cases in the US and OUS. All differences were significant (p<.05) Open table in a new tab

PO-02-075 ASSOCIATIONS OF DEMOGRAPHICS AND COMORBIDITIES WITH LEFT ATRIAL SCAR BURDEN IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION UNDERGOING CATHETER ABLATION FROM THE REAL-AF REGISTRY

Previous research has shown that women are more likely to suffer significant complications of atrial fibrillation (AF). Scar burden at catheter ablation (CA) may indicate substrate and disease progression, but data are conflicting from small studies. Issues with voltage data include choice of mapping catheter, rhythm mapping was performed in, voltage cut-off used, and how truly representative low voltage is of scar. To examine the relationship of LA scar to demographics and patient comorbidities in a large registry of patients undergoing first-time radiofrequency AF ablation for persistent AF (PsAF). The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal AF and PsAF Using Novel Contact Force Technologies registry (Real-AF) is a prospective, observational, multicenter registry of over 5,000 patients undergoing CA with follow-up at 6 and 12 months. We evaluated 1,431 eligible patients among this cohort by using independent sample t and chi square testing to identify associations of demographics and comorbidities with degree of LA scar burden >= 5%, calculated from CARTO as total % LA area < 0.50mV bipolar. Mapping was performed using the Pentaray catheter and subgroup analysis was prespecified in those mapped during sinus. Mean age was greater among patients with LA scar burden ≥ 5% (66 vs 72 years, p<0.001). Women were more likely than men to have LA scar (55% vs 31%, p <0.001). Congestive heart failure (CHF) was associated with greater LA scar burden as well (46% vs 37%, p = <0.001). CHADSVASc was also greater in patients with LA scar (2.8 vs 3.6, p<0.001). Patients with scar were more likely to undergo substrate modification (SM) during ablation (85% vs 47%, p = <0.001). Among a subgroup of patients presenting in sinus (n=344), all above associations remained significant other than that of CHF and increased LA scar (46% vs 37%, p = 0.12). In early outcome data, LA scar was not predictive of increased AF recurrence 12 months following ablation compared to scar burden < 5% (24% vs 17%, p = 0.075). Increased LA scar burden was associated with female sex, greater age, CHADSVASc and CHF. As a categorical variable, there was no significant correlation between scar burden at time of first ablation and AF recurrence at 12 months, but further data is pending. This is the largest study to our knowledge to investigate correlation of patient characteristics and AF recurrence with degree of LA scarring in patients with persistent AF.

Central venous catheter-associated complications in pediatric patients diagnosed with Hodgkin lymphoma: implications for catheter choice.

PurposeThe purpose of this study was to determine the most optimal central venous catheter (CVC) for pediatric patients with Hodgkin lymphoma (HL) in terms of complications.MethodsA retrospective study including patients diagnosed with HL from 2015 to 2021 at the Princess Máxima Center was performed. Patients were followed from CVC insertion until removal or 06–2021, whichever came first. The primary outcome was the CVC-related complication incidence rate (IR) per 1000 CVC-days. Furthermore, the incidence rate ratio (IRR) was calculated by comparing complication IRs between peripherally inserted central catheters (PICC) and totally implantable venous access ports (TIVAP). Additionally, risk factors for central venous thrombosis (CVT) were identified.ResultsA total of 98 patients were included. The most frequently observed complications were local irritation/infections (18%; IR 0.93), malfunctions (15%; IR 0.88), and CVC-related CVTs (10%; IR 0.52). Single lumen PICCs were associated with a higher risk of complications (49% vs. 26%; IRR 5.12, CI95% 2.76–9.50), severe complications (19% vs. 7%; IRR 11.96, CI95% 2.68–53.42), and early removal (18% vs. 7%; IRR 9.96, CI95% 2.18–45.47). A single lumen PICC was identified as a risk factor for CVC-related CVT when compared to TIVAPs (12% vs. 7%, IRR 6.98, CI95% 1.45–33.57).ConclusionThe insertion of a TIVAP rather than a PICC should be recommended for pediatric patients with HL, especially in the presence of CVT-related risk factors. Future trials should evaluate the efficacy and safety of direct oral anticoagulants for the primary prevention of CVT in pediatric patients with a PICC and other CVT-related risk factors.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-022-07256-3.

