Closed Drainage System Research Articles

Large thyroglossal duct cyst with a long term evolution: a case report

A 57-year-old male presented with a progressively enlarging mass in the anterior cervical region, persisting for 41 years without accompanying symptoms. Physical examination revealed a well-defined, mobile, soft mass measuring 16×15×15 cm, not fixed to deep tissues, and extending from the medial edge of the sternocleidomastoid muscle. Computed tomography scan showed a cystic lesion involving the hyoid bone, suggestive of a thyroglossal duct cyst. The patient underwent a Sistrunk procedure, with dissection from the base of the tongue to the sternal notch. He was discharged six hours after surgery without any complications and had a closed drainage system removed during a subsequent outpatient visit.

Chest Tubes and Pleural Drainage: History and Current Status in Pleural Disease Management.

Thoracostomy and chest tube placement are key procedures in treating pleural diseases involving the accumulation of fluids (e.g., malignant effusions, serous fluid, pus, or blood) or air (pneumothorax) in the pleural cavity. Initially described by Hippocrates and refined through the centuries, chest drainage achieved a historical milestone in the 19th century with the creation of closed drainage systems to prevent the entry of air into the pleural space and reduce infection risk. The introduction of plastic materials and the Heimlich valve further revolutionized chest tube design and function. Technological advancements led to the availability of various chest tube designs (straight, angled, and pig-tail) and drainage systems, including PVC and silicone tubes with radiopaque stripes for better radiological visualization. Modern chest drainage units can incorporate smart digital systems that monitor and graphically report pleural pressure and evacuated fluid/air, improving patient outcomes. Suction application via wall systems or portable digital devices enhances drainage efficacy, although careful regulation is needed to avoid complications such as re-expansion pulmonary edema or prolonged air leak. To prevent recurrent effusion, particularly due to malignancy, pleurodesis agents can be applied through the chest tube. In cases of non-expandable lung, maintaining a long-term chest drain may be the most appropriate approach and procedures such as the placement of an indwelling pleural catheter can significantly improve quality of life. Continued innovations and rigorous training ensure that chest tube insertion remains a cornerstone of effective pleural disease management. This review provides a comprehensive overview of the historical evolution and modern advancements in pleural drainage. By addressing both current technologies and procedural outcomes, it serves as a valuable resource for healthcare professionals aiming to optimize pleural disease management and patient care.

Reconstructing early sedimentation patterns of the lower Codó Formation (Early Cretaceous, NE Brazil): Evidence of marine influence and the onset of an alkaline hypersaline lake

The upper Aptian lower Codó Formation is an attractive stratigraphic unit within the Parnaíba and São Luís basins, northeastern Brazil, formed during the break-up of Western Gondwana. Located in a large sag basin, the formation records a dynamic depositional history of deltaic, lacustrine, and sabkha environments. This sedimentary evolution is reflected in a diverse lithological succession characterized by intermittent terrestrial input, episodic marine incursions, and restricted lacustrine phases culminating in sulfate evaporite precipitation. While the later stages of the formation have been extensively studied, the initial sedimentary processes and environmental conditions remain poorly understood. This research aims to reconstruct the depositional paleoenvironments during the initial stages of Codó sedimentation, elucidating the onset of the alkaline hypersaline lake environment and the earlier marine incursions in the study region. To achieve this, it was conducted a high-resolution facies analysis using core descriptions, trace fossil analysis, petrography, various types of X-ray fluorescence, scanning electron microscopy, X-ray diffractometry, and isotope analyses (δ1³C, δ1⁸O, and ⁸⁷Sr/⁸⁶Sr) on a ∼63-m-thick succession from borehole 2-TV-1-MA. Thirteen facies were recognized and grouped into brackish lake, prodelta, delta front, and alkaline hypersaline lake facies successions. The lower Codó Formation exhibits cyclic sedimentation, indicating fluctuating water dynamics associated with shifts between open and closed drainage systems controlled by paleoclimate. Tectonic subsidence drove the basin's evolution from a brackish lacustrine-deltaic environment with an incipient marine influence (balanced-fill basin stage) to a restricted system with the establishment of an alkaline hypersaline lake (underfilled basin stage).

