Catheter Fixation Research Articles

Application of the 3M elastic cloth adhesive tape application for fixation of the CVC catheter

Objective To investigate the effect of the fixation of CVC catheter via the 3M elastic cloth adhesive tape. Methods As for the control group, 60 patients with double cavity CVC catheterwereselected from January to June, 2013. They used the 3M Tegaderm TM transparent film regularly to fix the CVC catheter.As for the experimental group, 62 patients with double cavity CVC catheter were selected from July to December, 2013. They were treated with the 3M Tegaderm TM transparent film to fix the CVC catheter, and then used the 3M elastic cloth adhesive tape to fix the uncovered tube of the CVC catheter. The rates of catheter displacement, catheter occlusion, transparent film hemming, transparent film renewal were compared. Results The rates of catheter displacement, catheter occlusion, transparent film hemming, transparent film renewal were 6%, 6%, 8%, 8% of theexperimental group, which were significantly lower than 42%, 33%, 52%, 42% of the control group (χ2=20.87, 13.94, 27.87, 18.57, respectively; P<0.01). Conclusions The fixation method of experimental group is superior to the control group, and it has better effect on fixation of the CVC catheter, which has a great clinical significance. Key words: Elastic cloth adhesive tape; CVC catheter; Fixation

Management of central venous catheters in intensive care units: Comparative study of guidelines versus practice.

Sir, An observational study was conducted on 100 nurses with minimum 6 months of experience in various intensive care units (trauma, swine flu, medical, and renal) of the hospital to assess their knowledge and clinical practice. A two-part questionnaire [Table 1] was filled by the nurses after every central venous catheter (CVC) insertion for a period of 2 months. Each correct response was scored 1; incorrect 0. Total number of catheter insertions was 148. Mean score for the study was 53%. Table 1 Questionnaire Results from Part A: Standardized equipment set, barrier precaution, filling of the checklist, and an assistant was available in 96%, 95%, 86%, and 98% of the insertions. Two-third were done on monitored beds with head low; only 1% on unmonitored beds. Povidone iodine, 70% alcohol, 2% chlorhexidine-based preparations were preferred in decreasing order for disinfection of skin (60%, 21%, and 19%, respectively). Eighty percent preferred sutures for catheter fixation and transparent bio-occlusive dressing. Results from Part B: Subclavian, internal jugular and femoral vein were preferred by 66.6%, 25%, and 9%. One-fifth were not aware of use of ultrasound. 98% managed unintended arterial puncture by removal of needle/catheter and application of pressure. 90% opined that chest X-ray confirmed placement of CVC. 96% preferred heparin based solution; 4% used normal saline. Two inspections of CVC/day were made by 50%; one/day were made by 40%. One-fifth wiped access ports with antiseptic before drug administration. Removal of infected CVC was considered by 60%; 25% believed in giving an antibiotic and observing. Three-fourth marked 4 h as maximum infusion time for blood products; 24 h for change of intravascular catheters/sets. Tubings for blood products and lipid emulsions were changed by 80% 12 hourly. Three-fourth believed in no fixed duration for changing CVC; one-fourth believed in the weekly change. Half believed in administration of antibiotics for central lines inserted in emergency. Only 25% considered a replacement of the catheter within 48 h. The remaining 25% considered replacement only on signs of infection. Routine prophylactic antibiotics was advocated by 36%. Results show that awareness on the use of chlorhexidine, ultrasound, correct management of arterial punctures and protocol for CVC inserted in emergency departments needs to be increased. Regular training programs with the nursing staff on bundles of care related to insertion and maintenance of CVC are needed.[1,2,3] American Society of Anesthesiologists guidelines[4] are focused on elective insertions of CVC's performed by anesthesiologists, but the Centers for Disease Control and Prevention guidelines[5] also address emergency placements, peripherally inserted central catheters, pulmonary artery catheter and tunneled central lines. Safety or efficacy of chlorhexidine in neonates and infants aged <2 months remains an unresolved issue. Fluid administration sets need to be changed at 96 h intervals and tubings for blood products and lipid emulsions every 24 h. Routine replacement of CVCs on the basis of fever alone and prophylactic administration of systemic antimicrobial agents is discouraged. Mandatory replacement is to be done within 48 h for all catheters inserted in an emergency without aseptic precautions.