Computed Tomographic Analysis of Aortic Arch Branching Patterns: Revisited

Branching pattern of aortic arch (AA) has a direct impact on the outcomes of thoracic surgical and angiographic procedures. Since, geographical variations in the branching pattern of AA have been described, this descriptive cross-sectional study describes the AA variations in a Sri Lankan population compared to the available global data. For that, contrast-enhanced computed tomographic studies (CTC) of thorax (n = 219) performed in males (49.3%) and females (50.7%), aged 59 ± 17 years (range: 4 to 96 years), were evaluated. Branching patterns of AA were categorized into seven types as described by Popieluszko et al. Only, four AA types were identified in the study population: type 1 (90%; n = 197), type 2 (n = 10, 4.6%), type 3 (n = 8, 3.7%), and type 6 AA (n = 4; 1.8%). The prevalence of AA variations was 10%. Type 1 AA was the most prevalent pattern in both genders: female, 91%; males, 88.9%. The most prevalent AA variant in females was type 2 (n = 6; 5.4%); males type 3 (n = 5; 4.6%). However, the branching pattern of AA has not demonstrated a significant gender influence (odds: 0.792; 95% CI: 0.327–1.917; p = 0.605). Variations in branching pattern of AA are as high as 10% among Sri Lankans. Thus, an in-depth knowledge on population specific prevalence of AA variants would influence the modifications of surgical approaches and the choice of angiographic catheters to be utilized, which in turn would minimize inadvertent vascular injuries during thoracic surgical and angiographic interventions.

Peritoneal dialysis in very low and extremely low birthweight infants: A pooled analysis.

Peritoneal dialysis (PD) represents an important therapeutic option in neonatal acute kidney injury (AKI), although evidence regarding its effects in preterm neonates remains unclear. The present study aims to evaluate the feasibility of PD in very low birthweight (VLBW) and extremely low birthweight (ELBW) infants and clarify the association of catheter choice with clinical outcomes. Medline, Scopus, Web of Science, Clinicaltrials.gov and CENTRAL databases were systematically searched from inception to 15 January 2021. Studies reporting individual participant data of VLBW and ELBW infants treated with PD were selected. Overall, 20 studies were included comprising 101 patients. Catheter-related complications were significantly more frequent among ELBW infants (odds ratio: 5.18, 95% confidence intervals (CI): 1.23-29.09). After inverse probability treatment weighting, compared to drainage catheters, death risk was significantly lower with the use of PD (hazard ratio: 0.42, 95% CI: 0.19-0.90) but not vascular catheters (hazard ratio: 0.58, 95% CI: 0.28-1.20). Similarly, kidney function loss was significantly lower only with the implementation of PD catheters (hazard ratio: 0.44, 95% CI: 0.21-0.94). PD is a feasible kidney replacement therapy modality in VLBW and ELBW infants with AKI. The use of drainage catheters may be linked to significantly worse kidney recovery and overall survival rates, compared to PD catheters. Future cohorts should confirm the most appropriate catheter type and contribute to the standardisation of PD procedures.

