External Catheter Research Articles

Acanthus Condom Catheter: A Reusable and Adjustable Silicone Male External Catheter With Pressure-Sensitive Silicone Adhesive for Urinary Drainage.

Condom catheters are also called external urinary collection devices tocollect urine and monitor urine output in hospitalized and other patients with urinary incontinence. They play an important role in reducing catheter-associated urinary tract infections by using invasive indwelling catheters that are placed inside the bladder.Currently, male external catheters come with or without adhesives. Major problems with current condom catheters are finding the right size to fit, excessive slippage needing to replace too many, urine leak, skin irritation, and damage. In some cases, it's a common practice to wrapadhesive tape around the catheter and penisto keep the catheter in place which can cause skin injury. The Acanthus condom catheter is an expandable silicone male external catheter designed and developed to reduce excessive catheter slippage and keep the catheter longer.It works by applying silicone adhesive to the inner catheter wall just below the catheter rim and applying gentle pressure after the placement. It can be adjusted after the placementand can be kept in place by applying gentle pressure around the catheter to prevent slippage. After laboratory testing of the catheter showed it was able to withstand 250% more pressure and 187% higher tensile forces, we have retrospectively reviewed a nursing survey of14 hospitalized patients using the Acanthus condom catheter for urinary drainage. The mean age was 89 years. A total of 55 evaluations were collected, of which 46 were day shift and nine were night shift responses for a total of 44 catheter days.Results showed that the catheter was easy to use (100%). There was no skin irritation or damage during the application or removal (100%). The catheter was able to drain urine and stayed in place most of the time (89%) except in a few instances it came out, especially during the night shift, but the nurse was able to place it back. There was one instance of urine leak (1.8%). Nurses felt that the catheter was better than existing products in 95% of responses. In conclusion, the Acanthus condom catheter was easy to use, can be reused for up to three days, and was safe on the skin; most importantly, nurses were able to adjust the catheter when they noticed it to be slipping and kept it in place using gentle finger pressure or adding few additional drops of silicone adhesive on the inner catheter wallbelow the rim and applying brief pressure around the catheter. One size (medium-large) fits most of the patients in the study due to elasticity and stretch dimensions, which eliminated the problem of finding the right size to use.

Candida parapsilosis intracerebral abscess and intralesional amphotericin B: a novel treatment approach to a rare infection. Illustrative case.

Candida parapsilosis has been implicated in central nervous system (CNS) infections (i.e., meningitis or ventriculitis) but has not been previously reported to cause intracerebral abscesses. CNS infections secondary to C. parapsilosis are notoriously difficult to treat due to the poor CNS penetration of amphotericin B. Historically, intraventricular amphotericin B has been used to treat C. parapsilosis ventriculitis. A 15-year-old female with no comorbidities presented with nonresolving headaches, photophobia, fevers, and meningism. Computed tomography (CT) of the brain revealed a right frontal abscess. After multiple drainage surgeries, subsequent CT scans showed reaccumulation of her abscess. C. parapsilosis was cultured, and the patient was then taken to the operating room where an external ventricular drain catheter was successfully placed within the abscess cavity. Pus was repeatedly aspirated, followed by the instillation of intralesional amphotericin B twice a day for 2 weeks. The patient's clinical condition improved substantially with complete resolution of symptoms, improvement of infective markers, and resolution of radiological features of the abscess. Follow-up of the patient revealed the absence of symptoms and image characteristics of abscess on CT 3 months posttreatment. Intralesional amphotericin B is a novel but effective treatment of C. parapsilosis intracerebral abscess, an organism not previously described as a cause of intracerebral abscesses. https://thejns.org/doi/10.3171/CASE2484.

Securement to Prevent Noncuffed Central Venous Catheter Dislodgement in Pediatrics

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

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

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

QAPI 150 - Quality initiative to provide alternative external catheters to reduce utilization of indwelling catheters and infection rates

QAPI 150 - Quality initiative to provide alternative external catheters to reduce utilization of indwelling catheters and infection rates

Development of an adjustable patient-specific rigid guide to improve the accuracy of external ventricular catheter placement.