Flexible endoscopic single-incision extraperitoneal implant and fixation of peritoneal dialysis catheter: proof of concept in the porcine model.

Peritoneal dialysis (PD) catheters placed in the pelvic space without anchoring present a high rate of migration. We aimed to assess the feasibility of a single-incision approach, using a flexible endoscopic preperitoneal tunneling for catheter implantation and fixation. Eight pigs were involved in this experimental study. A 2/0 Vicryl loop was sutured at the tip of a PD catheter. In 4 pigs, a 1.5 cm incision was made on the left paramedian line and the parietal peritoneal layer was identified by splitting rectal muscles. A gastroscope was inserted in the incision and advanced in the extraperitoneal space. An exit hole was made in the peritoneum over the low pelvic cavity. A guidewire was left in the abdominal cavity, and the PD catheter was inserted over the guidewire. The endoscope was inserted in the tunnel again, and endoscopic clips were deployed over the Vicryl loop to fix the catheter. In 4 pigs, the PD catheter was inserted laparoscopically using a two-port approach. The catheter's tip was fixed with laparoscopic clips on the Vicryl loop. A strain test to assess the force required to detach clips was performed using a digital dynamometer. Operative time for flexible endoscopic tunneling was longer when compared to the laparoscopic implant (29.5 ± 4.43 vs. 22.7 ± 2.51 min). Mean force to displace the catheter was similar after flexible endoscopic fixation when compared to laparoscopic clip fixation (5.57 N ± 2.76 vs. 4.15 N ± 1.76). Flexible endoscopic extraperitoneal tunneling allows for minimally invasive single-incision PD catheter placement and fixation.

Peritoneal Catheter Fixation to the Abdominal Wall in Surgical Catheter Implantation to Prevent Malfunction

Background: Catheter failure, especially catheter displacement and obstruction remain the major barriers for peritoneal dialysis. We have developed a new surgery technique of catheter fixation on the lower abdominal wall in the catheter planting to avert the catheter mechanical complications. Method: A retrospective study was performed on 93 patients; among them, 52 patients underwent the traditional method of surgery for catheter insertion and 41 patients received additional catheter fixation. Comparisons of complications including infection, leak, infusion pains, catheter displacement, and obstruction occurred during a follow-up period of 6 months, were made between the fixed and non-fixed groups. Results: Catheter fixation cost more time than the conventional operating procedure (94.2 w 14.6 min vs. 83 w 13.3 min, p = 0.043). Complications of infection, leak, and infusion pain that occurred in the fixed and unfixed groups are comparable. Catheter fixation reduced the complications of catheter displacement or obstruction to 0 episode in the fixed group, whereas those complications were encountered by 7 patients in the unfixed group (0/41 vs. 7/52, p = 0.022). All these 7 patients received re-exploration and catheter replacement with further catheter fixation. In the following time until now (ranging from 3 to 16 months), no catheter dysfunction was observed. Conclusions: These results suggest that catheter fixation is effective in preventing catheter displacement and obstruction in peritoneal dialysis. i 2014 S. Karger AG, Basel

Safe and secure: catheter fixation

Nursing and Residential CareVol. 16, No. 11 EditorialSafe and secure: catheter fixationDrew PayneDrew PayneSearch for more papers by this authorDrew PaynePublished Online:16 Oct 2014https://doi.org/10.12968/nrec.2014.16.11.608AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Eastwood L (2009) Safe and secure - improving practice in the UK. Journal of Community Nursing 23(5): 30–33 Google ScholarFisher J (2010) The importance of effective catheter securement. Br J Nurs (Continence Care Supplement) 19(18): S14–S18 Abstract, Google ScholarTurner B, Dickens N (2011) Long-term urethral catheterisation. Nurs Stand 25(24): 49–56 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 November 2014Volume 16Issue 11ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 16 October 2014 Published in print 2 November 2014 Information© MA Healthcare LimitedPDF download

PO-0898 Umbilical Catheter And Blood Sampling In Very Low Birth Weight Infants For The First 72 Hour Of Life Protocol