Redo accessory pathway ablation in the pediatric population

BackgroundLiterature reports 5% of recurrence/failure in paediatric accessory pathway ablations. Our aim was to investigate the reasons underlying this finding and share techniques to obtain long-term success.MethodsThirty-nine paediatric patients referred for a repeat procedure were analysed: characteristics of the pathways and the initial and redo procedures were identified.ResultsMean age was 11.9 ± 3.3 years (59% males). Three patients (8%) had multiple accessory pathways. The most frequent location was left lateral (26%). Left sided pathway recurrence was caused mainly by poor contact (60%) and inadequate mapping (40%). For right lateral accessory pathways, poor contact accounted for 70% of failures. For antero-septal and para-Hisian locations, the use of cryoablation and choice of low radiofrequency energy delivery accounted for > 75% of failures. Long-term success strategies included choice of contact force catheters and radiofrequency applications at the ventricular insertion of the pathway and in the aortic coronary cusps. In postero-septal substrates, the main reason accounting for failure was deep or epicardial location of the pathway (37%), solved by using an irrigated tip catheter or applying lesions within the coronary sinus, or applications from both right and left postero-septal areas.ConclusionAcute failure and post-procedure recurrence in paediatric accessory pathway ablations have multiple reasons related to the characteristics of the pathway and the technology available. Accurate understanding of the anatomy, careful mapping and pacing manoeuvers, and incorporation of new technologies contribute to achieve a definitive success in > 98% of procedures.

In vitro flow rates through five different catheters intended for intravenous use in horses at two different heights

SummaryBackgroundFluid therapy is an important component of equine practice. The choice of intravenous catheter is likely to impact fluid flow rates, which is of relevance in clinical cases.Objectives(i) To assess fluid flow rates through five different equine catheters; (ii) to evaluate the impact of height on fluid flow rates and (iii) to compare agreement of flow rates achieved through identical catheters.Study designIn vitro experimental study.MethodsFlow rates were measured through five different equine catheters (2 × 14, 13, 12 and 10‐gauge) at 150 and 200 cm from ground level. Each catheter was attached to a standardised fluid administration system, time taken to reach 1000 g of fluids was measured. Three catheters were used to assess the agreement between identical catheters. Statistical analysis: (i) one‐way ANOVA assessed whether catheter type influenced flow rate and a post‐hoc Tukey's test compared mean flow rates with all other flow rates; (ii) two‐way ANOVA assessed whether height and catheter type influenced the flow rate. Finally, (iii) an intraclass correlation assessed how closely flow rates from identical catheters resembled each other.Results(i) The fastest mean flow rates were achieved through the 10‐gauge catheter at 150 (14.1 L/h) and 200 cm (17.8 L/h). (ii) Mean flow rates through all five catheters increased by a range of 25.4–28.6% at 200 vs. 150 cm. (iii) There was excellent agreement between mean fluid rates through identical catheters (intraclass correlation 0.994–0.998).Main limitationsFlow rates achievable in vivo are likely to be lower. We used water which may have a different viscosity compared with fluids used commonly in equine practice.ConclusionsFluid flow rates can be increased using wider bore catheters and increasing the height of the fluid bag. There is excellent agreement between fluid flow rates through identical catheters.

Catheters in urology: Indications and management in daily practice for the nurse

The urology nurse cares for patients wearing many different types of urinary catheters. Her role in the management of these devices in external care, clinical units, operating room or at home is fundamental. We performed a state of the art of good practices and of the up to date knowledge regarding the indication, placement, and specific care of these devices, which are every day more numerous on the market. Indwelling bladder catheter are placed, daily managed and removed by nurses, depending on an initial medical indication. The type of catheter must be adapted to the patient and to the clinical situation. Its daily care and management should allow not only the best comfort for the patient, but also an efficient management of the associated infectious risk. The placement of ureteral catheters (simple monoJ, double J or nephrostomy), are mainly of surgical initial indication. We developed what we thought was compulsory knowledge about them for an operating theater's nurse. The associated care for urology's nurses is also detailed. This inventory of available urinary catheter's, of their indications and management, aims to be a help for the urology nurse in her daily practice. Her/his role is essential in the choice of the adequate catheter and in its correct management, not only for the urologist but also for the patient himself.

