Difficult Catheterization Research Articles

Ventricular tachycardia ablation with pentaspline pulsed field technology in two patients with ischemic cardiomyopathy.

Due to its unique features, pulsed field ablation (PFA) could potentially overcome some limitations of current radiofrequency (RF) ventricular tachycardia (VT) ablation. However, data on the use of PFA in this setting are currently scarce. Two patients with ischemic cardiomyopathy and previously failed RF VT ablations were treated with PFA. A total of 18 bipolar applications (case1) and seven bipolar applications (case2) were delivered to the infero-lateral and infero-septal areas (case1) and to the apical lateral left ventricular (LV) wall (case2), placing the catheter adjacent to the LVwall in the flower configuration. A rapid cessation of VT and restoration of sinus rhythm were observed during PFA delivery in both cases. Further applications were delivered to achieve complete elimination of late potentials. In case 1, during the in-hospital stay, ECG monitoring did not show VT recurrences. Six-month follow-up was uneventful, with no VT recurrences at ICD interrogation. In case 2, due to postdischarge VT recurrences, a second RF procedure was scheduled 1 month later. The voltage map performed in sinus rhythm showed a low-voltage zone located at the anterolateral wall, near the previous ablation site. Numerous late potentials were recorded. At the 6-month follow-up, no further VT recurrences were documented after RF redo ablation. While the speed of application and potential transmural effect can facilitate the ablation of large diseased endocardial areas, early loss of contact due to difficult pentaspline catheter manipulation in the LV could lead to insufficient contact force and, consequently, inadequate energy penetration.

Safety and Feasibility of Electrocardiogram-Guided Tip Positioning Combined with Ultrasound-Guided Placement of Peripherally Inserted Central Catheter Performed in Severe Brain Injury Patients

ObjectiveTo explore the safety and feasibility of using electrocardiogram (ECG)-guided tip positioning combined with ultrasound-guided placement of peripherally inserted central catheters (PICC) in patients with severe brain injury in a neurosurgery intensive care unit.MethodsWe retrospectively analyzed 400 patients who underwent PICC catheterization in a neurosurgery intensive care unit from January 2017 to January 2021. Of those, a group of 157 patients received only ultrasound-guided PICC placement. The second group (243 patients) received ECG-guided tip positioning combined with ultrasound-guided PICC placement. A logistic regression analysis was conducted on gender, arm circumference, and ECG usage based on whether the results were in place. The positioning accuracy, success rate of primary catheterization, incidence of ectopic catheters, average catheterization depth, and incidence of catheterization complications were observed.ResultsLogistic regression analysis showed that only ECG guidance helps to achieve accurate PICC (OD, 4.541; 95CI, 2.224–9.271; p < 0.001). The correct placement rate of the PICC tip was significantly higher in ECG-guided tip positioning combined with the ultrasound guidance group (90.73%) compared to the ultrasound-only group (79.00%, P < 0.001). There was no significant difference between the two groups in terms of difficult catheter delivery and replace the punctured vessel, and the incidences of blocked blood return in the ECG-plus-ultrasound group was significantly better than the ultrasound group (9.55%) (χ2 = 14.402, P < 0.001).ConclusionIn patients with severe brain injury, ECG-guided tip positioning combined with ultrasound guidance in PICC catheterization can significantly increase the rate of correct tip placement without increasing the difficulty of catheterization.

Erasing narrow paravisceral true lumen with endoseptostomy to favor adequate expansion of branched endograft during postdissection thoracoabdomimal aortic aneurysm endovascular repair

Narrow paravisceral aortic true lumen in postdissection thoracoabdominal aneurysm, represents a challenging situation when branched endovascular aneurysm repair is required; it may be responsible for intraprocedural technical difficulties, such as inadequate main endograft deployment, difficult vessels catheterization, or long-term branch instability related to compression. We describe the case of a 56-year-old man with post-type B thoracoabdominal aortic aneurysm and a severely narrow true lumen (10 mm) at the paravisceral segment. Endovascular aortic septostomy was performed first, to erase the narrow paravisceral aortic true lumen, and subsequently allow branched endograft adequate expansion and regular vessels catheterization.

Difficult catheterization and previous urethral obstruction are associated with lower urinary tract tears in cats with urethral obstruction.