The Presence of Blood in a Strain Gauge Pressure Transducer Has a Clinical Effect on the Accuracy of Intracranial Pressure Readings.

Patients admitted with cerebral hemorrhage or cerebral edema often undergo external ventricular drain (EVD) placement to monitor and manage intracranial pressure (ICP). A strain gauge transducer accompanies the EVD to convert a pressure signal to an electrical waveform and assign a numeric value to the ICP. This study explored ICP accuracy in the presence of blood and other viscous fluid contaminates in the transducer. Preclinical comparative design study. Laboratory setting using two Natus EVDs, two strain gauge transducers, and a sealed pressure chamber. No human subjects or animal models were used. A control transducer primed with saline was compared with an investigational transducer primed with blood or with saline/glycerol mixtures in mass:mass ratios of 25%, 50%, 75%, and 100% glycerol. Volume in a sealed chamber was manipulated to reflect changes in ICP to explore the impact of contaminates on pressure measurement. From 90 paired observations, ICP readings were statistically significantly different between the control (saline) and experimental (glycerol or blood) transducers. The time to a stable pressure reading was significantly different for saline vs. 25% glycerol (< 0.0005), 50% glycerol (< 0.005), 75% glycerol (< 0.0001), 100% glycerol (< 0.0005), and blood (< 0.0005). A difference in resting stable pressure was observed for saline vs. blood primed transducers (0.041). There are statistically significant and clinically relevant differences in time to a stable pressure reading when contaminates are introduced into a closed drainage system. Changing a transducer based on the presence of blood contaminate should be considered to improve accuracy but must be weighed against the risk of introducing infection.

Family health assessment in Ifugao, Philippines: a baseline study for Health In-tervention Program

A study was conducted to assess the health status of families in selected communities in Ifugao, Philippines. Interviews were done using a guide questionnaire adopted from the Family Health Management Manual for Nursing Students by Lydia Capistrano-Viet. The findings showed that the majority of households are nuclear, consisting of 5–10 people, and have an average monthly family income of 5,000–10,000 Philippine peso. The majority of the families possessed their own lots and homes made of wood and concrete, with enough space for the entire family. The majority of them disposed of their trash by burning it or giving it to animals. Nearly majority of them feature closed drainage systems and flush toilets. The majority reported that their homes lacked bug and rodent breeding grounds and shared a water supply. Additionally, they felt that their families' health was good as they had only experienced colds and the common cold over the previous six months. As shown by the fact that all of the respondents visit doctors and the health center for their medical requirements, 80% of them have complete immunization records. More or less seventy percent of people said they also follow healthy habits. The findings also demonstrate the availability of transportation, communication, and health resources in the neighborhood. A health intervention program aimed at enhancing the health and well-being of family clients in the community will be developed based on the study's findings.

Underwater versus Closed Drainage System for Surgical Treatment of Chronic Subdural Hematoma

Chronic subdural hematoma (CDH) is a prevalent condition in neurosurgery. Standard care includes surgical evacuation with drainage of residual subdural cavity. We hypothesized that effective and timely drainage of subdural space may improve clinical and radiological outcomes. This study was conducted to compare the effectiveness of standard closed drainage and underwater drainage. Medical data of 300 surgically treated chronic subdural hematoma CDH patients were retrospectively collected and analyzed. The patients were divided into two 2 groups: Group I with underwater drainage, and Group II with closed drainage. Groups were compared in terms of gender, age, complication rates, recurrence rates, seizure rates, and length of hospital stay. Underwater drainage was found superior to closed system by all clinical and radiographic parameters. The recurrence rate was significantly lower in Group I (2%) compared to with Group II (10%). Subdural empyema was observed in 10 patients in Group II and none in Group I. The seizure rate was higher in Group II (18%) compared to with Group I (5%). Postoperative pneumocephalus rates was were 20% in Group I and 54% in Group II. The length of hospital stay was 6±2.6 days in Group I and 8.9±6.1 days in Group II. The length of intensive care unit (ICU) stay was 0.6±1.12 days in Group I and 2.7±5 days in Group II. A minority (5%) of the patients in Group II required reoperation due to recurrence. The use of underwater system significantly the reduces the rates of pneumocephalus, seizures, infection, and recurrence. Additional benefits are shorter intensive care unit ICU and total hospital stays.