13 Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Surfactant delivery via a thin endotracheal catheter during spontaneous breathing, a technique called minimally invasive surfactant therapy (MIST), is an alternative to intubation and surfactant administration. Procedural details among different centres vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multi-access catheters, vascular catheters and, recently, custom-designed catheters for this purpose. The impact of choice of catheter on procedural success and adverse effects has not been reported. Objectives The objective of the present study was to compare the procedural success and adverse effects of MIST, using a semi-rigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multi-access catheter (MAC). Design/Methods This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics, data on procedural details (premedication, type of catheter) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath were compared using a Chi Square test or Fisher’s test, as appropriate. A P value of less than 0.05 was considered significant. Results A total of 139 neonates received surfactant via MIST method during the study period. 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two groups were similar (Table 1). A higher proportion of neonates in the Angiocath group received atropine (100% vs. 76%, P =.002] and fentanyl (98% vs. 36%; p&amp;lt;0.001) than the MAC group. The procedural success was 91% in the Angiocath group and 89% in the MAC group (p &amp;gt;.99). Multiple attempts were needed in 24% of neonates in the Angiocath group, and 37% in the MAC group (p=0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%) (P=0.012). Other rates of common adverse effects were similar between the two groups (Table 2). Conclusion The overall procedural success of MIST was similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with Angiocath use, though this difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, possibly related to higher use of procedural sedation in this group.

Impact of Catheter Choice on Procedural Success of Minimally Invasive Surfactant Therapy.

Surfactant delivery via a thin endotracheal catheter during spontaneous breathing; a technique called minimally invasive surfactant therapy (MIST) is an alternative to intubation and surfactant administration. Procedural details among different centers vary, with marked differences in the choice of catheter to instill surfactant. Studies report use of feeding catheters, multiaccess suction catheters, vascular catheters, and more recently custom-built catheters for this purpose. The impact of choice of catheter on procedural success and procedural adverse effects has not been reported. Our present study compares the procedural success and adverse effects of MIST using a semirigid vascular catheter (16G Angiocath-Hobart Method) versus a flexible multiaccess catheter (MAC). This was a retrospective review of prospectively collected data at a tertiary care neonatal intensive care unit in Southwestern Ontario. All neonates who received surfactant via MIST between May 1, 2016 and September 30, 2020 were included in the study. Relevant baseline characteristics and data on procedural details (premedication, type of catheter, etc.) were collected. The procedural success, number of attempts, and adverse effects between neonates who received MIST via MAC and 16G Angiocath was compared by using Chi-square test or Fisher's test as appropriate. A p-value of less that 0.05 was considered significant. A total of 139 neonates received surfactant via MIST method during the study period. Moreover, 93 neonates received the surfactant via MAC, while 46 received it via Angiocath. The baseline demographic characteristics in the two group were similar. A higher proportion of neonates in Angiocath group received Atropine (100 vs. 76%, p = 0.002) and Fentanyl (98 vs. 36%, p < 0.001) than the MAC group.The procedural success was 91% in the Angiocath group and 89% in the MAC group (p > 0.99). Multiple attempts were needed in 24% of neonates in the Angiocath group and 37% in the MAC group (p = 0.158). More episodes of desaturations were noted in the Angiocath group (89%) than the MAC group (69%; p = 0.012). Other rates of common adverse effects were similar between the two groups. On exploratory analysis fentanyl use held significant association with less success, more desaturation, apneic episodes, and need of positive pressure ventilation /intubation. The overall procedural success of MIST is similar in both catheter groups. The proportion of neonates requiring multiple attempts was lower with the Angiocath, though difference was not statistically significant. Desaturation episodes were seen more frequently in the Angiocath group, which was related to higher use of procedural sedation in this group. · MIST is emerging as a less invasive method of surfactant delivery that has proven clinical benefits.. · Considerable, procedural variation is reported, particularly regarding choice of catheter.. · Our present study compares the procedural success and adverse effects of MIST using a semirigid vascular catheter (16G Angiocath-Hobart method) versus a flexible MAC.. · High and comparable procedural success was seen in both groups..

