Catheter Device Research Articles

Reprogrammable 3D Shapes from 1D Metamaterial

AbstractThree billion years of evolution have produced a vast variety of protein molecules, whose functions are directly dependent on their ability to assume and maintain specific shapes. Proteins are defined by the sequence and chemical characteristics of their amino acids, which dictate their 3D shape and function, ranging from enzymatic activity to immune responses. Here, we explore a synthetic form of linear structure that can be bent in a programmable way into various specific 3D shapes inspired by the way functional proteins are defined using genetic codes. This synthetic structure is based on non‐circular multistable corrugated tubes, which can be fabricated at various length scales and cross‐sectional shapes, thus enabling the modification of their properties. Additionally, the cross‐section shape can be rewritten multiple times, allowing for the repair of structural damage and the rewriting of the properties of the structure's multi‐stability. A numerical model is used to describe the bending energy landscape of different cross‐sections. The proposed reprogrammable 3D shapes of a rewritable 1D metamaterial are promising candidates for futuristic robotic systems, complex deployable structures, catheter devices, and energy absorption and harvesting.

SP2.10 - Early outcomes with the Insides Chyme Reinfusor (ICR) device in the management of parenteral nutrition dependent high output stomas (PN-HOS)

Abstract Aims PN-HOS represent a complex challenge, requiring input from surgical, gastroenterology and nutritional teams. Length of stay (LOS) is prolonged with difficulties in achieving output control and adequate nutrition with other associated risks. ICR is a modified stoma bag/mechanical pump and catheter device, reinfusing chyme into the distal limb, maintaining gut continuity, preserving enteral nutrient absorption and preventing distal limb atrophy. ICR may accelerate establishment of nutritional autonomy and reduce costs associated with PN/LOS. We report the largest study of ICR outcomes Methods Prospective study of ICR outcomes in patients with PN-HOS. Analysis included LOS, duration of PN, establishment of nutritional autonomy, nutritional markers, adverse ICR effects. Results Sixteen patients were trained to use the ICR (6M:10F). Median age 60yr. 75% achieved independent use (median 5.6 days). Overall usage was 395 days (median 32 days). Nutritional autonomy achieved in nine patients (pre-reversal). ICR increased median albumin 10.5 g/l. Adverse events included changing difficulties, spillage, noise, and discomfort. Two patients discontinued ICR because of pain/reflux. One patient died from unrelated post-operative complications. One patient with multiple loop stomas was successfully established on dual ICR. Nursing experience with ICR demonstrated ease of use and straightforward patient education. Cost analysis PN £5000/mth v ICR 1800/mth. Anecdotally at the time of reversal, surgical opinion was of much favourable bowel for anastomosis and return to function. Conclusions The ICR device is safe and contributes to restoration of nutritional autonomy. It reduces PN dependence with cost-benefits and acceptable adverse effects. At time of initial surgery distal limb should be fashioned to allow potential use of ICR.

Materials-based incidence of urinary catheter associated urinary tract infections and the causative micro-organisms: systematic review and meta-analysis

BackgroundBoth long (> 30 days) and short-term (≤ 30 days) catheterisation has been associated with urinary tract infections (UTIs) due to the invasive nature of device insertion through the urethra. Catheter associated Urinary Tract Infections (CAUTIs) are common (prevalence of ~ 8.5%) infections which can be treated with antibiotics; however, CAUTIs are both expensive to treat and contributes to the antibiotic usage crisis. As catheters are unlikely be replaced for the management of patients’ urination, ways of reducing CAUTIs are sought out, using the catheter device itself. The aim of this review is to assess the incidence of CAUTI and the causative micro-organisms when different urinary catheter devices have been used by humans, as reported in published research articles.MethodsA Systematic Literature Review was conducted in Ovid Medline, Web of Science and PubMed, to identify studies which investigated the incidence of UTI and the causative micro-organisms, in patients with different urinary catheter devices. The articles were selected based on a strict set of inclusion and exclusion criteria. The data regarding UTI incidence was extracted and calculated odds ratio were compared across studies and pooled when types of catheters were compared. CAUTI causative micro-organisms, if stated within the research pieces, were also gathered.ResultsA total of 890 articles were identified, but only 26 unique articles met the inclusion/exclusion criteria for this review. Amongst the large cohort there were catheters of materials silicone, latex and PVC and catheter modifications of silver nanoparticles and nitrofurantoin antibiotics. The meta-analysis did not provide a clear choice towards a single catheter against another although silver-based catheters, and silver alloy, appeared to statistically reduce the OR of developing CAUTIs. At genus level the three commonest bacteria identified across the cohort were E. coli, Enterococcus spp. and Pseudomonas spp. whilst considering only at the genus level, with E. coli, Klebsiella pneumonia and Enterococcus faecalis most common at the species-specific level.ConclusionsThere does not appear to be a catheter type, which can significantly reduce the incidence of CAUTI’s in patients requiring catheterisation. Ultimately, this warrants further research to identify and develop a catheter device material that will reduce the incidence for CAUTIs.