Postoperative Incidence of Symptomatic Urinary Tract Infection (UTI) and Microbial Pattern Seen in TURP Patients with Negative Cultures Preoperatively

Background: Transurethral Resection of the Prostate (TURP) is the gold standard for surgical treatment of benign prostate hyperplasia (BPH). One of the postoperative complications of TURP is urinary tract infection (UTI). Symptomatic UTI occur despite preoperative sterile urine, prophylactic antibiotics and a closed drainage system. We studied the incidence of such symptomatic UTI and the microbial pattern observed. Material and Methods: This was a prospective study of 220 patients who had monopolar TURP in our centre from 2015 to 2020. All patients had sterile urine before surgery. Catheters were removed three days postoperatively. Patients presenting with symptoms of UTI were subjected to urine culture and antibiotic sensitivity. The recorded variables include patient demographics, co-morbid factors; Diabetes, hypertension, presence or absence of preoperative catheterization, duration of surgery, presence of postoperative UTI, microbial patterns and antibiotic sensitivity patterns. Results: The mean age of the patient was 66.25 years. 35.5% had preoperative catheterization. 42 (19%) patients were established to have symptomatic UTI. Age ≥ 65 years, duration of surgery ≥60 mins led to higher infection rates but preoperative catheterization, diabetes and hypertension did not influence UTI rates. The commonest organism was E. Coli and the most common sensitive antibiotic was levofloxacin (quinolone). Conclusions: Symptomatic UTI post-TURP still occurs despite preoperative sterile urine and routine prophylactic antibiotics.

Effect of closed drainage system on prevention of seroma after laparoscopic total extraperitoneal repair in primary M3 and L3 inguinal hernia

Effect of closed drainage system on prevention of seroma after laparoscopic total extraperitoneal repair in primary M3 and L3 inguinal hernia

Dehumidification efficiency in the conditions of climate change in the Novgorod region

Agricultural production is closely related to natural and climatic factors, of which meteorological factors are the most variable and active. The analysis of climatic precipitation and temperature norms according to the data of 4 meteorological stations of the Novgorod region for the period 1891-2020 showed their steady increase, except for the Novgorod meteorological station, where the annual precipitation rate by 2020 decreased against the background of temperature growth. Analysis of the results of meteorological observations over the past 60 years has shown that there is a steady trend in the Novgorod region to increase the degree of humidification: the hydrothermal coefficient has increased from 1.36 to 1.46. This happened due to the excess of the increase in precipitation over the increase in temperature, so agricultural production of crop production is impossible without reclamation measures. The aim of the research was to gain new knowledge in the formation of soil moisture regimes under the influence of drainage reclamation in the conditions of climate change. In the Non-Chernozem zone, two main methods of drainage are common - a network of open channels and closed drains. Studies on the formation of soil moisture regimes were carried out during 2019-2021 on experimental production sites of closed and open drainage on 8 variants of structures. The conducted studies of the efficiency of the drainage systems of closed and open drainage allowed us to conclude that closed drainage systems better provide the water-air regime of the soil compared to open drainage: the period of soil being in a waterlogged state is 2 times shorter (50 days on open drainage structures and 25 days on closed drainage structures).The most optimal water-air regime of the soil among the options with closed drainage was provided by drainage systems with filling the drainage trench with wood chips, on which the range of moisture changes in the root-inhabited soil layer during 3 years of observation was closest to optimal and amounted to 210-114 mm. Among the options for open drainage are systems of runoff hollows in combination with cultivation strips.

Subarachnoid Hemorrhage Following Drainage of Chronic Subdural Hematoma: A Case Report

Background: Acute subarachnoid hemorrhage (SAH) is a rare but severe complication after burr hole surgery for Subarachnoid hemorrhage (CSDH). Case presentation: An 86-year-old male was found fainted. Computed tomography (CT) scans showed a right fronto-temporo-parietal CSDH with a shift in the midline structures. Under local anesthetic with medical sedation a closed-system drainage of the hematoma was performed via one burr hole. Two days after surgery the patient complained of headache and a subsequent CT scan revealed SAH. The presence of intracranial aneurysms was excluded by CT angiogram. The patient survived with medical management.

How I do it: simplified craniotomy for acute subdural hematoma in the elderly.