To retrospectively assess the hospital prevalence and risk factors associated with iatrogenic lower urinary tear in cats with urethral obstruction (UO). 15 client-owned cats diagnosed with concurrent UO and lower urinary tears and year-matched control population of 45 cats diagnosed with UO. University teaching hospital records were reviewed for cats presenting with UO between January 2010 and December 2022. Signalment, anatomic location of tear, experience of the individual passing the urinary catheter, difficulty level of catheter passage, history of previous UO, blood work parameters on presentation, presence of visible grit in urine, and survival to discharge were recorded. In addition, prevalence of lower urinary tears in cats presenting with UO was calculated. The prevalence of lower urinary tears was 0.92% in UO cats. Cats with lower urinary tears were significantly less likely to survive to discharge and had a longer period of hospitalization than cats without tears. In addition, cats with tears were more likely to have a history of previous UO and had more difficult urinary catheter passage than cats in the control group. Cats with tears also had a higher Hct than the control UO cats. Cats that develop lower urinary tears are more likely to have a history of previous UO and difficult catheter passage. This group of cats is also more likely to have a longer hospitalization period and lower survival to discharge rates.

Transurachal Catheter for Management of Difficult Catheterization in Anorectal Malformations: A Novel Technique

BackgroundUrinary tract drainage is necessary to facilitate the maneuver in laparoscopic-assisted anorectoplasty (LAARP). Male patients with Anorectal malformations (ARM) are often encounter difficult catheterization during surgery. ObjectiveWe pioneered the urinary catheterization through the urachus in ARM patients and evaluated the efficacy. MethodFourteen ARM patients undergoing urinary catheterization through urachus between September 2015 and September 2023 were reviewed. ResultsThe median age at the time of surgery was 0.06 months. Nine neonatal patients underwent the one-stage LAARP, while five patients underwent staged procedure. Four ARM patients with rectoprostatic fistula, while ten with rectobulbar fistula. All patients successfully underwent transurachal catheterization. No incidents of catheter blockage, accidental removal, or urinary tract infection symptoms were detected during hospitalization. ConclusionsTransurachal catheterization is a safe, effective, and cosmetic procedure for ARM patients with difficulty urethral catheterization. Level of EvidenceIV.

Turn-Over Technique for Inserting and Stabilizing Guiding Sheath without Straightening It during Carotid Artery Stenting via Trans-Brachial Approach in Cases with Severe Vascular Access Conditions.

In cases of severe atherosclerosis or tortuous arteries, inserting the guiding sheath into the target vessel is challenging. Here, we present the turn-over technique for inserting and stabilizing the guiding sheath without straightening it during carotid artery stenting (CAS). Two patients with severe left internal carotid artery stenosis underwent CAS via the trans-brachial approach. Although inserting the guiding sheath into the common carotid artery using conventional techniques was challenging, we succeeded in inserting it into the target vessel using the "turn-over technique." At first, the guidewire was U-turned just above the aortic valve and inserted into the left external carotid artery. The inner catheter and guiding sheath were then followed along the guidewire to the left common carotid artery, and the guidewire and inner catheter were removed. The guiding sheath was stable in a U-turned position, and straightening the guiding sheath was difficult. Devices such as stents and balloons could be delivered without problems, and CAS was completed with the guiding sheath in a U-turned position. The turn-over technique for inserting and stabilizing the guiding sheath for CAS via the trans-brachial approach is an option in cases of difficult catheter access due to atherosclerosis or tortuous arteries.

Angiographic Imaging of Prostatic Artery Origin in a Greek Population and Correlation With Technical and Clinical Aspects of Prostatic Artery Embolization.