Long-distance Tele-robotic-assisted Percutaneous Coronary Intervention: A Case Report of First-in-patient in China

Robotic-assisted percutaneous coronary intervention (R-PCI) is an innovative way of performing percutaneous coronary intervention (PCI) whereby the operator can manipulate coronary intraluminal guidewires and catheter devices by using remotely controlled technology. Performing tele-R-PCI from a remote location via fifth generation network communication technology has never been reported in China; however, if this were possible, the technique could be used to treat many patients with coronary artery disease who would otherwise not have the opportunity of treatment. The case of a 73-year-old male patient with coronary artery disease who underwent successful tele-R-PCI at 800 km from the operators is presented. Performing long-distance tele-R-PCI in patients with coronary artery disease is feasible with predictably successful outcomes when reliable network connectivity and local cardiac catheterization facilities are present.

Narrative review of latest research progress about robotic percutaneous coronary intervention.

Robotic percutaneous coronary intervention (R-PCI) is a novel technology in which operators can manipulate guidewires and catheter devices in interventional cardiology. This approach provides great benefits to interventional cardiologists in terms of reducing both radiation exposure and orthopedic injuries. Several large, high-quality cohort studies have confirmed the short-term safety and high technical success rate of R-PCI. However, randomized long-term data are still needed before adopting them as part of standard coronary interventions. Furthermore, tele-stenting for complex coronary lesions has significant potential for R-PCI. We need to overcome the present relevant challenges for its application such as inherent delays, bedside care for unstable patients from R-PCIs to manual PCIs (M-PCIs), incompatibility for a thrombus aspiration catheter and heavily calcified lesions. There is a great future in laboratory workflow teams, 3D-printed anatomical models and multiple joint collaborative control algorithms. This narrative review summarizes the latest developments in R-PCI, with a focus on developments in robotic technology, and discusses the current and future potential use of R-PCI in clinical practice globally.

A pilot study on endoscopic delivery of injectable bioadhesive for esophageal repair in a porcine model

Endoscopic submucosal dissection (ESD) is the gold-standard surgical procedure for superficial esophageal cancer. A significant and challenging complication of this technique is post-ESD esophageal stricture. In this study, the feasibility of endoscopic catheter delivery of bioadhesive to esophageal lesions in a porcine model was tested. Injectable bioadhesive was composed of oxidized dextran (ODA) and chitosan hydrochloride (CS), its physicochemical properties, injectability, antibacterial activity, and cytocompatibility were investigated beforein vivotest. ODA-CS bioadhesive was delivered to the wound bed of the esophageal tissue using a custom-made catheter device after ESD in a porcine model. Our results show that the ODA-CS bioadhesive is of good injectability, tissue adhesive strength, antibacterial capacity, and blood compatibility.In vivodelivery was achieved by endoscopic spraying of ODA and CS in separate catheters fixed on the endoscopic probe. ODA and CS can be mixed well to allow in situ bioadhesive formation and firmly adhere to the esophageal wound surface. After two weeks, the bioadhesive maintained structural integrity and adhered to the surface of esophageal wounds. However, histological analysis reveals that the ODA-CS bioadhesive did not show improvement in attenuating inflammatory response after ESD. This pilot study demonstrates the feasibility of ODA-CS bioadhesive for shielding esophageal wounds after ESD, whereas efforts need to improve its anti-inflammatory activity to reduce fibrosis for stricture prevention.