Acute subdural hematoma (ASH) is responsible for significant morbidity and mortality in the elderly. As military neurosurgeons, we perform a simplified technique using a linear skin incision and a small craniotomy bone flap in order to ease perioperative tolerance. The patient lies supine, a pad under the shoulder ipsilateral to the ASH, the head completely rotated on the other side and placed on a circular pad, without head clamp. The linear frontotemporal skin incision should be twice the size of the bone flap's diameter, allowing to access the whole subdural space. Care is taken to obtain complete decompression of the temporal fossa in order to alleviate uncal herniation. A subdural drain can be placed, and the subdural space is filled with warm saline solution in order to create a closed drainage system. The patient is allowed to sit at postoperative day 1 and to walk at postoperative day 2. Simplified craniotomy for ASH allows to reduce operative time and provides faster functional recovery.

Surgical treatment of chronic subdural hematoma by twist drill craniotomy: A 9-year, single-center experience of 219 cases

ObjectiveThis study aims to assess the safety and efficiency of twist drill craniotomy (TDC) for surgical treatment of chronic subdural hematoma (CSDH) based on a single-center experience of 219 cases performed over nine years. MethodsWe performed a retrospective analysis of CSDH patients who underwent TDC treatment in our hospital between January 2013 and December 2021. Clinical and radiological characteristics, as well as surgical outcomes of the included patients, were reviewed and analyzed. Factors that may affect hematoma recurrence and outcomes were also investigated. ResultsA total of 219 patients (186 males and 33 females) were included. Eighteen (8.2%) patients experienced postoperative complications. The in-hospital mortality and recurrence rates in our series were 0.5% (1/219) and 4.1% (9/217), respectively. 91.7% (199/217) of patients achieved favorable outcomes six months after the operation. Duration of drainage catheter (odds ratio [OR] 0.135, 95% confidence interval [CI] 0.017–1.099; P = 0.030) was the only factor significantly related to the recurrence of CSDH. Moreover, brain infarction (OR 5.175, 95% CI 1.417–18.896; P = 0.013), Alzheimer’s disease (OR 20.515, 95% CI 1.950–215.840; P = 0.012), and preoperative dysfunction of coagulation (OR 6.509, 95% CI 1.501–28.217; P = 0.012) were markedly associated with unfavorable functional outcomes. ConclusionTDC with irrigation and closed-system drainage is a minimally invasive, simple, safe, and effective surgical technique that can serve as the first-choice for the treatment of CSDH with a low recurrence rate.

A rare case of bleeding into the Sylvian arachnoid cyst: A case report

Arachnoid cysts are primarily developmental in origin and constitute rare, benign lesions. Sylvian arachnoid cysts may infrequently present with subdural and/or intracystic hemorrhage. Hemorrhage is typically of venous origin and occurs due to stretching and tearing of bridging veins, depending on minor traumas. The annual risk of bleeding associated with Sylvian arachnoid cysts, with no additional complaints other than headache and an asymptomatic course, has been reported to be 0.04%. Symptoms can range from headache to coma, depending on the mass effect after hemorrhage. If there is no clinical evidence linking the arachnoid cyst, it is sufficient to perform surgery only for the hematoma without resecting it. In this case report, we present a rare instance of hemorrhage due to a Sylvian arachnoid cyst that developed after trauma and was observed in a patient who came to our clinic with a headache. In our patient, the cyst-dependent left parietal subdural hemorrhage was evacuated through a burr-hole craniotomy, and a closed-system drainage with a Hemovac drain was applied for 48 hours. During post-operative follow-up, complete resorption of subdural and intracystic hemorrhages was observed. A case-based surgical approach is necessary for bleeding due to arachnoid cysts in the Sylvian region.