Background and aims Very low birth weight (VLBW) infants are extremely vulnerable and usually require central catheters and frequent blood tests. Our aim was to develop a protocol regarding umbilical catheter fixation and blood samples for VLBW during the first 72 h of life. Methods A retrospective study was carried out by a multidisciplinary team describing the intervention variables in 10 VLBW admitted to our Unit. In parallel a bibliographic research was performed on the International data bases, answering our PICO questions. The population of the study was VLBW under 32 weeks of life and/or under 1.500 grams of weight. Interventions were catheter fixation, number, volume and speed of extraction and reinfusion during first 72 h. Results Our population had a mean gestational age and birth weight of 30 weeks and 1200 grams. Our data showed a mean of 11 tests per patient during first 72 h of life, none using umbilical cord blood. Registration of velocity was not reported. After a literature review we designed a protocol of catheter fixation and blood samples for VLBW during first 72 h. The protocol included using cord blood for the first sampling and a description of adequate sample size and velocities. Conclusions An evidence based practice leads to improve blood sampling in VLBW infants. Post intervention results are still to be measured.

Urinary catheter fixation devices: an essential part of catheter management in the community.

Within community, residential and nursing homes, urinary catheter fixation devices are usually used on an ad hoc basis. Adhesive tape is often used to secure and anchor an indwelling catheter in place, although some complications have been identified in the literature (see, for example, Bierman and Carignan, 2007) including: w Adhesive tape failing to adhere to external catheter surface w Tape loosening quickly and frequently w Cumbersome for patients to manage w Adhesive build-up, creating potential bacterial colonisation w May cause too much or not enough traction on catheter to stop movement w Skin integrity can be compromised (Hanchett, 2002). Although fixation devices have been identified as an important part of the management of indwelling urinary catheters by national guidelines (Royal College of Nursing (RCN), 2012; National Institute for Health and Care Excellence, 2012; Loveday et al, 2014), they are rarely used routinely. Health professionals are sometimes unaware of the different types of fixation devices and the benefits they can provide to patient care. The Wound, Ostomy and Continence Nurses Society (WOCN) (2012) specify the indications for use of these devices as follows: ‘to prevent the catheter or its retention balloon from exerting excessive force on the bladder neck or urethra’. This principle is also supported by the Health Protection Surveillance Centre (2011) and NHS Quality Improvement Scotland (2004), who state that: ‘the catheter and attached drainage systems should be well supported in a comfortable position for the individual at catheter insertion to prevent complications’.

Securing urethral catheters can help to reduce their complications

British Journal of Neuroscience NursingVol. 10, No. 4 CommentSecuring urethral catheters can help to reduce their complicationsSue WoodwardSue WoodwardSearch for more papers by this authorSue WoodwardPublished Online:26 Aug 2014https://doi.org/10.12968/bjnn.2014.10.4.162AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Billington A, Crane C, Jownally S, Kirkwood L, Roodhouse A (2008) Minimizing the complications associated with migrating catheters. Br J Community Nurs 13(11): 502–67 Link, Google ScholarDarouiche RO, Goetz L, Kaldis T, Cerra-Stewart C, AlSharif A, Priebe M (2006) Impact of StatLock securing device on symptomatic catheter-related urinary tract infection: a prospective, randomized, multicenter clinical trial. Am J Infect Control 34(9): 555–60 Crossref, Google ScholarFakih MG, Pena ME, Shemes S et al. (2010) Effect of establishing guidelines on appropriate urinary catheter placement. Acad Emerg Med 17(3): 337–40. doi: https://doi.org/10.1111/j.1553-2712.2009.00677.x Crossref, Google ScholarFisher J (2010) The importance of effective catheter securement. Br J Nurs 19(18): S14–8 Link, Google ScholarFreeman C (2009) Why more attention must be given to catheter fixation. Nurs Times 105(29): 35–6 Google ScholarNazarko L (2009) Providing effective evidence-based catheter management. Br J Nurs 18(7 Suppl): S4–S12 Link, Google ScholarOrme LA, Smith RJ, Berry JC (2008) Development and evaluation of CliniFix, a catheter/tubing fixation device. Br J Nurs 17(8): 544–9 Link, Google ScholarVaidyanathan S, Soni BM, Brown E, Singh G (2005) Erosion of urethra in female patients with spinal cord injury. Spinal Cord 43(7): 451 Crossref, Google ScholarWilson M (2013) Catheter lubrication and fixation: interventions. Br J Nurs 22(10): 566–9 Link, Google Scholar FiguresReferencesRelatedDetailsCited byManaging complications associated with the use of indwelling urinary catheters19 October 2020 | Nursing Standard, Vol. 35, No. 11Management of indwelling urinary catheters for people with learning disabilitiesLearning Disability Practice, Vol. 22, No. 4Urinary catheter securement: what are the options?19 October 2015 | Nursing and Residential Care, Vol. 17, No. 11Urine-drainage leg bags: an overview9 October 2015 | British Journal of Nursing, Vol. 24, No. Sup18Assessing and treating urinary incontinence in men4 June 2015 | British Journal of Community Nursing, Vol. 20, No. 6 2 August 2014Volume 10Issue 4ISSN (print): 1747-0307ISSN (online): 2052-2800 Metrics History Published online 26 August 2014 Published in print 2 August 2014 Information© MA Healthcare LimitedPDF download