Securement to Prevent Noncuffed Central Venous Catheter Dislodgement in Pediatrics

Catheter dislodgement is a common complication for children with tunneled or peripherally inserted noncuffed central venous catheters (CVCs). A subcutaneous anchor securement system (SASS) may reduce this risk compared with traditional adhesive securement. To compare dislodgement of noncuffed CVCs secured with SASS with dislodgement of noncuffed CVCs secured with sutureless securement devices (SSDs). The SECURED (Securing Central Venous Catheters to Prevent Dislodegment) trial was a pragmatic, multicenter, superiority randomized clinical trial with an internal pilot and was conducted from August 5, 2020, to August 30, 2022, at 2 Australian quaternary pediatric hospitals. Data analysis was performed in January 2023. Patients aged 0 to 18 years requiring a noncuffed CVC (≥3F catheter) were eligible for inclusion. Follow-up duration was 8 weeks or until device removal. Patients were randomly assigned 1:1 to receive an SASS or SSD, stratified by hospital and catheter type. Only 1 catheter was studied per patient. The primary outcome was dislodgement (partial or total), defined as movement of the catheter tip by greater than 1 cm (change in external catheter length) at any point during catheter dwell. Dislodgement, reported as a risk ratio (RR), was estimated using a generalized linear model with binomial family and log link. Secondary outcomes were reported as incidence rate ratios and were analyzed using Poission regression. Outcomes reported as mean differences (MDs) were analyzed using linear regression. Of 310 randomized patients, 175 patients (56.5%) were male and median (IQR) patient age was 48 (16-120) months. A total of 307 patients had a catheter device inserted, of which 153 (49.8%) were SASS and 154 (50.2%) were SSD, and were included in the intention-to-treat (ITT) analysis. Device dislodgement was lower with SASS (8 dislodgements in 153 patients [5.2%]) compared with SSD (35 dislodgements in 154 patients [22.7%]) (RR, 0.23; 95% CI, 0.11-0.48; P < .001). The per-protocol analysis was consistent with the ITT analysis. Partial dislodgement accounted for most dislodgement events, including 6 partial dislodgements in the SASS group (3.9%) and 30 partial dislodgements in the SSD group (19.5%) (RR, 0.18; 95% CI, 0.08-0.42). This contributed to fewer complications during dwell in the SASS group (37 reported complications [24.2%]) vs the SSD group (60 reported complications [39.0%]) (RR, 0.62; 95% CI, 0.44-0.87). Staff reported greater difficulty removing devices anchored with SASS vs SSD (mean [SD], 29.1 [31.3] vs 5.3 [17.0], respectively; MD, 23.8; 95% CI, 16.7-31.0). However, use of SASS resulted in reduced per-participant health care costs of A$36.60 (95% credible interval, 4.25-68.95; US $24.36; 95% credible interval, 2.83-45.89). In the SECURED trial, noncuffed CVCs secured with SASS had fewer dislodgements compared with SSDs, with a lower cost per patient and an acceptable safety profile. Future efforts should be directed at SASS implementation at the health service level. anzctr.org.au Identifier: ACTRN12620000783921.

Implementation of an external female urinary catheter strategy on prevention of skin breakdown in acute care: A quality improvement study.

To evaluate the incidence of skin-related complications attributable to incontinence-associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care. Multicenter quality improvement study. Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines. Three hundred and eighty-one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown. The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention. Significant negative outcomes are associated with UI patients. External female urinary catheters are a non-invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD-related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown. Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care.

Advances in Multifunctional Electronic Catheters for Precise and Intelligent Diagnosis and Therapy in Minimally Invasive Surgery.