Background This study aimed, first, to angiographically investigate and analyze prostatic artery (PA) origin in a Greek male population with benign prostatic hyperplasia (BPH) treated with prostatic artery embolization (PAE) and, second, to correlate prostatic arterial anatomy with technical and clinical aspects of PAE. Methodology This was a retrospective study of BPH patients who underwent PAE in a single tertiary center in Greece from June 2019 to July 2022. For the first part of the study, PA was imaged with computed tomography angiography (CTA) before PAE and with digital subtraction angiography (DSA) during PAE in all patients. A widely accepted system for the classification of PA origin was applied. Type I, a common origin of PA and superior vesical artery (SVA) from the anterior division of internal iliac artery (IIA). Type II, PA originating from the anterior division of IIA, separate from, and inferior to SVA. Type III, the origin of PA from the obturator artery. Type IV, the origin of PA from the internal pudendal artery. Type V, rarer origins of PA. For the second part of the study, a subgroup of patients from the first part (treated with the same PAE protocol and free of vascular pathology that could have interfered with the technical success of PAE) was selected. In this subgroup, differences in PA origin were correlated with technical aspects (feasibility of catheterization of PA, fluoroscopy time (FT), dose area product (DAP)) and clinical outcomes of PAE. Results After the exclusion of four patients, 159 patients were included in the first part of the study. From a total of 355 PAs, 110 (31%) were compatible with type I, 58 (16.3%) type II, 45 (12.7%) type III, 110 (31%) type IV, and 32 (9%) type V. PA origin from an accessory internal pudendal artery was the most common among the rare origins of type V. Regarding the second part of the study (a subgroup of 101 patients selected to facilitate comparisons between the different types of PA origin), type I was associated with significantly more incidences of failed or difficult catheterization of the PA compared to all other types combined (27/64 vs. 18/138, p < 0.001). Types III, IV, and V showed a relatively low degree of technical difficulty. Patients with type I PA origin of at least one pelvic side (subgroup (I), n = 48) had significantly longer FT and DAP compared to the rest (subgroup (O), n = 53). Clinical success rates of PAE were slightly lower for the subgroup (I), although the difference was not statistically significant (75.8% vs. 83.8% at 18 months post-PAE, p = 0.137). No major complications were observed. Conclusions This is the first study of PA origin in Greece. It was demonstrated that types I and IV of PA origin were the most common and had the same prevalence. Type I showed significantly higher technical difficulty compared to the others, but had no significant impact on the clinical outcomes of PAE.

1018 Emergency Urology Crash Course: Teaching Non-Urologists Pays Back

Abstract Aim To improve the knowledge, practical skills as well as professional skills of non-urologist health care professionals and bridge the gap between different specialties. Method One-day emergency urology crash course has been organised by urology team in our trust. The course is provided by 4 urology SpR under supervision of a urology consultant. Our course includes alternating sessions between lectures and practical skills. Lectures include interactive talks about common emergency urology case scenarios including obstructive uropathy, urinary infections &amp; sepsis, andrological emergency, urologic trauma etc. Hands-on training using mannequin models includes difficult catheter, bladder wash out, 3-way catheter irrigation, flexible cystoscopy, foreskin problems, SPC insertion etc. Pretest and posttest questionnaires as well as a feed-back forms have been used to collect data used to analyse performance and the overall outcome of the course. We ran the course 3 times so far. Results Candidates included 60% A&amp;E, 20% General surgery, 10% medical, 10% others. 70% were SpR,25% SHO and F1 or 2, 5% Nursing staff. 80% of candidates were from our trust and 20% from other trusts who got interested to attend. Candidate to faculty ratio was 5:1. Pre and post test result showed increase in knowledge by 4 points and increase in practical skills of 3 points. Conclusions One-day emergency urology course can achieve a lot on practical grounds as candidates feel more confident dealing with emergency urology cases after bridging the gaps in their knowledge and practical skills. This reflects on the overall service provided to urology patients presenting in the acute settings.

Expanding access to difficult urinary catheter insertion services through a novel nurse practitioner led team.

Within the United States health care system, one of the most common procedures performed daily is urinary catheterization. Oftentimes, the urinary catheter is placed by nursing personnel without any difficulty. Although the procedure is usually simple and routine, there are instances in which placement can be problematic. Urology is one of the smallest surgical subspecialties, with intermittent availability given active commitments in the operating room and clinic. This opened an opportunity for nurse practitioners (NPs) at an urban quaternary care hospital to further enhance their skill set in the care of these patients. Fifteen Rapid Response Team NPs were selected based on specific criteria. Their roles expanded to include consults for difficult urinary catheter insertions. A 2-step training program was implemented for NPs to develop proficiency in inserting urinary catheters in patients with new or known urologic conditions. Of the 391 catheter consults made to the NP group, 73 (18.7%) of them required urology follow-up. This program can benefit patients by potentially reducing catheter-related complications and associated length of stay.

