Difficult Catheterizations Research Articles

Tiger Catheter for Difficult Femoral Artery Approach Coronary Catheterization

Background: While most catheters are designed for the natural anatomy of the coronaries at the origin, we often end up using multiple catheters in failed attempts to hook the coronary ostia in case of unusual origins. We had similar issues where we used multiple catheters in vain during femoral approach catheterizations and ended up successfully hooking with a tiger (TIG) catheter in a few of our cases in the catheterization laboratory. We mostly used Judkins left (JL) and Judkins right (JR) catheters as the first choice for femoral approach catheterizations. Hence, we wanted to see how frequently we had to use catheters other than JL and JR and which catheter was most useful in such cases. Methods: This is a retrospective study of catheterization laboratory angiographic data and recordings involving femoral artery approach coronary catheterization at King George Hospital, Visakhapatnam, from January 2022 to December 2022. We analyzed and interpreted the data of difficult femoral artery catheterizations where JL/JR catheters could not hook the coronaries successfully. We tabulated such data in percentages to understand which catheter was most useful in such cases. We analyzed the angiograms of such cases to understand the coronary origins. Results: Overall, 1130 cases underwent femoral artery approach coronary angiograms. Of them, 1100 (97.3%) cases could be hooked with JL and JR catheters. Thirty (2.65%) cases were found to be difficult femoral artery approach catheterizations where either JL or JR catheter could not be used successfully. Out of those difficult ones (30 cases – 100%), 22 (73.3%) cases could be hooked with TIG catheter, 4 (13.33%) cases with extra backup (EBU) catheter, 1 (3.33%) case with JR side hole (JRSH) catheter, 2 (6.66%) cases with no torque right (NTR) catheter, and 1 (3.33%) case with multipurpose catheter (MPA). Out of these 30 cases, a left coronary angiogram was needed other than a JL catheter in 8 cases, while a right coronary angiogram was needed other than a JR catheter in 25 cases, showing that the right coronary artery (RCA) was mostly involved in difficult catheterizations. For left coronary angiograms, 4 cases hooked with TIG (1 case – posteriorly/low takeoff, 1 – high takeoff, 1 – mid-takeoff, and 1 – RCA/left main coronary artery [LMCA] from left sinus) and 4 cases with EBU catheter (1 – anterior/high takeoff, 2 – high takeoffs, and 1 – posteriorly/high takeoff). For right coronary angiograms, 21 cases hooked with TIG (3 cases – left sinus/anteriorly, 3 – high takeoff/anteriorly, 3 – low takeoff, 2 – mid takeoff/anteriorly, 3 – posterior/high takeoff, 1 – RCA/LMCA from left sinus, 1 – posteriorly/left sinus, 3 – high takeoff, 1 – anteriorly/low takeoff, and 1 – right sinus/mid-takeoff), 1 case with JRSH, 1 case with MPA (anterior/high takeoff) and 2 cases with NTR (1 – low takeoff and 1 – high takeoff). Conclusion: We found that the TIG catheter was useful in difficult femoral approach catheterizations in the majority of cases and it can be tried in difficult cases.

Implementation and Assessment of a Urology Education Curriculum for Nursing Residents.

Urethral catheter placement is a common hospital procedure, and the urology service is often consulted for difficult catheterizations. Simulation-based education is used to improve procedural proficiency and could be used to increase confidence and comfort with difficult catheter placement. This study provides simulation-based education to help new nursing residents learn to perform independent Foley catheter placement and maintenance. All incoming nursing residents at our institution prospectively participated in this curriculum beginning in January 2020 (n = 291). Participants watched an instructional video and participated in a hands-on simulation. Nursing trainees rated pre- to post-curriculum gains in content knowledge (p < .001) and confidence (p < .001). Participants reported that the curriculum increased their understanding of the procedure (p < .001) and that they would recommend it to peers (p < .001). This educational initiative is a partnership between the Department of Urology and Department of Nursing to introduce and reinforce best practices for the care of patients who need Foley catheter placement and maintenance. [J Contin Educ Nurs. 2021;52(11):511-516.].