The most common method for external ventricular drain (EVD) placement is the freehand approach, which has reported inaccuracy rates of 12.3%-44.9%, especially in the case of altered ventricular anatomy. Current assistive devices require added time or equipment or do not account for shifted ventricles. To improve the accuracy of emergent EVD placement in the setting of altered ventricular anatomy, the authors designed a patient-specific EVD (PS-EVD) guide. The PS-EVD guide has a tripod base and a series of differently angled inserts that lock in place at multiple rotational positions, allowing for numerous insertion angles. For testing, the authors designed a 3D-printed phantom skull with a gelatin brain analog containing ventricles simulating normal and altered ventricular anatomy. Low-resolution CT scans of the phantom were used to calculate the insertion angle in relation to the standard perpendicular entry. The corresponding insert at the correct rotational position within the base unit was positioned over the entry point on the phantom, and the catheter was inserted. Accuracy was evaluated with repeat CT scans. With normal ventricular anatomy, as well as abnormally shifted ventricles, proper use of the PS-EVD guide led to accurate catheter insertion into the ventricle in trials, as confirmed on coronal and sagittal CT images, including cases in which a perpendicular trajectory, such as with the Ghajar guide, was insufficient. The PS-EVD guide allows consistent and accurate EVD placement in phantom skulls with both normal and altered ventricular anatomy. Further trials comparing this device to the freehand approach are required.

Flexible low-profile external ventricular drain catheter for real-time brain monitoring

External ventricular drainage is one of the most common neurosurgical procedures in the world for acute hydrocephalus, which must be performed carefully by a neurosurgeon. Although various neuromonitoring external ventricular drain (EVD) catheters have been utilized, they still suffer from rigidity and bulkiness to mitigate post-EVD placement trauma. Here, we introduce a flexible and low-profile smart EVD catheter using a class of technologies with sensitive electrical materials, seamless integration, and flexible mechanics, which serves as a highly soft and minimally invasive device to monitor electrical brain signals. This device reliably captures biopotentials in real time while exhibiting remarkable flexibility and reliability. The seamless integration of its sensory system promises a minimally invasive EVD placement on brain tissue. This work validates the device's distinct characteristics and performances through in vitro experiments and computational analysis. Collectively, this device's exceptional patient- and user-friendly attributes highlight its potential as one of the most practical EVD catheters.

Impact of external female urinary catheter use on urine chemistry test results

We aimed to evaluate how urine chemistry tests are impacted by collection using a female external urinary catheter employing wicking and suction, to assess this catheter's potential as an alternative to transurethral catheters for collecting urine samples from incontinent patients. We obtained 50 random 40mL refrigerated urine specimens from excess volume submitted to the Michigan Medicine Biochemical Laboratory. Specimens were split into a 10mL "control" sample simulating voided urine, and a 30mL paired "wicked" sample applied dropwise to and collected from a fresh PureWick system simulating collection from an incontinent patient. Each sample pair was tested for glucose, sodium, potassium, creatinine, urea, total protein, and derived ratios of sodium/creatinine, urea/creatinine, and protein/creatinine, then compared using Pearson correlation coefficients. Wicking materials were imaged via absorption contrast tomography on a laboratory X-ray microscope, to study the structure through which urine passes. Control and wicked urine samples had very similar results for all chemical tests evaluated: strong Pearson correlation coefficients ranging from 0.955 (potassium) to 0.997 (glucose). Microscopic assessment of the amorphous wicking materials demonstrated an average pore spacing of 95.38µm. Common urine chemistry tests were unaltered by collection using the PureWick female external catheter system. This external device can be used to collect urine for chemistry tests as an alternative to transurethral catheters.