V07-11 USE OF ULTRASOUND IN DIFFICULT URINARY CATHETERIZATION

You have accessJournal of UrologyCME1 Apr 2023V07-11 USE OF ULTRASOUND IN DIFFICULT URINARY CATHETERIZATION Jeffrey Lee, Dhaval Jivanji, Benjamin Shpeen, Elie Kaplan-Marans, Ariel Schulman, and Ruslan Mamedov Jeffrey LeeJeffrey Lee More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Benjamin ShpeenBenjamin Shpeen More articles by this author , Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , Ariel SchulmanAriel Schulman More articles by this author , and Ruslan MamedovRuslan Mamedov More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of point-of-care ultrasound (POCUS) has become ubiquitous within medicine and can be utilized in numerous clinical scenarios. Various studies have shown the benefits of training urologists to use ultrasound (US), but there is currently scant literature regarding its use in difficult urinary catheterization (DUC). The goal of this video is to demonstrate the equipment and US-guided techniques we used to aid in DUC. METHODS: We present the case of an 89-year-old who developed oliguria and fecaluria after placement of a urinary catheter. Two days later, he underwent a CT which showed evidence of a urethral false passage and urethrorectal fistula with the catheter balloon inflated within the rectum. Urology was consulted to evaluate the patient. Due to the trauma caused by initial failed catheter placement, the decision was made to place a new catheter under direct vision via flexible cystoscopy. For our US, we used a Mindray TE5 with a C5-2s convex transducer. After successfully advancing a sensor guidewire into the bladder under cystoscopy, we were able to visualize the wire as a hyperechoic structure under US. Next, the wire was exchanged for a 5 French open-ended catheter in order to obtain a clean urine specimen. To confirm appropriate placement of the open-ended catheter in the bladder, we injected 10ml of normal saline to visualize flow using the color doppler feature of the US. After we exchanged the open-ended catheter for a guidewire, we used a 16 gauge angiocatheter to bore a hole into an 18 French foley to create a council tip, which was advanced into the bladder. Lastly, we inflated the catheter balloon to the recommended maximum capacity of 30ml in order to aid in easier identification under US. RESULTS: The patient underwent successful placement of a urinary catheter using US assistance and he immediately drained of 700 ml of purulent urine. A CT obtained after the procedure showed a decompressed bladder with the catheter tip in appropriate position. Our video demonstrates three techniques using US guidance to help aid DUC: 1.) visualization of the wire, 2.) use of doppler flow, and 3.) visualization of the foley balloon. CONCLUSIONS: Our video demonstrates how POCUS can be used in a safe and reproducible manner to aid DUC. US-guided catheter placement may improve the likelihood of successful catheterization in other complex cases such as those where blind wiring or urethral dilation are used. More studies will be necessary to validate these techniques. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e599 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Lee More articles by this author Dhaval Jivanji More articles by this author Benjamin Shpeen More articles by this author Elie Kaplan-Marans More articles by this author Ariel Schulman More articles by this author Ruslan Mamedov More articles by this author Expand All Advertisement PDF downloadLoading ...

Lower Patient Height and Weight Are Predisposing Factors for Complex Radial Arterial Catheterization.

Background: Radial artery (RA) catheterization for invasive blood pressure monitoring is often performed via palpation, and an ultrasound is used secondarily only in case of multiple unsuccessful attempts. Although more elaborate, it has been shown that primary ultrasound-guided catheterization may be advantageous compared with palpation. The aim of this study was to identify factors associated with difficult RA catheterization. Methods: Left RA ultrasound assessments were performed in patients with indicated invasive blood pressure monitoring the day before surgery. RA catheterization was performed by personnel blinded to the ultrasound results. Based on the number of attempts needed for successful catheter placement, the cohort was divided into uncomplicated (group 1) and difficult (more than one attempt, group 2) catheterization cases. Cases subjected to primary ultrasound were excluded from the analysis. Results: Body weight, height and surface area (BSA) of patients in group 2 (n = 16) were significantly lower than those of patients in group 1 (n = 25), and internal RA diameters were significantly smaller in group 2 patients. In the whole cohort, BSA was significantly associated with distal and proximal internal RA diameters. In contrast, no differences were observed in the skin-to-artery distance, the longitudinal axis deviation (kinking) or blood flow velocity. Median time to successful catheterization was 77 (47-179) s. Prolonged time needed for cannulation was significantly associated with lower body weight, BMI and BSA, and with reduced distal and proximal internal RA diameter. Conclusions: RA catheterization performed through pulse palpation may be difficult, especially in adult patients with lower body weight and height, due to reduced arterial diameters. Initial use of ultrasound in these patients may reduce first-attempt failure, preventing procedural delays and patient discomfort.