1059 Confidence and Knowledge of Urethral Catheterization and Complications Amongst Junior Doctors: The Immediate Impact of Peer-Led Clinical Mentorship

Abstract Aim Approximately 20% of inpatients have urinary catheters. Deficiencies in knowledge and errors in catheterization techniques can cause short and long-term complications. This study aims to evaluate the short-term benefit of peer-led sessions on the knowledge and confidence of junior doctors in performing urethral catheterizations. Method 81 Foundation Year doctors participated in a one-hour basic catheterization workshop. Data was collected via a validated questionnaire covering three domains (confidence, procedural knowledge, and knowledge about complications) administered before and after the workshop. Confidence was measured using a 5-point Likert scale; knowledge was assessed through 10 questions about the procedure and three further questions about complications. Data are expressed as mean±standard deviation and were analyzed using SPSS v23. Result The majority (96.4%) had performed less than five catheterizations. 21% felt adequately trained to catheterize, 70% believed they would benefit from semi-formal training, and 97.5% found the information covered in the session to be very useful. The average pre-session confidence in performing easy and difficult catheterizations were 3.03±1.05 and 2.01±1, respectively, and increased to 3.7±1 and 3±1.1, respectively, following the session (p &amp;lt; 0.005). Out of a total of 10 points, pre-workshop knowledge assessment scores were 3.9±1.6 and increased to 8.85±1.4 (p &amp;lt; 0.005). Likewise, from a total of three points, the average pre-session knowledge of complications score was 1.75±0.7, which increased to 2.65±0.6 after the session (p &amp;lt; 0.005). Conclusions Peer-led mentorship is an important and efficient educational tool. Short sessions have shown to improve the confidence and knowledge of junior doctors in urethral catheterization.

Diagnosis, management and recurrence rates of Mitrofanoff polyps

Intraluminal polyps are a known complication following creation of a urinary continent catheterizable channel (Mitrofanoff). These polyps can lead to difficult catheterizations in addition to symptomatic bleeding. However, there is limited data available regarding management and outcomes of these polyps. We aim to describe clinical presentation and management of a large series of polyps occurring in a Mitrofanoff channel. We performed a retrospective review of all patients that were treated for polyps in a Mitrofanoff at our institution. Information was collected regarding presenting symptoms, management and recurrence rates of the polyps. A total of 24 patients were identified that fulfilled inclusion criteria. The majority of these polyps developed in channels composed of appendix (87%), while only 3 patients (13%) had polyps develop in an ileal composed channel. Thirteen (54%) of these polyps were incidentally diagnosed while 11 patients presented with a variety of symptoms such as difficulty in catheterization, bleeding with catheterization or both difficulty catheterizing and bleeding. For management of the polyps, a cystoscopy was performed and snaring the polyp with stone basket was performed in 37%, energy was applied to base to remove polyps in 33%, 16% were fulgurated and only 13% were left in situ. All procedures were performed under general anesthesia and all of the pathology was benign showing chronic inflammatory tissue. Eight polyps (33%) recurred after initial treatment. We did not observe an asymptomatic channel polyp convert to a symptomatic during our follow up period. Our experience has led us to not intervene on all asymptomatic Mitrofanoff polyps encountered during cystoscopy under assumption they will inevitably become symptomatic. Although we admit our follow up period may not be long enough to make this a universal declaration of best practice when any Mitrofanoff polyp is diagnosed. Endoscopic treatment was effective minimally invasive method to address the symptomatic polyp rather than excision and construction of new channel. This is the largest series to date of polyps developing in urinary continent catheterizable channels. The majority of these polyps were encountered incidentally however symptomatic polyps presented with difficulty with catheterizations. Symptomatic polyps can be managed endoscopically but recurrence of the polyp can occur.