On-demand antimicrobial release from a temperature-sensitive polymer — Comparison with ad libitum release from central venous catheters

Antimicrobial releasing biomaterial coatings have found application for instance in the fixation of orthopedic joint prostheses and central venous catheters. Most frequently, the release kinetics is such that antimicrobially-effective concentrations are only reached within the first days to weeks after implantation, leaving no local antimicrobial release available when a biomaterial-associated infection occurs later. Here we compare the ad libitum release of chlorhexidine and silver-sulfadiazine from a central venous catheter with their release from a new, on-demand release coating consisting of a temperature-sensitive copolymer of styrene and n-butyl (meth)acrylate. The copolymer can be loaded with an antimicrobial, which is released when the temperature is raised above its glass transition temperature. Ad libitum release of chlorhexidine and silver-sulfadiazine from a commercially-purchased catheter and associated antimicrobial efficacy against Staphylococcus aureus was limited to 16days. Consecutive temperature-triggers of our on-demand coating yielded little or no antimicrobial efficacy of silver-acetate release, but antimicrobially-effective chlorhexidine concentrations were observed over a time period of 60–80days. This attests to the clear advantage of on-demand coatings above ad libitum releasing coatings, that may have released their antimicrobial content before it is actually needed. Importantly, glass transition temperature of chlorhexidine loaded copolymers was lower (48°C) than of silver loaded ones (61°C), facilitating their clinical use.

A novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer.

The aim of this randomized controlled study was to investigate the effects of a novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer.Patients diagnosed with cervical cancer were randomly divided into a control group (n = 32) and a treatment group (n = 33). Patients in the control group underwent a traditional fixation method using a haemostat, elastic band and abdominal bandage. Patients in the treatment group underwent an improved fixation method using an indwelling needle and membrane cover. We used a visual analogue scale (VAS) to evaluate each patient's comfort score and also recorded the incidence of needlestick injury and the length of injection time in each group. The VAS scores measured before and after chemotherapy in the treatment group were lower than in the control group. The incidence of needlestick injury in the treatment group was significantly lower than in the control group. The length of injection time in treatment group was significantly lower than in the control group. Compared with the traditional fixation method, the improved fixation method not only increased patient comfort but also reduced both the risk of needlestick injury and the length of injection time. This improved technique deserves increased clinical use.

Reducing patient pressure sore incidence density in the pediatric surgical intensive care unit

Our unit recorded 21 cases of pressure sores from January 2011 to June 2011. The resulting pressure-sore incidence density of 0.74% exceeded the Taiwan Clinical Performance Indicator (TCPI) for medical centers (0.62%) as well as the mean incidence density for our unit (0.55%) during the same period in 2010. We developed this project to decrease the incidence density of pressure sores at our pediatric-surgical-intensive-care unit from 0.74% to 0.31%. Strategies implemented included: 1. providing on-the-job education; 2. providing bedside teaching; 3. developing a series of pictures to illustrate proper sitting, lying, and changing positions and the proper fixation of catheters; 4. implementing a reminder mechanism; 5. introducing pressure-preventing devices; 6. and establishing an audit team. Incidence density decreased from 0.74% (Jan. to Jun. 2011) to 0.18% (Mar. to Jul. 2012). We demonstrated that the developed improvement program effectively reduced the incidence density of pressure sores and increased the quality of nursing care.