Abstract Number ‐ 11: Automated Measurement Of Vascular Tortuosity: Association With Baseline Clinical Characteristics And Impact On Mechanical Thrombectomy

Introduction Vascular tortuosity is considered one of the main hurdles that may negatively impact mechanical thrombectomy in stroke treatment, delaying catheter access to the occluded vessel. Automatic characterization of anatomical vascular features may help in the planification of endovascular interventions. We developed a fully automatic algorithm for vascular tortuosity measurement and explored the association of several anatomical features with baseline characteristics and procedural outcomes. Methods An automatic software integrating segmentation, centerline extraction and vessel labelling, was used to extract features directly from computed tomography angiograms (CTA) of stroke patients undergoing transfemoral endovascular treatment.Mean vessel diameter and tortuosity index (TI) of the carotid arteries and brachiocephalic trunk were used as relevant tortuosity indicators. Patients were compared according to six different clinical conditions(gender, hypertension, dyslipidemia, diabetes, obesity and atrial fibrillation). Tortuosity values were also correlated with age.Patients with an anterior circulation stroke were further classified according to four procedural measures:time from groin puncture to first angiographic run, time to first retrieval attempt, time to revascularization. Results A sample of 558 patients with acute ischemic stroke who underwent mechanical thrombectomy at our medical center were included in this study. Forty patients (7.2%) were discarded due to sub‐optimal segmentation (n = 30) or processing errors (n = 10), leaving a final sample size of N = 518 (51% female, 74.8±12.9 years). Women presented significantly smaller mean diameter for all analyzed vessels (p &lt; 0.01) and an increased TI for both carotid arteries(p &lt; 0.01). Age was significantly correlated with increased TI in all analyzed vessels (0.35£r£0.52;p &lt; 0.01) Patients with hypertension and/or atrial fibrillation displayed significantly higher TI in both carotid arteries (p &lt; 0.01). Additionally, the brachiocephalic trunk was found to be more tortuous in patients with atrial fibrillation (p &lt; 0.01). A higher TI in all ipsilateral carotid segments was associated with higher times to first angiographic run and to final revascularization (p &lt; 0.05). A TI from the ipsilateral carotid segment over 0.28 independently predicted difficult catheter access (time to first angiographic run &gt;40 min, 3.8% of cases) with a sensitivity of 0.92 and a specificity of 0.68. Conclusions An automated software was successfully used to characterize the anatomical vascular features from CTA. Gender, age, hypertension and atrial fibrillation were found to significantly influence vascular tortuosity in anterior circulation arteries. Patients with difficult catheter access and/or delayed revascularization presented higher TI of ipsilateral carotid arteries. Carotid TI emerged as a potential predictor of difficult catheter access.

Abstract TMP67: Automated Measurement Of Vascular Tortuosity: Association With Baseline Clinical Characteristics And Impact On Thrombectomy Procedures

Introduction: Vascular tortuosity is considered one of the main barriers for mechanical thrombectomy in stroke. We developed a fully automatic algorithm for vascular tortuosity characterization and explored the association of several anatomical features with baseline characteristics and procedural outcomes. Methods: An automatic software integrating segmentation, centerline extraction and vessel labelling, was used to extract features directly from computed tomography angiograms (CTA) of stroke patients undergoing transfemoral endovascular treatment. Mean diameter and tortuosity index (TI) of the carotid arteries and brachiocephalic trunk were used as relevant tortuosity indicators. Patients were compared according to seven different clinical conditions and four procedural measures. Results: 518 patients (51% female, 74.8±12.9 years) were included in this study. Women presented significantly smaller vessels and increased TI in both carotid arteries ( p &lt;.01). Hypertension and atrial fibrillation were associated with higher TI in both carotid arteries ( p &lt;.01). Age correlated with TI in all vessels (.35&lt; r&lt; .52, p &lt;.01). Patients with longer time to first angiographic run and time to revascularization presented higher TI in all ipsilateral carotid segments ( p &lt;.05). Conclusion: An automated software was successfully used to characterize anatomical vascular features from CTA. Gender, age, hypertension and atrial fibrillation were found to influence vascular tortuosity. The algorithm was able to detect higher TI in ipsilateral carotid arteries of patients with further difficult catheter access or longer time to revascularization. This information could potentially be used to plan best arterial access site.