The advent of catheter-based minimally invasive surgical instruments has provided an effective means of diagnosing and treating human disease. However, conventional medical catheter devices are limited in functionalities, hindering their ability to gather tissue information or perform precise treatment during surgery. Recently, electronic catheters have integrated various sensing and therapeutic technologies through micro/nanoelectronics, expanding their capabilities. As micro/nanoelectronic devices become more miniaturized, flexible, and stable, electronic surgical catheters are evolving from simple tools to multiplexed sensing and theranostics for surgical applications. The review on multifunctional electronic surgical catheters is lacking and thus is not conducive to the reader's comprehensive understanding of the development trend in this field. This review covers the advances in multifunctional electronic catheters for precise and intelligent diagnosis and therapy in minimally invasive surgery. It starts with the summary of clinical minimally invasive surgical instruments, followed by the background of current clinical catheter devices for sensing and therapeutic applications. Next, intelligent electronic catheters with integrated electronic components are reviewed in terms of electronic catheters for diagnosis, therapy, and multifunctional applications. It highlights the present status and development potential of catheter-based minimally invasive surgical devices, while also illustrating several significant challenges that remain to be overcome.

Consumer experience and outcomes of insertion, removal, and management practices of short and midline peripheral intravenous catheters in acute health care: a mixed methods systematic review protocol.

This review will synthesize and integrate current research on the practices relating to the insertion, removal, and management of short and midline peripheral intravenous catheters on consumer experiences and outcomes in acute health care. The aim is to provide consolidated evidence to support policy decision-makers and health care workers in overcoming peripheral intravenous catheter device management challenges. Implementing the evidence provided by this review could increase positive consumer outcomes and reduce the gap between research evidence and clinical practice. Peripheral intravenous catheterization is a process in which a device is inserted into a patient's peripheral vein to administer medication, blood products, and therapeutic fluids. Recent studies have demonstrated the positive and negative impacts of peripheral intravenous catheter site placement, pain relief for insertion, complications, consumer engagement, and routine versus clinically indicated removal of these devices on consumers and the health care system. Managing these impacts in relation to research-practice gaps and conflicting evidence remains challenging. Moreover, consumer experiences and outcomes concerning these challenges are unclear. This review will consider quantitative, qualitative, and mixed methods studies on consumer experiences and outcomes in acute health care. The quantitative component will consider outcomes of patients' pain, satisfaction, anxiety, distress, preferences, fear, and comfort. The qualitative component will consider consumer experiences, including perceptions, preferences, perspectives, attitudes, expectations, and satisfaction. This study will follow JBI's convergent segregated approach for mixed method systematic reviews. A search of 11 databases will be conducted for peer-reviewed published articles, theses, and dissertations. There will be no age, date, or language limitations. PROSPERO CRD42023410214.

PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE AFTER A FAILED DEVICE–CLOSURE ATTEMPT: A HIGH–VOLUME SINGLE CENTRE EXPERIENCE

Abstract Introduction Persistence of patent foramen ovale (PFO) has been associated with cryptogenic stroke due to a paradoxical systemic embolism. In these cases, a percutaneous closure allows to decrease the risk of redo cerebral ischemic events. However, the presence of a complex anatomy might prevent a correct device–deployment with a high–risk o residual shunt and/or device embolization. We describe our experience about alternative technique after a failed device closure attempt. Methods We reviewed six cases wherein the device was not able to close effectively the PFO. In these cases, alternative techniques and skills were adopted to close the PFO. Results From 2021 to 2023, 194 PFO were closed in the congenital catheterization laboratory of Monaldi Hospital (Naples). In the most of cases (188/194 pts, 96.9%) an effective device closure was obtained. However, in 6 cases (3.1%) the device failed to have a PFO closure. In these 6 patients, the PFO anatomy was characterized by: a severe hypertrophy of the septum secundum (2 cases, 33%), an aneurysmatic interatrial septum (3 cases, 50%), a long stiff tunnel (6 cases, 100%). In three cases a deviceless suture–mediated system (NoblestichTM) was effective to achieve a complete PFO closure; whereas, in two cases a combined approach (suture–mediated system followed by a device deployment) allowed to achieve a complete PFO closure. In a patient with Ebstein anomaly and significant cyanosis due to right–to–left PFO shunt, a partial PFO closure (with mild residual right–to–left shunt) was obtained after NoblestichTM deployment. In this setting, the partial PFO closure was effective to achieve a significant improvement of the patient’s arterial saturation and the procedure stopped without to complete the PFO closure with a device. Conclusion Trans–catheter device closure is often effective to achieve a complete PFO closure. However, in some circumstances, the device was unable to have an appropriate PFO closure. A suture–mediated system or a combined approach (suture–mediated system with concomitant device deployment) are effective to achieve the PFO closure in these complex scenarios.