Formation of groundwater levels of drained lands in the natural and climatic conditions of the Novgorod region

Studies on the formation of groundwater levels have been carried out on open and closed drainage systems in the natural and climatic conditions of the Novgorod region for more than 30 years at 2 pilot production sites. On the first site there are 4 structures of closed drainage: shallow with a depth of 70 cm; medium-deep drainage (drainage depth 110 cm) with various options for filling the drainage trench-wood chips and sand-gravel mixture; two-tier drainage (drainage depth 110 and 60 cm). On the second site there are four open drainage structures: channels; hollows – without hydro-reclamation structures; with drainage along the bottom-tubular and strip-free. The average long-term data on groundwater regimes on experimental structures were obtained and conclusions were drawn that the average seasonal groundwater level formed by closed drainage systems is 18 cm lower compared to open drainage systems; the most favorable groundwater regime is formed by drainage systems of two-tier drainage. The dependences of groundwater levels formed during the most intense periods of operation of drainage systems (May – 1st decade of June) on the amount of precipitation for previous periods are analyzed. It was revealed that the closeness of the relationship between groundwater levels and the amount of precipitation in the open drainage variants is less close (r2 = 0.01-0.30) compared with the closed drainage variants (r2 = 0.02-0.54). The closest relationship on closed drainage systems is observed between the groundwater level of the third decade of May and precipitation for May: during this period, with an increase in precipitation by 1 mm, groundwater rises by 0.3 cm – in the variant with chip filling and by 0.6 cm – in the variants of shallow and two-tier drainage.

Exhaustive drainage versus fixed-time drainage for chronic subdural hematoma after one-burr hole craniostomy (ECHO): study protocol for a multicenter randomized controlled trial

BackgroundChronic subdural hematomas (CSDHs) are one of the most common neurosurgical conditions. The standard surgical technique includes burr-hole craniostomy, followed by intraoperative irrigation and placement of subdural closed-system drainage. The drainage is generally removed after 48 h, which can be described as fixed-time drainage strategy. According to literature, the recurrence rate is 5–33% with this strategy. In our retrospective study, postoperative hematoma volume was found to significantly increase the risk of recurrence. Based on these results, an exhaustive drainage strategy is conducted to minimize postoperative hematoma volume and achieve a low recurrence rate and good outcomes.MethodsThis is a prospective, multicenter, open-label, blinded endpoint randomized controlled trial designed to include 304 participants over the age of 18–90 years presenting with a symptomatic CSDH verified on cranial computed tomography or magnetic resonance imaging. Participants will be randomly allocated to perform exhaustive drainage (treatment group) or fixed-time drainage (control group) after a one-burr hole craniostomy. The primary endpoint will be recurrence indicating a reoperation within 6 months.DiscussionThis study will validate the effect and safety of exhaustive drainage after one-burr hole craniostomy in reducing recurrence rates and provide critical information to improve CSDH surgical management.Trial registrationClinicaltrials.gov, NCT04573387. Registered on October 5, 2020.

The Value of Suction Drainage for a Chronic Subdural Hematoma in Elderly Patients: A Retrospective Cohort study

Background: The use of suction in the subgaleal drainage system after the burr-hole evacuation of chronic subdural hematoma (CSDH) is still debatable. This study aimed to investigate the value of adding suction to the drainage system of CSDH in elderly patients. Methods: This cohort study retrospectively reviewed the data of the CSDH patients operated on at our university hospital in the last eight years. The inclusion criteria were elderly patients who underwent evacuation of a unilateral CSDH through two burr holes followed by placing a subgaleal drainage tube. Two hundred seventy-three consecutive patients met the inclusion criteria. Seventy-six patients (27.8%) received suction drainage. The comparison between groups with qualitative data was done using the chi-square test. The comparison between groups with quantitative data was done using the t-test. The statistical analyses were conducted using SPSS software version 21 (IBM Corp., Armonk, New York, USA). Results: There were no statistically significant differences between the suction and the non-suction drainage groups regarding the hospitalization period, the postoperative seizures, or the recurrence rate. However, the postoperative pneumocephalus volume in the suction drainage group was significantly lower than in the non-suction drainage group. None of the patients developed acute subdural or intracerebral hemorrhage. Conclusions: Suction drainage did not add statistically significant value to the closed drainage system regarding the hospitalization period, postoperative seizures, or recurrence rate of the CSDH. A prospective controlled study is needed to increase the evidence for this finding.

Evaluating the optimal number of burr-holes for treating chronic subdural haematomas: good results from a single burr-hole?