Conservative management by embolization of a ruptured renal arterio-venous malformation (AVM) in Hereditary Hemorrhagic Telangiectasia (HHT)

BackgroundRenal arteriovenous malformation (AVM) in Hereditary Hemorrhagic Telangiectasia (HHT) is uncommon and only few cases have been described, mainly with surgical management because of uncontrolled hematuria.Case presentationWe managed a 70-year-old patient with HHT who presented with hematuria and left flank pain. Computed Tomography and ultrasound showed left renal AVM of 18 mm with clotting in the urinary tract. An external ureteral catheter was placed during 3 days to allow rinsing and facilitate elimination of clots.Given the patient's hemodynamic stability, a non-surgical management was chosen. Treatment of the AVM was performed by trans-arterial embolization using micro-coils and ethylene–vinyl alcohol copolymer.ConclusionsOur case study shows a conservative management by embolization of ruptured left renal AVM revealed by hematuria in a 70-year-old patient with HHT.

External urinary catheter devices: A multisite project involving point prevalence

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

ECABLE (External Catheter Flexible) innovation of catheter external products for women

The increasing age of humans leads to reduced strength and muscle mass. Increasing age can also cause a decrease in the function of other organs, such as the urinary tract so that some elderly people have difficulty moving places to urinate and need to use diapers. The types of urinary catheters on the market are intermittent catheters, suprapubic catheters, and external catheters. The purpose of this study was to design a special external catheter for women with the name Ecable. Ecable is designed according to the needs of users both the elderly themselves and people who care for the elderly. The method used in this design is design thinking. ecable consists of five major components: a urine bag, an alarm, a hose, special underwear, and a urine funnel. The advantages offered by this product are easy to install and remove, comfortable to use, minimize unpleasant odors, there is a full urine bag detection alarm, minimize the cause of irritation, and are cost-effective because they can be used repeatedly. This catheter is expected to help the elderly and caregivers to overcome existing needs.

1933. Characteristics of Community-Associated Extended-Spectrum β-Lactamase Producing Enterobacterales Infections in Monroe County, NY, 2020-2021

Abstract Background Extended-spectrum β-lactamase–producing Enterobacterales (ESBL) have emerged as a serious multidrug resistant threat to the community. Epidemiologic data for community-associated (CA) ESBL infections are limited compared to that for healthcare-associated (HA) infections. We examined characteristics of CA ESBL cases over a two-year period and compared them to those of HA cases to guide prevention. Methods CA ESBL cases from 1/2020-12/2021 were identified via laboratory and population-based surveillance in Monroe County as part of the CDC Emerging Infections Program. Cases were defined as the first instance of positive culture in a county resident from a normally sterile site or urine of Escherichia coli, Klebsiella pneumoniae, or K. oxytoca resistant to ≥ 1 3rd-generation cephalosporin and nonresistant to carbapenems. Epidemiologic data were collected through medical record abstraction. Cases were classified as HA if they had prior healthcare exposures (e.g. hospitalization, surgery, chronic dialysis, indwelling devices, or external catheters) and CA if they did not. Case addresses were geocoded to the census tract level to obtain Social Vulnerability Index (SVI) percentiles. Chi-square analyses were conducted to quantify the difference in distribution of these characteristics between CA and HA cases. Results From 2020-2021, 1729 incident cases were identified; 854 (49%) were classified as CA. Compared to HA cases, CA cases were younger (median 59 vs. 70 years), more likely to be female (89.8% vs 65.3%), less likely to have a urinary tract abnormality (27.0% vs 56.8%) or underlying comorbidities (73.2 % vs 95.8%), and less likely to have received prior antibiotics (24.0% vs 55.1%). Interestingly, CA cases were more widely spread across SVI quartiles compared to HA cases; a higher proportion of HA cases resided in census tracts in the 3rd or 4th SVI quartiles (Table 1). Conclusion Patient-specific risk factors classically associated with HA ESBL are less commonly associated with CA ESBL in Monroe County. Community-based preventions may need to target different populations than hospital-based strategies. As ESBL incidence increases, continued surveillance to identify at-risk groups and explore the association of specific social determinants of health is necessary. Disclosures Rebecca Tsay, MPH, CDC: Grant/Research Support Ghinwa Dumyati, MD, Pfizer: Grant/Research Support

Male External Catheter Care and Maintenance.