Ten steps to transform ideas into product innovations: An interdisciplinary collaboration between nursing and engineering.

To describe the development process of a device from the conception of the idea to the first contact with the commercial environment, and to demonstrate its practical application through an interdisciplinary collaboration between nursing and engineering for the design of a protective device for peripheral venous catheters. Nurses are key agents for identifying unresolved needs or problems related to nursing care. To address these needs, creative ideation processes are often triggered among nurses to seek technological answers to these challenges. The ten steps to develop a device are presented: (1) detecting an unsatisfied clinical need; (2) searching for preexisting marketed products; (3) searching for patents; (4) maintaining confidentiality throughout the process; (5) obtaining institutional support; (6) forming a multidisciplinary team; (7) developing the idea; (8) applying for a patent; (9) building the prototype; (10) marketing the device. This methodology was applied to design a protective device for peripheral venous catheters in hospitalized patients. Nurses can play a key role in the promotion of healthcare innovation in their field to improve procedures, thanks to their direct contact with patients, and by providing their insight on devices that can enhance patient care. The successful interdisciplinary collaboration between nurses and engineers can provide a response to relevant clinical problems such as the manipulation or removal of peripheral venous catheters. A hospital policy is required to encourage the participation of nurses in innovative actions. Furthermore, it is important to support nurse leaders who can play a pivotal role in incorporating creativity into work environments and empowering other nurses to innovatively address clinical issues. This article describes the process for developing a health device.

Factors associated with the disinfection of devices attached to peripheral intravenous catheters performed by the nursing team in pediatric units.

Peripheral intravenous catheterization, as well as drug administration through it, represents one of the most performed procedures by the Nursing team and, for that, precautions need to be adopted to offer harm-free care. To verify the association of Nursing professionals' work shift and training time with proper disinfection of intravenous catheter devices in pediatric units. A cross-sectional and analytical study conducted between June and August 2021 in three hospitalization units of a Pediatric Hospital. The inclusion criterion was drug administration via peripheral intravenous catheters performed by Nursing professionals. The data were analyzed according to inferential statistics, adopting p ≤ .05 as significance level. There were a total of 385 observations of drug administration procedures. The device was not disinfected in 60.3% of the cases, there was no friction at the suitable time in 86.3%, and the disinfectant was not allowed to dry in 72.5%. The work shift exerted no influence on performance of the disinfection procedure (p = .376). However, longer training time was associated with a lower rate in performing such procedure (p < .001). Performing friction below the recommended time can cause a false sense of prevention of catheter-associated bloodstream infection; therefore, training sessions and strategies for adherence to the disinfection procedures should be considered, mainly for professionals with more training time.

External urinary catheter devices: A multisite project involving point prevalence

External urinary catheter devices used in hospitals can offer an alternative to indwelling urinary catheters. Prevalence and patient outcomes are not well understood. This multisite project involved point prevalence of device use in patients with labia on acute care units. All patients on included units with corresponding anatomy were observed for presence of device in addition to review of indication of use and chart audit. Device use was 28.8 %. Immobility was the leading indication, and most patients had severe dysfunction as to mobility. For most patients, level of mobility remained the same from admission to discharge. Many patients were either potentially physically able to mobilize out of bed to urinate or were likely continent. There was variation in suction setting and chart documentation. The project lacked a comparison group and collected limited patient information. Areas for future inquiry include prevalence and impact on mobility, continence, and skin integrity.