PD38-06 A NOVEL RISK PREDICTION MODEL TO TRIAGE DIFFICULT URETHRAL CATHETERIZATIONS

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety III (PD38)1 Sep 2021PD38-06 A NOVEL RISK PREDICTION MODEL TO TRIAGE DIFFICULT URETHRAL CATHETERIZATIONS Albert Ha, Jamie Pak, Christopher Haas, Caleb Miles, David Weiner, Christopher Anderson, and Gina Badalato Albert HaAlbert Ha More articles by this author , Jamie PakJamie Pak More articles by this author , Christopher HaasChristopher Haas More articles by this author , Caleb MilesCaleb Miles More articles by this author , David WeinerDavid Weiner More articles by this author , Christopher AndersonChristopher Anderson More articles by this author , and Gina BadalatoGina Badalato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002048.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While urologic consultations for Foley catheter placement are important, improper placement can lead to potentially preventable complications. We constructed a risk prediction model to identify cases of difficult urethral catheterizations (DUC). METHODS: Using a single-institution database of urologic consults for Foley catheterizations from June 2016 to January 2020, a model to predict DUC in male patients was constructed. DUC was defined as requiring the use of a guidewire, cystoscopy, urethral dilation, and/or new suprapubic tube (SPT) placement, while a simple Foley was defined as an uncomplicated placement of a regular or coude catheter. Repeat encounters and routine SPT exchanges were excluded. A multivariable model was constructed using logistic regression, and its performance was internally validated using bootstrap statistics. RESULTS: A total of 841 consults were identified, with 181 (27%) classified as a DUC. Numerous factors were associated with difficult placement, with patients with a prior history of urethral stricture (adjusted OR: 6.8, 95% CI: 3.34-14.18, p <0.001) having the greatest magnitude of effect (Table 1). Bootstrap analysis of the final model demonstrated good overall accuracy (predictive accuracy: 76%) (Figure 1A). A predictive nomogram was also constructed using the multivariable model (Figure 1B). CONCLUSIONS: This model is a promising tool to triage a DUC, which can be used to identify patients who likely require placement by a urologist to potentially reduce catheterization-related complications. The high rate of uncomplicated catheterizations also highlights the need for further education on proper technique. External validation and application to the initial Foley encounter will shed additional light on its overall utility. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e664-e664 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Albert Ha More articles by this author Jamie Pak More articles by this author Christopher Haas More articles by this author Caleb Miles More articles by this author David Weiner More articles by this author Christopher Anderson More articles by this author Gina Badalato More articles by this author Expand All Advertisement Loading ...

Approach to difficult urethral catheterizations in male patients during the Covid-19 pandemic

Background/Aim: Difficult urethral catheterization (DUC) is a frequent urological emergency in daily practice. Anticoagulant and antiaggregant drugs, included in the treatment protocols for COVID-19, tend to increase the risk of possible complications of alternative interventions, such as cystoscopy and suprapubic percutaneous cystostomy. Therefore, a less invasive method is needed in patients with DUC. This study aims to evaluate the results of Foley catheter insertion and urethral dilatation over a hydrophilic guidewire in patients with DUC. Methods: A total of 23 male patients who visited the urology outpatient clinic or were referred due to urinary retention or inability to place a Foley catheter in the last 8 months were included in this case series. The patient charts were evaluated retrospectively. After the hydrophilic guidewire, blindly advanced from the urethral meatus under sterile conditions, reached the bladder, a Foley catheter was placed over the guidewire. In cases of urethral stricture, dilatation was performed over the guidewire with the help of hydrophilic S-Curve dilators, and a Foley catheter of suitable diameter was placed. Results: A Foley catheter was successfully placed in 22 out of 23 patients. Urethral dilatation was performed in 13 patients due to urethral stricture, and a transurethral Foley catheter was placed in the other 10 patients without the need for dilatation. Although most of our patients (17 of 23 patients) were receiving anticoagulant or antiaggregant treatment during the procedure, no significant hemorrhagic complications occurred. A Foley catheter could not be placed in one patient with this technique; a percutaneous cystostomy catheter was placed instead. Conclusion: The results of this study, conducted during the COVID-19 pandemic, show that our technique is safe and successful. We believe that our technique will be useful in preventing additional surgical interventions due to complications, especially during this pandemic.

A Novel Risk Prediction Model to Triage Difficult Urethral Catheterizations

ObjectiveTo construct a risk prediction model to identify cases of difficult urethral catheterizations (DUC) in order to prevent complications from improper placement. Materials and MethodsUsing a single-institution database of urologic consults for Foley catheterizations from June 2016 to January 2020, a model to predict DUC in male patients was constructed. DUC was defined as requiring the use of a guidewire, cystoscopy, urethral dilation, and/or suprapubic tube (SPT) placement, while a simple Foley was defined as an uncomplicated placement of a regular or coudé catheter. A final model to predict DUC was constructed using multivariable logistic regression and internally validated using bootstrap statistics. ResultsA total of 841 consults were identified, with 181 (21.5%) classified as a DUC. On multivariable regression, patient-specific factors as overweight BMI (OR: 1.71; P = .014), urethral stricture disease (OR: 7.38; P < .001), BPH surgery (OR: 2.47; P < .001), radical prostatectomy (OR: 4.32; P = .001), and genitourinary (GU) prosthetic implants (OR: 3.44; P = .046) were associated with DUC. Situational factors such as blood at the meatus (OR: 2.40; P < .001), and consulting team (eg, surgery OR: 4.82; P < .001) were also significant. Bootstrap analysis of the final model demonstrated good overall accuracy (predictive accuracy: 75%). ConclusionThis model is a promising tool to help providers identify patients who likely require catheterization by a urologist and potentially reduce catheterization-related complications. The high rate of uncomplicated catheterizations also highlights the need for continuing education amongst healthcare professionals. External validation and application to the initial Foley encounter will shed light on its overall utility.

Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study

OBJECTIVETo determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. METHODSThis was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. RESULTSNine hundred fifteen women were included in the final analysis. Median age was 34 (range, 21−45) years and median body mass index was 23 (range, 16−41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1−16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0−10), and only 17 (1.9 %) of women reported severe pain (VAS ≥ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. CONCLUSIONHYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.

Application of wireless ultrasound-guided internal jugular vein catheterization in hemodialysis patients

Objective To explore the effectiveness and safety of wireless ultrasound guidance in the treatment of internal jugular vein catheterization in hemodialysis patients. Methods We collected 120 patients who were treated in our hospital's blood purification center from October 2017 to October 2018, then we made a random grouping, divided into traditional group and wireless ultrasound group, each group was 60 cases.Anatomical markers were used to locate and puncture in the traditional group, while the location and puncture of the wireless ultrasound group were performed under the guidance of wireless ultrasound. The gender, age, body mass index(BMI), number of difficult catheterizations, average puncture time, average puncture frequency, one puncture success rate, secondary puncture success rate, total puncture success rate, and complication rate were compared between the two groups. Results There were no significant differences in clinical data between gender, age, BMI and number of difficult catheterizations between the two groups(P>0.05). The average puncture time, average puncture frequency and complication rate in the wireless ultrasound group were lower than those in the traditional group, and the difference was statistically significant(P<0.05). The success rate of one puncture and the success rate of secondary puncture in the wireless ultrasound group were higher than those in the traditional group, and the difference was statistically significant(P<0.05). Conclusions Wireless ultrasound-guided internal jugular vein catheters are more convenient, easier, safer, and faster.It is safer and more effective for patients with difficult catheterization(obesity, history of internal jugular vein catheterization, incompatibility of body position, vascular malformation, edema). Key words: Renal Dialysis; Punctures; Ultrasonography, Doppler, Color

A time and equipment saving tip for difficult urethral catheterizations

A time and equipment saving tip for difficult urethral catheterizations

A Practical Approach to Difficult Urinary Catheterizations

Routine placement of transurethral catheters can be challenging in some situations, such as urethral strictures, severe phimosis and false passages. Intravaginal retraction of the urethral meatus can complicate Foley placement in postmenopausal females. In men, blind urethral procedures with mechanical or metal sounds without visual guidance or guidewire assistance are now discouraged due to the increased risk of urethral trauma and false passages. Newer techniques of urethral catheterization including guidewires, directed hydrophilic mechanical dilators, urethral balloon dilation, and direct vision endoscopic catheter systems are discussed, along with the new standardized protocol for difficult transurethral catheter insertions. Suprapubic catheter placement techniques, including percutaneous trocars and the use of the curved Lowsley tractor for initial suprapubic catheter insertion, are reviewed. Prevention and management of common catheter-related problems such as encrustation, leakage, Foley malposition, balloon cuffing and frequent blockages are discussed.

Current Trends in the Management of Difficult Urinary Catherizations

Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failed catheterization and concomitant complications increase. Repeated and unsuccessful attempts at urinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of follow-up evaluations. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient with acute urinary retention, including attending emergency physicians who often are the first physicians to encounter such patients. Best practice methods for blind catheter placement are summarized in this review. In addition, for progressive clinical practice, an algorithm for the management of difficult urinary catheterizations that incorporates technology enabling direct visualization of the urethra during catheter insertion is presented. This algorithm will aid healthcare personnel in decision making and has the potential to improve quality of care of patients.

Expanding the Role of the Ureteroscope

Although the rigid ureteroscope was designed exclusively for the diagnosis and treatment of pathological conditions of the ureter, its smaller diameter and extended length allow for its increased use in endoscopic procedures that cannot be performed successfully with a cystoscope. The indications can be divided into 3 categories: 1) difficult ureteral catheterizations, 2) augmented bladders and diverticula, and 3) narrow, strictured urethras and bladder necks. Several cases from each category are presented to illustrate the expanded role of the rigid ureteroscope in daily urological practice.

A helpful technique for difficult urethral catheterizations in boys for voiding cystourethrography.

A simple technique used to catheterize boys for voiding cystourethrography, using a feeding catheter while the urethra is distended by a saline solution is described.