Male External Catheter Care and Maintenance.

Catheter Tract Hemorrhages and Intracerebral Hemorrhage Outcomes in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Trial.

Factors associated with external ventricular catheter tract hemorrhage (CTH) are well studied; whether CTH adversely influence outcomes after intracerebral hemorrhage (sICH), however, is poorly understood. We therefore sought to evaluate the association between CTH and sICH outcomes. We performed a post hoc analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage trial. The exposure was CTH and evaluated on serial computed tomography scans between admission and randomization (approximately 72 hours). The primary outcomes were a composite of death or major disability (modified Rankin Score >3) and mortality alone, both assessed at 6 months. Secondary outcomes were functional outcomes at 30 days, permanent cerebrospinal fluid (CSF) shunt placement, any infection, and ventriculitis. We performed logistic regression adjusted for demographics, comorbidities, sICH characteristics, and treatment assignment, for all analyses. Of the 500 patients included, the mean age was 59 (SD, ±11) years and 222 (44%) were female. CTH occurred in 112 (22.4%) patients and was more common in minority patients, those on prior antiplatelet therapy, and patients who had more than 1 external ventricular drain placed. The end of treatment intraventricular hemorrhage volume was higher among patients with CTH (11.7 vs 7.9 mL, P = .01), but there were no differences in other sICH characteristics or the total duration of external ventricular drain. In multivariable regression models, CTH was not associated with death or major disability (odds ratio, 0.7; 95% CI: 0.4-1.2) or death alone (odds ratio, 0.8; 95% CI, 0.5-1.4). There were no relationships between CTH and secondary outcomes including 30-day functional outcomes, permanent CSF shunt placement, any infection, or ventriculitis. Among patients with sICH and large intraventricular hemorrhage, CTH was not associated with poor sICH outcomes, permanent CSF shunt placement, or infections. A more detailed cognitive evaluation is needed to inform about the role of CTH in sICH prognosis.

Male External Catheter Care and Maintenance.

Male External Catheter Care and Maintenance.

Internal versus external biliary drainage in malignant biliary obstructions: is there a difference in the rate of infection?

Percutaneous biliary drainage is a frequently used method to provide biliary decompression in patients with biliary obstruction. To investigate the between drainage type and infection risk in patients treated with internal-external and external biliary drainage catheterization for malignant biliary obstruction. A total of 410 patients with malignant biliary obstruction who underwent internal-external or external biliary drainage catheterization between January 2012 and October 2016 were retrospectively evaluated. We investigated the correlation between percutaneous biliary drainage technique and infection frequency by evaluating patients with clinical findings, bile and blood cultures, complete blood counts, and blood biochemistry. There was no statistically significant difference between the selected patient groups (internal-external or external biliary drainage catheter placed) in terms of age, sex, primary diagnosis, receiving chemotherapy, catheter sizes, and outpatient-patient status. After catheterization, catheter-related infection was observed in 49 of 216 (22.7%) patients with internal-external and 18 of 127 (14.2%) patients with external biliary drainage catheters, according to the defined criteria. There was no difference in infection rate after the biliary drainage in the two groups (P > 0.05). There was also no difference concerning frequently proliferating microorganisms in bile cultures. Internal-external biliary drainage catheter placement does not bring an additional infection risk for uninfected cholestatic patients whose obstruction could be passed easily in the initial drainage.

Prospective Randomized Trial of Antibiotic Prophylaxis Duration for Percutaneous Nephrolithotomy in Low-Risk Patients.