Report on users, and user experience with discreet catheters in The Netherlands

AbstractThose using intermittent catheterization (IC) have many catheter types and styles to select from; including what manufacturers refer to as discreet catheters. Discreet catheters are often manufactured to be smaller in length, coiled in design, or foldable, thus allowing for easier concealment or discretion when carried in public and offering a degree of personal privacy. This study explores discreet catheter use and its alignment with the lifestyle experience of those who use such catheters. This study assesses the user and user experience with discreet catheters. User experience is defined as catheter choice, associated activities, and urinary tract health. A cross‐sectional survey investigated life and health status of individuals in the Netherlands requiring IC. The study enrolled 1892 individuals of which 784 use a discreet catheter as their primary catheter. Catheter choice: 82% of study respondents state they have the ability to choose the type of catheter they use. Of those indicating not having the ability to choose their catheter, they state their health care professional did not inform them of different catheters, brands, or options. Catheter associated activities: Those employed full or part time are satisfied with their discreet catheter (95.1%) claiming it is discreet, and gives them confidence to live their life the way they choose; that the catheter did not interference with social activities (72.6%), and had little to no interference with work outside of the home (76.1%). Urinary tract infections (UTI): 39.4% report a clinician diagnosed UTI within 6 months prior to the survey. The data indicates that 18.3% of the sample are deficient in UTI knowledge stating they do not know what a UTI is, or what associated symptoms are; 41% followed a clinician suggested regimen for catheterizing; 25.5% altered catheterization schedules to fit daily activities; 33.3% stated they did not follow a regimen, but catheterized when convenient The data supports positive experiences for individuals who use discreet catheters as their primary method of bladder voiding, particularly socially active individuals requiring an element of personal privacy in their life. However, UTI's are a matter of concern due to a reported deficit in knowledgeable about UTI's and symptomology.

Choice of access route for artificial nutrition in cancer patients: 30 y of activity in a home palliative care setting

ObjectivesMalnutrition negatively affects the quality of life, survival, and clinical outcome of patients with cancer. Home artificial nutrition (HAN) is an appropriate nutritional therapy to prevent death from cachexia and to improve quality of life, and it can be integrated into a home palliative care program. The choice to start home enteral nutrition (HEN) or home parenteral nutrition (HPN) is based on patient-specific indications and contraindications. The aim of this observational study was to analyze the changes that occurred in the criteria for choosing the access route to artificial nutrition during 30 y of activity of a nutritional service team (NST) in a palliative home care setting, as well as to compare indications, clinical nutritional outcomes, and complications between HEN and HPN. MethodsThe following parameters were analyzed and compared for HEN and HPN: tumor site and metastases; nutritional status (body mass index, weight loss in the past 6 mo); basal energy expenditure and oral food intake; Karnofsky performance status; access routes to HEN (feeding tubes) and HPN (central venous catheters); water and protein-calorie support; and survival and complications of HAN. ResultsFrom 1990 to 2020, HAN was started in 1014 patients with cancer (592 men, 422 women; 65.6 ± 12.7 y of age); HPN was started in 666 patients (66%); and HEN was started in 348 patients (34%). At the end of the study, 921 patients had died, 77 had suspended HAN for oral refeeding and 16 were in the progress of HAN. The oral caloric intake was <50% basal energy expenditure in all patients: 721 (71.1%) were unable to eat at all (HEN 270, HPN 451), whereas in 293 patients (28.9%), artificial nutrition was supplementary to oral intake. From 2010 to 2020, the number of central venous catheters for HPN, especially peripherally inserted central catheters, doubled compared with that in the previous 20 y, with a decrease of 71.6% in feeding tubes for HEN. At the beginning, patients on HEN and HPN had comparable nutrition and performance status, and there was no difference in nutritional outcome after 1 mo of HAN. In 215 patients who started supplemental parenteral nutrition to oral feeding, total protein-calorie intake allowed a significant increase in body mass index and Karnofsky performance status. The duration of HEN was longer than that of HPN but was similar to that of supplemental parenteral nutrition. ConclusionsOver 30 y of nutritional service team activity, the choice of central venous catheters as an access route to HAN increased progressively and significantly due to personalized patient decision-making choices. Nutritional efficacy was comparable between HEN and HPN. In patients who maintained food oral intake, supplemental parenteral nutrition improved weight, performance status, and survival better than other types of HAN.