A New Simplified One-Port Laparoscopic Technique for Peritoneal Dialysis Catheter Placement

Various techniques for laparoscopic insertion of a peritoneal dialysis catheter have been described. Usually 2 - 3 ports are required, and complications related to the port sites (such as abdominal wall hernia, leakage, and hemorrhage) cannot be avoided. To minimize the potential complications, we designed a simplified 1-port laparoscopic technique for peritoneal dialysis catheter placement. ♢ We conducted a retrospective data review of 44 patients who underwent 1-port laparoscopic insertion of a Tenckhoff catheter from June 2009 to February 2011. All patient data, including postoperative complications, were analyzed. ♢ The mean follow-up period was 11.52 months. All catheters were working properly, except in 1 patient who developed peritonitis 3 months after catheter placement. (The catheter was removed.) No postoperative abdominal wall hemorrhage, early leaks, hernias, or catheter migration occurred. No exit-site or tunnel infections were observed. ♢ Our 1-port laparoscopic technique provides excellent catheter fixation, avoids excessive port sites, and yields good cosmesis. The low complication rate and the simplicity of the method justify its standard use for Tenckhoff catheter placement.

Indwelling Urinary Catheters: Pattern of Use in a Public Tertiary-Level Australian Hospital

An audit of charts from patients identified as having an indwelling urinary catheter (IDC) was conducted in a 450-bed, tertiary level hospital (Concord Repatriation General Hospital) in Australia. Documentation of relevant information regarding IDC in the medical record included indication for catheterization, insertion and removal dates, use of antibiotics, place of insertion, designation of inserter, catheter type, availability of IDC kits, and use of catheter fixation devices.

Comparison Between the Fixation of Peritoneal Dialysis Catheters to the Peritoneal Wall and the Conventional Placement Technique: Clinical Experience and Follow‐Up of a New Implant Technique for Peritoneal Dialysis Catheters

Peritoneal dialysis (PD) catheters often become severely dislocated, which may lead to malfunction. With the aim of preventing this complication, we have developed a simple method of fixing the catheter downwards in the peritoneal cavity (fixation technique), a technique that does not require a laparoscope. Sixteen patients were implanted using the conventional placement technique and 25 patients were implanted using the fixation technique. The location of the catheter tip was classified from grade 1 (downward, normal) to 5 (dislocated). The frequency of dislocation (defined as the extended time and/or decrease in volume when draining the PD solution) was measured for both the fixation technique and conventional placement technique. There was a significant difference in grade between the fixation technique (2.72±1.01) and conventional technique (3.92±1.31). The time until first dislocation was significantly different between the fixation technique (59.3±48.1days) and conventional technique (8.8±14.6days). The time until any dislocation was significantly different between the fixation technique (69.2±41.9days) and conventional technique (12.9±13.7days). Complications were not significantly different between the fixation technique and conventional technique. The fixation technique appears to be simple, safe, and useful for preventing severe dislocation and for lengthening the time until dislocation in PD patients.

Steriled and Nonsteriled Urinary Catheters and the Urinary Tract Infection in Hospitalized Patients

Background:: Urinary tract infection (UTI) is one of the most common types of infection which can occur in all age groups. The use of catheters is one of the most important underlying factors, especially when they are left in place for a long time. Objectives:: This study aimed to investigate the effect of sterile catheter fixation on bacteriuria and urinary tract infections. Patients and Methods:: The present research is a clinical trial study. The patients who had urinary catheters based on the existing indications in 2012, hospitalized in Imam Hussein (AS) Hospital, Tehran enrolled in the study. Patients were divided into two groups. The first group consisted of patients whom the catheters were installed by a medical intern in the emergency department. The second group consisted of patients whom the catheters were installed in the same department by two medical interns using a completely sterile method especially at fixation and lubrication steps. The information contained in the patients' check list including the background information, age, hospitalization days, history of urinary catheters, history of infection and results of urine culture and analysis. Results:: A total of one hundred and eighty-eight individuals with the mean age of 39.1 ± 19 years (age range between 18 - 77 years old) enrolled in this study. There was no significant difference in the number of hospitalization days between the two groups (P > 0.05). The number of hospitalization days and incidence of infection were significantly correlated (P < 0.05). The results showed a total OR of 1.5 indicating that the risk of infection is higher in the first group. Overall, the rate of urinary tract infection in this study was 16.4% while this rate was 19.1% and 13.8% in the first and second groups, respectively. The statistical tests showed significant difference between two groups in the incidence of urinary tract infection (P < 0.05), and also positive urine cultures were reported for twelve patients in the first group and nine patients in the second group. Escherichia coli (E. coli) was the most common infective microorganism in both groups, which was observed in 66.6% of the first and 88.8% of the second groups. The frequency of Gram-negative bacteria was 10 cases (83.3%) in the first group and 8 cases (88.8%) in the second group. Conclusions:: According to this study, employing the principles of sterile techniques during the catheterization and sterilization of instruments, as well as skills and experiments of individuals in this process, are the most important factors that can significantly reduce the number of infections after catheterization.