Effect of a Structured Simulation-Based Training on Oncology Nurses' Performance Regarding Port A Catheter Devices

Effect of a Structured Simulation-Based Training on Oncology Nurses' Performance Regarding Port A Catheter Devices

Characterization of a 3D Printed Endovascular Magnetic Catheter

Minimally invasive endovascular procedures rely heavily on catheter devices. However, traditional catheters lack active steering requiring considerable skill on the surgeon’s part to accurately position the tip. While catheter tips could be made steerable using tendon-driven and Pneumatic Artificial Muscle (PAM) approaches, remote magnetic actuation is uniquely suited for this task due to its safety, controllability, and intrinsic miniaturization capabilities. Soft composite magnetic materials feature embedding distributed magnetic microparticles compared with attaching discrete permanent magnets proving beneficial in steerability and control. This work demonstrates the fabrication of a soft hollow magnetic tip that can be attached to a catheter to make the assembly steerable. The catheter tip is extensively characterized in terms of bending hysteresis, bending force, and dynamic response. The catheter showed average hysteresis between 5% and 10% and bending forces up to 0.8 N. It also showed a good dynamic response by changing its bending angle in &lt;200 ms under a step response.

Impact of drainage catheter material, size, and anti-dislodgement mechanism on percutaneous nephrostomy exchange intervals: a systematic review protocol.

Background: Percutaneous nephrostomy (PCN) is a commonly performed procedure by interventional radiology and urology to treat urinary obstruction. In this procedure, a catheter is percutaneously placed into the renal pelvis for urinary diversion or hemorrhagic cystitis. Material type, catheter size, and catheter shape (anti-dislodgement feature) ultimately contribute to the inherent traits of longevity in drainage catheter device. Reviewing the relative strengths or weaknesses of products in the existing clinical market may help clinicians critically appraise the devices they use with evidence-based findings from this review. Furthermore, a deeper understanding of the relative strengths and weaknesses of existing devices may help inform the next generation of drainage catheter devices to prolong the interval between exchanges without detriment to patient safety. Methods: The following electronic databases will be queried: PubMed, Web of Science, Cochrane from their inception to January 2023 to identify randomized controlled trials (RCTs) and cohort studies to investigate the differences that our interventions of catheter material, size, and dislodgement mechanism will have on the exchange interval (standard of care 90 days vs. 60 days vs. 45 days vs. 30 days).The primary outcomes will be the drainage catheter exchange frequency. Ethics and dissemination: We aim to share our findings through high-impact peer reviewed journals. As drainage catheters and minimally invasive interventional radiology procedures become more popular, it is important for healthcare providers taking case of these populations to understand which variables might optimize patient care and minimize emergent exchanges. Data will be made available to readers. Registration: PROSPERO ( CRD42023432788, 16 June 2023).

A Deployable Multifunctional Sensor for a Catheter Device for the Renal Denervation of Resistant Hypertension

A Deployable Multifunctional Sensor for a Catheter Device for the Renal Denervation of Resistant Hypertension

Design and application of urinary catheterization device capable of preventing blockage

Design and application of urinary catheterization device capable of preventing blockage

Frequent Skin Injuries in Neonates from Various Skin Injuries Monitoring Instruments: A Systematic Review

Aims: Maintenance of skin and tissue integrity is one of the main focuses of various health care facilities throughout the world so that the implementation of effective prevention of skin trauma requires a protocol for early identification of at-risk patients in prevention of skin trauma. Objective: Knowing the effektiveness of the SRAMT instrument compared to other skin trauma monitoring instruments for monitoring neonatal skin trauma. Method: This research method is in the form of systematic review, database search is done through proquest, SAGE Journal, Sciencedirect, Clinicalkey Nursing and manual research. There were eight journal articles that met the inclusion criteria. Based on the article it was concluded that the instrument had gone through validity, reliability, interrater tests and correlation coefficients so that it was suitable for use in pediatric and neonatal patients. Result: There were seven journal articles that met the inclusion criteria. The most common type of skin injury are caused by the use of an indwelling vascular catheter and medical devices. The most common locations for skin injury are the nasal septum and the head area, including the face and scalp. Compared to other skin injury monitoring instruments, the SRAMT subscale is more comprehensive by having three skin trauma risk assessment sections, including skin trauma risk categories, management guidelines based on skin injury risk categories and prevention that can be carried out based on the type of skin injury that occurred. This guide is very important to reduce the risk of skin injury in neonates and provide uniformity in nursing care provided by nurses.