Chronic subdural haematomas (cSDH) are one of the most common types of traumatic intracranial lesion. Burr-hole craniostomy followed by closed-system drainage has become the treatment of choice. However, there is no definitive indication as to the number of burr-holes needed. Our aim was to to assess clinical and radiological outcomes taking into account the number of burr-holes made. A retrospective single-centre-study was performed including patients treated for cSDH by performing burr-hole craniostomy from 2012 to 2018. After collecting data regarding demographics, comorbidities, and clinical and radiological records, haematomas were grouped depending on the number of burr-holes made (Group 1: single burr-hole; Group 2: double burr-holes). Clinical and radiological outcomes were statistically compared between groups, as well as the main complications. After collecting 171 patients, 205 cSDHs were analysed. 173 were treated with a single burr-hole (we called these Group 1) and 32 with double burr-holes (Group 2). No differences in preoperative characteristics were found between the groups, except for diabetes mellitus and previous antiplatelet/anticoagulation treatment. No radiological differences were found regarding haematoma volume (p = 0.7) or thickness (p = 0.3). Surgical site infection (p = 0.13), recurrence (p = 0.6), acute rebleeding (p = 0.25) and mortality (p = 0.94) were assessed without evidencing statistically significant differences. At the time of hospital discharge, most patients showed a remarkable clinical improvement, regardless of the number of burr-holes made (p = 0.7). This study suggests that cSDH can be efficiently evacuated by a single burr-hole craniostomy, a less invasive and shorter surgical procedure with quite good clinical outcomes and a low rate of complications.

Comparative Study to assess Environmental sanitation practices and its effect on health among people residing at selected rural and urban area of Rahata taluka

Background: Environment sanitation is one of the determinant of quality of life and necessary for human development. Safe water and basic sanitation is of crucial important for promotion of health and prevention of health illness/issues. The aim of sanitation system is to protect human health by providing a clean environment that will stop transmission of diseases. Objectives: 1) to assess the environmental sanitation practices and its effect on health among selected urban population. 2) To assess the environmental sanitation practices and its effect on health among selected rural population. 3) To find out relationship between health effect of environmental sanitation practices with socio - demographic variable. Material and Methods: A descriptive research study design with cross sectional survey approach was undertaken in community area Astagaon and Rahata. A total of 100 people were selected with the help of systemic random sampling technique to assess the environmental sanitation practices and its effect on health among selected urban and rural area of Rahata taluka. A nurse investigator conducted a structured interview for 40 minutes to collect data. A proforma was prepared and to collect the data. The data was analyzed with descriptive and inferential statistics wherever required. Results: Housing qualities were shows highest percentage (82%) were had pakka house in urban area while (76%) in rural area. Highest percentage (94%) were purifying water drinking by various methods in urban area than in rural area (84%). Toilet facility were shows highest percentage (100%) of availability of toilet facility in urban area than rural area (90%). Waste management shows that highest percentage (78%) were had closed drainage system in urban area than rural area (64%). Highest percentage (64%) people were using community dustbin in urban area where (48%) people were burning waste in open in rural area. Hygienic practices were highest percentage (94%) peoples practicing hand washing after defecation in urban area than rural area (90%). The 4.25 was mean/average score of presence of illness in urban area. while in rural area mean of presence of illness was 4.71. Conclusion: The major findings of study shows that community people are more vulnerable to develop physical health problem due to poor environmental sanitation and hygienic practices as compare to urban community people. Thus it should be emphasized having awareness session with community people regarding importance of maintaining good environmental sanitation and hygienic practices and its effect on health.

MP31-19 REDUCING CATHETER ASSOCIATED-URINARY TRACT INFECTIONS WITH STERILE, CONTINUOUSLY CLOSED DRAINAGE SYSTEMS DOES NOT HAVE TO BE COSTLY