Introduction and Objective: Postoperative infection and sepsis account for the most common complications following percutaneous nephrolithotomy (PCNL), as high as 14% in low-risk patients. Although the American Urological Association (AUA) recommends perioperative antibiotics for 24 hours or less for PCNL, practice patterns vary regarding duration of antibiotic therapy. We aimed to compare the efficacy of 24-hour antibiotic coverage vs short-course protocol of antibiotic prophylaxis for PCNL. Materials and Methods: Low-risk patients with a sterile preoperative urine culture undergoing PCNL were prospectively randomized to antibiotics for up to 24 hours after procedure (24Hr) or continued until external urinary catheters were removed (CR) study groups. Patients were given a first generation cephalosporin, or ciprofloxacin in patients with penicillin allergy. Exclusion criteria included age <18 years, receiving antibiotics immediately before the procedure, history of urosepsis, presence of indwelling catheter >1 week, multistage procedure, immunosuppression, pregnancy, multiple antibiotic allergies, and patients who are breastfeeding. Results: Ninety-eight patients were randomized to either 24Hr (n = 49) or CR (n = 49). Mean duration of antibiotic administration was 20.6 and 34.0 hours in the 24Hr and CR groups (p = 0.04), respectively. Age, comorbidities, stone size, operative time, number of punctures, dilations, and proportion of "tubeless" procedures were similar between groups. There were no differences in febrile episodes, rates of systemic inflammatory response syndrome, bacteremia, or culture-proven postoperative urinary tract infection between the 24Hr and CR groups. Overall complication rates were similar between groups. In a subgroup analysis which excluded "tubeless" patients (24 and 29 patients in 24Hr and CR groups, respectively), no differences were seen in postoperative outcomes. Conclusions: In a randomized, prospective study, we found that a 24-hour protocol for antibiotic prophylaxis is not associated with increased risk of infection-related events compared to giving antibiotics until external catheters are removed in patients with low infectious risk undergoing PCNL. Clinicaltrials.gov: NCT02579161.

Candida auris: a growing threat to global health

Candida auris (C. auris) belongs to the Candida genus and is a fungal yeast resistant to multiple drugs. It is highly virulent and evades current therapeutic remedies. It was first discovered in a Japanese hospital in 2009 from a patient’s external auditory canal1. C. auris infection has a high worldwide mortality, which ranges from 30% to 60%, and is frequently associated with bloodstream infections2. The rapid spread of C. auris infection occurred after 2009. The Centers for Disease Control and Prevention (CDC) has estimated the presence of C. auris isolates in 41 countries, typically in hospital settings, as of March 20203. CDC also reported outbreaks of infections with C. auris in 47 countries globally on February 15, 20214. The United States reported 2377 clinical cases and 5754 screening cases from January 2022 to December 20225. Twenty-six isolates of C. auris from India were different genetically and phenotypically from the ones found in Japan and Korea, which provided evidence for C. auris’s ability to mutate and its resistance to Azoles6. The mechanism of C. auris virulence factors is relatively unknown. According to genomic comparison, C. auris has the ability to adapt to different environments. Two mechanisms of its pathogenesis have been identified, which include hydrolytic enzyme production and attack host cells and tissues. It can also form biofilms that protect it from antifungal drugs and increase its ability in nosocomial transmission4. C. auris can be spread in health care facilities such as hospitals and nursing homes through direct patient-to-patient contact. Contaminated surfaces are a significant culprit in the spread when a person comes in contact with them. As C. auris colonizes the skin and can be transmitted into the environment, both properties make it easily transmissible. Population susceptible are immunocompromised people, recently hospitalized patients in areas where C. auris is endemic; catheter use, extended stay in ICU, previous history of antimicrobial exposure, and resistance to antifungal therapy7. Identifying this pathogen is tricky as the methods used to determine the yeast in laboratories often must be corrected for other fungi. Detection of C. auris requires reliable sampling procedures from the most common sites of colonization, including the axillae and groin. Nares, external auditory canals, urine, rectum, catheter sites, and vagina also serve as colonization sites8. Making use of water and soaps or using a hand sanitizer with a 60% alcohol content is effective in preventing infection. Health care workers should take proper precautions to use gowns and gloves in the hospital setting. Regular disinfection and cleaning of surfaces prevent the survival of C. auris. When referring a patient with C. auris, the health care facility on the receiving end should be informed of the patient’s infection or colonization status to take appropriate measures promptly9. The steadily rising incidence of C. auris outbreaks poses a significant public health threat. C. auris outbreaks are a challenge to control due to poor routine diagnostic detection, prompt transmission, and resistance to disinfection techniques. It is now a leading cause of fungal infections in many medical setups with high mortality rates. Rapid detection methods that provide reliable identification and diagnosis, as well as control measures and necessary precautions, will help contain the spread of C. auris in health care systems. Ethical approval None. Consent for publication None. Sources of funding None. Author contributions The conceptualization was done by H.F. and H.S.R. The literature and drafting of the manuscript were conducted by H.F., A.M.S., F.R., and B.S.R. The editing and supervision were performed by H.S.R. All authors have read and agreed to the final version of the manuscript. Conflict of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not applicable. Guarantor All authors take responsibility for the work, access to data and decision to publish. Provenancer and Peer review Not commissioned, externally peer reviewed.