Intermittent self-catheterisation and catheter fixation

British Journal of Community NursingVol. 18, No. 7 Clinical UpdateIntermittent self-catheterisation and catheter fixationLinda NazarkoLinda NazarkoSearch for more papers by this authorLinda NazarkoPublished Online:27 Sep 2013https://doi.org/10.12968/bjcn.2013.18.7.322AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Andrews HO, Nauth-Misir R, Shah PJ (1998) Iatrogenic hypospadias: a preventable injury? Spinal Cord 36(3): 177–80 Crossref, Medline, Google ScholarBillington A, Crane C, Jownally S, Kirkwood L, Roodhouse A (2008) Minimizing the complications associated with migrating catheters. Br J Community Nurs 13(11): 502–6 Link, Google ScholarBloom DA, McGuire EJ, Lapides J (1994) A brief history of urethral cath-eterization. J Urol 151(2): 317–25 Crossref, Medline, Google ScholarHanchett M (2002) Techniques for stabilizing urinary catheters: tape may be the oldest method, but it's not the only one. Am J Nurs 102(33): 44–8 Crossref, Medline, Google ScholarLowthian P (1998) The danger of long-term catheter drainage. Br J Nurs 7(7): 366–8, 370, 372 Medline, Google ScholarNaish W (2003) Intermittent self-catheterisation for managing urinary problems. Prof Nurse 18(10): 585–7 Medline, Google ScholarNazarko L (2009) Managing bladder dysfunction using intermittent self catheterisation. Br J Nurs 18(2): 110–14 Link, Google ScholarNazarko L (2012) Intermittent self catheterisation, past, present and future. Br J Community Nurs 17(9): 409–12 Link, Google ScholarNICE (2012a) CG139 Infection: Prevention and Control of Healthcare-associated Infections in Primary and Community Care. National Institute of Clinical Excellence, London Google ScholarNICE (2012b) Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease. National Institute of Clinical Excellence, London. Google ScholarPomfret I, Winder A (2007) The management of intermittent catheteriza-tion: assessing patient benefit. Br J Neurosci Nurs 3(6): 266–71 Link, Google ScholarVaidyanathan S, Soni BM, Brown E, Singh G (2005) Erosion of urethra in female patients with spinal cord injury. Spinal Cord 43(7): 451 Crossref, Medline, Google ScholarVapnek JM, Maynard PM, Kim J (2003) A prospective randomised trial of LoFric hydrophilic catheter versus conventional plastic catheter for clean intermittent catheterisation. J Urol 169(3): 994–8 Crossref, Medline, Google ScholarWoodward S, Rew M (2003) Patient's quality of life and clean intermittent self-catheterization. Br J Nurs 12(18): 1066–74 Link, Google Scholar FiguresReferencesRelatedDetailsCited byForewordSue Woodward8 August 2018 | British Journal of Nursing, Vol. 27, No. Sup15How intermittent self-catheterisation can promote independence, quality of life and wellbeingSharon Holroyd8 August 2018 | British Journal of Nursing, Vol. 27, No. Sup15Managing urinary tract infection in patients performing clean intermittent self-catheterisationSue Woodward27 August 2018 | British Journal of Neuroscience Nursing, Vol. 14, No. 4Innovation in catheter securement devices: minimising risk of infection, trauma and painSharon Holroyd12 May 2016 | British Journal of Community Nursing, Vol. 21, No. 5 1 July 2013Volume 18Issue 7ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 27 September 2013 Published in print 1 July 2013 Information© MA Healthcare LimitedPDF download

Catheter lubrication and fixation: interventions

This article looks at the indications for catheterisation, the anatomy of the urethra, the importance of asepsis and the rationale for the use of urethral lubrication for catheter insertion. The variations of lubrication available are discussed, including the use of products containing lidocaine and chlorhexidine. It then considers the problems caused by traction to the catheter and discusses the securement devices available for preventing tissue damage at the bladder neck, within the urethra and also at the meatus. The variation of devices is examined along with the potential problems associated with their use. Finally, it discusses the importance of clinicians being knowledgeable about the problems looked at and how to resolve them.