You have accessJournal of UrologyCME1 May 2022MP31-19 REDUCING CATHETER ASSOCIATED-URINARY TRACT INFECTIONS WITH STERILE, CONTINUOUSLY CLOSED DRAINAGE SYSTEMS DOES NOT HAVE TO BE COSTLY Janelle Fox, Christina Jockel, Leslie Konyk, Shaina Thomas, Omar Ayyash, Rajeev Chaudhry, Glenn Cannon, Francis Schneck, Daniel Pelzman, and Lindsay Montoya Janelle FoxJanelle Fox More articles by this author , Christina JockelChristina Jockel More articles by this author , Leslie KonykLeslie Konyk More articles by this author , Shaina ThomasShaina Thomas More articles by this author , Omar AyyashOmar Ayyash More articles by this author , Rajeev ChaudhryRajeev Chaudhry More articles by this author , Glenn CannonGlenn Cannon More articles by this author , Francis SchneckFrancis Schneck More articles by this author , Daniel PelzmanDaniel Pelzman More articles by this author , and Lindsay MontoyaLindsay Montoya More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002580.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infections (UTIs) are the fifth most common hospital-acquired infection. Each foley day increases the risk of UTI by 3-7%, hence the National Healthcare Safety Network (NHSN) has provided hospitals with a means of tracking catheter associated-urinary tract infections (CA-UTIs) and toolkits to help reduce their frequency. One means by which CA-UTIs are reduced is through use of sterile, continuously closed drainage systems. To do so, many hospitals have switched to use of pre-packaged and sealed systems which are more costly. An alternative was proposed in the UPMC Children’s Hospital of Pittsburgh (CHP) Pediatric Intensive Care Unit (PICU) whereby two nurses perform every foley placement to ensure sterile technique. They use a separate foley catheter, sterile insertion kit and urine meter bag which are then treated as a functionally closed system. METHODS: During the 7-month period of April–October 2021, the CHP PICU instituted the two-part, two-person foley insertion protocol and tracked both CA-UTI rates and cost savings compared with the 7-month period using a pre-packaged catheter kit. Closed-system catheter kits cost CHP $198.18 per unit. Two-part, two-person foley insertions cost CHP $68.33 per insertion, with each repeat attempt adding $5.33. RESULTS: A total of 215 patients had indwelling urinary catheters during the study period. Of these, 124 were placed in the PICU and 91 by other services (OR, IR, outside hospitals, Urology). Of the 124 PICU catheterizations, first attempts were successful in 101 patients with 17 second attempts, 5 third attempts and 1 fourth attempt. Costs of using the closed-system catheter kit based on these numbers of attempts would be $30,519. Costs of using a two-part, two-person protocol which remained closed after insertion were $8821.82, translating into a cost savings of $21,679.18 over 7 months or $37,164.30 over 1 year. Among 15 nurses who provided feedback on the new two-person, two-part protocol, 13 of the 15 (87%) preferred this method. There was no statistically significant increase in CA-UTIs after the new protocol was adopted, with CA-UTI rates remaining at 0 throughout the study period. CONCLUSIONS: Switching from pre-packaged closed system catheter kits to a two-part, two-person protocol for foley insertions translates into significant annual cost savings for pediatric acute care facilities, without an increase in CA-UTIs. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e529 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Janelle Fox More articles by this author Christina Jockel More articles by this author Leslie Konyk More articles by this author Shaina Thomas More articles by this author Omar Ayyash More articles by this author Rajeev Chaudhry More articles by this author Glenn Cannon More articles by this author Francis Schneck More articles by this author Daniel Pelzman More articles by this author Lindsay Montoya More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Effects of Dexamethasone Used in the Treatment of Chronic Subdural Hematoma

Aim: In this study, we aimed to analyze the properties of drained subdural fluid and post-operative follow-up of patients with chronic subdural hematoma subdivided randomly into two groups according to presence or absence of dexamethasone treatment. Material and Methods: 42 patients with chronic subdural hematoma were involved in this study. The patients were divided into two groups according to dexamethasone treatment. 21 of the patients were treated with dexamethasone. All patients underwent burr hole craniotomy and a closed system drainage was constructed. The amount and properties of per-operative versus post-operative drained subdural fluid (hemoglobin, total protein and albumin levels) were analyzed. Cranial computerized tomography scans were used for follow-up and presence of fluid collection in subdural space was controlled. Results: When compared to per-operative laboratory results, statistically significant decrease was observed in both groups. However, the decrease in dexamethasone group was more significant compared to none-dexamethasone group. Follow-up computerized tomography results showed rare new subdural fluid collection development in dexamethasone group. Conclusion: As a result, Our findings suggest that surgery with dexamethasone treatment in chronic subdural hematoma patients has a more favourable clinic result compared to surgery without dexamethasone treatment.