Outpatient PureWick™ female external catheter system performance: Healthy volunteer study

Objectives:The PureWick™ female external catheter provides a non-invasive method to manage female urinary incontinence, measure urinary output, and reduce skin breakdown from urinary incontinence. This study seeks to expand the limited clinical evidence of the PureWick™ System in a non-acute setting by evaluating the efficacy of self-placement compared with healthcare provider placement, comfort, and ease of use in the outpatient community setting. If the performance of the PureWick™ System is comparable to healthcare provider placement when used in a non-acute setting and placed by the participant, further research is needed to understand the benefits and risks of medical use of the PureWick™ System used in the home when absent from supervised medical care. Study Design:Prospective, single-center, non-randomized quasi-experimental healthy volunteer study. Methods:71 healthy, female volunteers were divided into cohorts based on body mass index (BMI) and performed two supervised, independent, supine voids. The first void was into a PureWick™ System placed by a healthcare provider followed by a void with independent participant placement after viewing of an instructional video. Outcome parameters included percent of void captured, comfort, and ease of use using a 5-point Likert scale. Adverse events were also collected. Descriptive analyses were conducted for all study variables. Results:Median capture rate was over 95% for healthcare provider-placed devices and over 98% for self-placed devices, regardless of BMI. Overall, 84.5% of participants rated the device as either “comfortable” or “very comfortable”. Device placement was rated “very easy” by 95.7% of healthcare providers and “very easy” or “somewhat easy” by 95.7% of participants. Device removal was rated “very easy” by 100% of healthcare providers and over 90% of participants in all cohorts. Conclusions:Healthy volunteers found the PureWick™ comfortable and easy to use for self-placement. The comparable performance of the PureWick™ System, when used in a non-acute setting and placed by the participant, may help to expand the limited clinical evidence of the PureWick™ System in a non-acute setting.

Use of Female External Urinary Catheters in a Burn Intensive Care Unit: Benefits and Challenges.

Burn patients have a relatively high rate of indwelling Foley catheter use because of their need for complex fluid management and wound care. However, Foley catheter use is associated with risks, including urinary tract infection. For female patients, an external urinary catheter is an alternative. To evaluate the use of female external urinary catheters in a burn intensive care unit and to develop a standard protocol. This study involved female patients admitted to a burn intensive care unit from 2017 to 2020. An initiative to increase the use of female external urinary catheters was begun in 2019. A retrospective review of medical records was used to determine rates of indwelling and external catheter use and of catheter-associated urinary tract infection before and after implementation of the initiative. Of 77 female burn patients admitted to the unit between 2019 and 2020, 56 (73%) required indwelling Foley catheterization, a significant decrease from 94% before the initiative (P = .002). The mean duration of indwelling Foley catheter use decreased significantly from 19.4 days to 10.47 days (P = .049). Female external urinary catheters were used in 21 patients (27%). No patients with female external urinary catheters contracted urinary tract infections, compared with 9 patients with indwelling Foley catheters. The use of female external urinary catheters may help reduce the risk of urinary tract infection in female burn patients. Further research is needed to refine the protocol for use of these devices and determine their safety profile.