Catheter fixation and ligation: a simple technique for ventriculostomy management following endovascular stenting

The object of this study was to describe a unique method of managing ventriculostomy catheters in patients on antithrombotic therapy following endovascular treatment of ruptured intracranial aneurysms. The authors retrospectively reviewed 3 cases in which a unique method of ventriculostomy management was used to successfully avoid catheter-related hemorrhage while the patient was on dual antiplatelet therapy. In this setting, ventriculostomy catheters are left in place and fixed to the calvarium with titanium straps effectively ligating them. The catheter is divided and the distal end is removed. The proximal end can be directly connected to a distal shunt system during this stage or at a later date if necessary. The method described in this report provided a variety of management options for patients requiring external ventricular drainage for subarachnoid hemorrhage. No patient suffered catheter-related hemorrhage. This preliminary report demonstrates a safe and effective method for discontinuing external ventricular drainage and/or placing a ventriculoperitoneal shunt in the setting of active coagulopathy or antithrombotic therapy. The technique avoids both the risk of hemorrhage related to catheter removal and reinsertion and the thromboembolic risks associated with the reversal of antithrombotic therapy. Some aneurysm centers have avoided the use of stent-assisted coiling in cases of ruptured aneurysms to circumvent ventriculostomy-related complications; however, the method described herein should allow continued use of this important treatment option in ruptured aneurysm cases. Further investigation in a larger cohort with long-term follow-up is necessary to define the associated risks of infection using this method.

Failed Epidural

Summary. Failed epidural anaesthesia or analgesia is more frequent than generally recognized. We review the factors known to influence the success rate of epidural anaesthesia. Reasons for an inadequate epidural block include incorrect primary placement, secondary migration of a catheter after correct placement, and suboptimal dosing of local anaesthetic drugs. For catheter placement, the loss of resistance using saline has become the most widely used method. Patient positioning, the use of a midline or paramedian approach, and the method used for catheter fixation can all influence the success rate. When using equipotent doses, the difference in clinical effect between bupivacaine and the newer isoforms levobupivacaine and ropivacaine appears minimal. With continuous infusion, dose is the primary determinant of epidural anaesthesia quality, with volume and concentration playing a lesser role. Addition of adjuvants, especially opioids and epinephrine, may substantially increase the success rate of epidural analgesia. Adjuvant opioids may have a spinal or supraspinal action. The use of patientcontrolled epidural analgesia with background infusion appears to be the best method for postoperative analgesia.

Shock Wave Lithotripsy of Vesical Stones in Patients With Infravesical Obstruction: An Underused Noninvasive Approach

To evaluate the effectiveness and safety of shock wave lithotripsy in the management vesical stones in patients with infravesical obstruction. From March 2007 to April 2010, 59 male patients with infravesical obstruction were treated using the Dornier Compact Delta II Lithotriptor for urinary bladder stones. The indications for shock wave lithotripsy included patients refusing invasive procedures or those with orthopedic malformations hindering the lithotomy position. The mean age was 61.6 ± 8.6 years (range 44-78), and the mean body mass index was 29 ± 5.1 kg/m(2) (range 20.5-45). The mean stone diameter was 26.6 ± 9.8mm (range 12-50). All patients underwent an initial session and were re-evaluated using ultrasonography and urinary tract plain radiography at 2-week intervals. All patients were treated in the supine position. The number of shocks ranged from 1910 to 9500. Of the 59 patients, 47 and 11 were cleared by 1 or 2 sessions, respectively; 1 patient required a third session to be cleared of stones. All patients develop mild hematuria and started to pass gravel in the first void after the shock wave lithotripsy session. All patients were rendered stone free within 6 weeks. During follow-up, only 2 male patients developed temporary acute urine retention necessitating urethral catheter fixation. Both patients had a neurologic insult. Extracorporeal shock wave lithotripsy is an effective, noninvasive approach to disintegrate vesical stones in patients with infravesical obstruction with adequate fragment clearance.