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country

ObjectiveAssessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management...

The effects of ultrasound guidance on first-attempt success for difficult peripheral intravenous catheterization: a systematic review and meta-analysis.

Identifying patients at risk of difficult intravenous access (DIVA) and increasing the success rates of peripheral intravenous catheterization (PIVC), preferably on the first catheterization attempt, is of clinical importance. The aim of this study was to compare the use of dynamic ultrasound guidance for PIVC with the traditional technique of visualization and palpation in patients with predicted DIVA. A systematic review and meta-analysis comparing ultrasound-guided PIVC with the traditional technique was performed. Data were systematically collected through MEDLINE and EMBASE databases from inception to March 2021. Eligibility criteria included randomized controlled trials performed on patients meeting criteria for difficult catheterization comprising either (a) no palpable or visible veins, (b) previous history of difficult venous catheterization, (c) patient age less than 4 years, (d) suspicion of difficult catheterization by operator, or (e) two or more unsuccessful attempts using the traditional technique before enrollment were included. For all outcomes, a random-effects meta-analysis using the DerSimonian and Laird method was performed. The primary outcome was the first-attempt success rate, and the secondary outcomes were the overall success rate and the number of attempts for successful intravenous catheterization. Bias was assessed using the Revised Cochrane Risk of Bias tool. Seven studies with a total of 994 patients were included. Patients comprised both children and adults and settings included operating rooms, emergency departments, and intensive care units. Ultrasound guidance was associated with a higher first-attempt success rate (OR, 3.07; 95% CI, 1.66-5.65; P < 0.001). For the secondary outcomes, ultrasound guidance was associated with a higher overall success rate (OR, 3.02; 95% CI, 1.04-8.79; P = 0.04); however, this finding did not meet statistical significance in a sensitivity analysis (OR, 2.90; 95% CI, 0.71-11.93; P = 0.14). Ultrasound was not associated with a significantly different number of attempts compared with the traditional technique (difference in means, 0.14; 95% CI, -0.32 to 0.05; P = 0.15). The use of ultrasound guidance resulted in a three-fold increase in odds for the first-attempt success rate in patients with predicted DIVA compared with the traditional technique of PIVC.

An Easy Solution for Difficult Urethral Catheter: Three-Way Urethral Catheter Insertion Using a Guidewire Technique.

Urethral catheter insertion is a skill taught to all medical students but often not practised for a multitude of reasons. The difficult catheter can be a clinical nightmare for the junior doctor, especially on call, and can lead to significant mortality and morbidity with suboptimal repeated attempts. The incorporation of a soft-tipped hydrophilic guidewire technique for the insertion of a two-way urethral catheterhas been described in the literature and has the potential to reduce the morbidity and mortality of patients by making the insertion of a catheter less traumatic. Here, we propose and describe the insertion of a three-way urethral catheter, performed using the technique employed for the insertion of a two-way urinary catheter via the use of a hydrophilic guidewire, with similar outcomes. A hydrophilic soft-tipped guidewire to insert a three-way urethral catheter can be used in the wards, in the emergency department, and in a theatre setting. The district hospital in which this method was employed demonstrated a 100% success rate in the insertion of a urethral catheter (N = 15), with 26% of cases (four patients out of 15) having a three-way urethral catheter inserted using the soft-tipped hydrophilic guidewire method. Follow-ups of these patients showed that there were no complications or adverse effects experienced by the patients. The use of a soft-tipped guidewire approach to insert a difficult urethral catheter can reduce the financial burden on the healthcare system by eliminating costs due to harm/trauma caused by repeated unsuccessful urethral catheter attempts or those attempts that have been performed suboptimally and have led to potential patient harm. The use of a hydrophilic guidewire-assisted technique to insert a three-way urinary catheter is a safe and easy option for those who have had repeated unsuccessful attempts. The hydrophilic guidewire approach has the potential to reduce morbidity and mortality associated with urethral catheterisation and improve patient safety.

Analysis of Vesicovaginal Fistulas in Sylhet MAG Osmani Medical Hospital: A Two Years Study

Background: Vesico-vaginal fistula (VVF) is still a persisting scourge in the developing countries with devastating medical and social consequences. These consequences were studied among patients presenting with vesico- vaginal fistula in Sylhet MAG Osmani Medical College Hospital, Sylhet. Objectives: To analyzethe vesico-vaginal fistula patients during the 2 years period. Materials and Methods: This was a descriptive and cross-sectional study conducted in the Department of Obstetrics and Gynaecology, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet from May 2008 to April 2010 (2 years).Fifty-three hospitalized patients with vesico-vaginal fistula were selected by Inclusion and exclusion criteria, undergoing repair operation irrespective of age. After selection of the patients informed written consent was taken. Each patient was interviewed using the semi-structured questionnaire containing socio- demographic and other relevant information like age, occupation, education of the patient and her husband, age at marriage, age at 1* child birth, monthly income and detailed history of the delivery. Type of fistula and related examination of the fistula was also done and noted. Type of repair of vesico-vaginal fistula, postoperative complications and outcome was recorded in the same manner. Results: The mean age of the patients with vesico-vaginal fistula was 30.5 years (SD± 8.5; range, 18 to 52). Majority (73.6%) were between 21 to 40 years; and 52.8% patients were primipara, 81.1% patients were illiterate and 69.8%patientswere from lower social class. The aetiology of fistula were obstructed labour 49.1%, emergency lower segment caesarean section 37.7%, destructive delivery 11.3% and caesarean hysterectomy 1.9%.The repair operation was done of all patients in this series through vaginal approach. Repair was done first time in 83% and rest had history of failed repair. Postoperative complications were catheter block and urine leakage in 37.7% and urinary tract infection in 11.3% patients. Successful outcome was found in 79.2% cases. Causes of failure were severe scaring 36.5% difficult operation, catheter block and others each constituted 18.2% and large fistula 1.9%. Conclusion: Young primi are the victims of vesico-vaginal fistula, obstetric causes add up to form a major share of the etiology of vesico-vaginal fistula. Proper perinatal management is most important to reduce obs fistula formation.

Application of Preset Zebra Guidewire in Patients with Difficult Catheterization

Application of Preset Zebra Guidewire in Patients with Difficult Catheterization

The Bedside Flexible Cystoscopy: The Right Answer to Difficult Catheterization in Adult Acquired Buried Penis. A Case Report

The Bedside Flexible Cystoscopy: The Right Answer to Difficult Catheterization in Adult Acquired Buried Penis. A Case Report

421 Improving Confidence with Difficult Catheterisations

Abstract Aim The use of catheters is common amongst inpatients with variable successful completion rates resulting in frequent calls to the on-call urology team for assistance. A common concern from the urology team is that there is inadequate equipment stocked in A&amp;E or CAU across NHS Ayrshire &amp; Arran. Additionally, it is felt anecdotally that most “difficult” catheters are in fact easily inserted by urologists via the use of a larger silicone catheter. The aim was therefore to improve confidence with difficult catheters and knowledge of when to refer to Urology; and to improve access to equipment required for a difficult catheter. Method A questionnaire using Likert scales was distributed to medical and nursing staff across both acute sites within the health board to establish baseline confidence and ease of finding equipment. An intervention in the form of a guide to difficult catheters was introduced with work started on a difficult catheters trolley. A follow up questionnaire using Likert scales was distributed to assess confidence. The subsequent data was then collated and analysed. Results 1st Cycle: 30 responses; 36.70% confident/very confident. 2nd Cycle: 7 responses; 85.70% confident/very confident and know when to refer; Ease of finding equipment remains variable; 71.5% found the guide to be clear/very clear. Conclusions Despite the lower response rate in the second cycle, the guide has been effective in improving the confidence of staff with difficult catheters and their knowledge of when to refer. Ease of finding equipment remains variable, however, due to the relative delay in establishing the trolley.