Foley Insertion Research Articles

Tugging the Foley catheter balloon every three hours in induction of labor after one previous cesarean: a randomized controlled trial.

Induction of labor after 1 previous cesarean delivery with an unripe cervix have an especially high risk for unplanned cesarean delivery and uterine rupture. Mechanical balloon ripening is often preferred over prostaglandin-based ripening during induction of labor after 1 previous cesarean delivery, because uterine rupture has been associated with prostaglandin use. The transcervical Foley balloon can be dislodged past the ripened cervix and be retained comfortably in the vagina during passive placement. Tugging of the Foley catheter can be a noninvasive and tolerated method for timelier retrieval of the retained balloon; expediting discovery of a ripened cervix would permit an earlier follow-on amniotomy and oxytocin infusion, thereby hastening birth. This study aimed to evaluate the effect of tugging of the Foley balloon for 30 seconds every 3 hours during 12 hours of scheduled placement in comparison with standard care (no tugging) on the induction to birth interval and patient satisfaction. This randomized controlled trial, conducted at a university hospital in Malaysia, recruited participants from April 2023 to March 2024. Eligible participants admitted for Foley balloon induction of labor who had 1 previous cesarean were recruited. After balloon insertion, participants were randomized to tugging or standard care. Following balloon displacement, a vaginal examination was performed to check the cervix. The examination findings then dictated the follow-on management of induction of labor after 1 previous cesarean according to standard practice. The primary outcomes were the induction (Foley insertion) to delivery interval and participants' satisfaction with the birthing process. Secondary outcomes were largely derived from the core outcome set for trials on induction of labor. Based on a superiority hypothesis, it was calculated that a sample size of 126 would be required to detect a 4-hour reduction in the induction-to-delivery interval and a 1.5 point increase in the satisfaction score based on a 0 to 10 numerical rating scale with the level of significance set at 0.05, power at 80%, and a 10% drop out rate. Comparative analyses using an intention-to-treat approach were conducted using t tests, Mann-Whitney U tests, chi square tests, and Fisher exact tests as appropriate. A total of 126 participants were randomized with 63 in each trial arm. The induction to birth interval was (mean ± standard deviation) 29.7±9.6 hours for those in the 3-hourly tugging group and 29.8±9.1 hours for those under standard care (P=.950), and maternal satisfaction with the induction of labor after 1 previous cesarean delivery birth process, assessed using a 0 to 10 numerical rating scale, was (median [interquartile range]) 8 [7-9] and 8 [7-9] (P=.936), respectively. The cesarean delivery rate was 37 of 63 (59%) vs 41 of 63 (65%) (P=.238) for those in the tugging group vs standard care, and the main indication for unplanned cesarean delivery was failure to progress with an incidence of 24 of 37 (65%) and 24 of 41 (59%) (P=.914) for tugging vs standard care arms, respectively. Three-hourly tugging also did not shorten the interval from induction to balloon displacement, amniotomy, the start of oxytocin infusion, or the second stage of labor. Tugging the catheter every 3 hours during scheduled 12-hour Foley balloon placement for induction of labor after 1 previous cesarean delivery did not hasten birth or improve patient satisfaction when compared with standard care.

Comparison of digital and speculum-guided methods of transcervical Foley catheter insertion in primigravida undergoing cervical ripening at term gestation: a noninferiority randomized clinical trial

BackgroundFoley catheter insertion is frequently utilized for cervical ripening during the induction of labour. However, the insertion failure, safety, maternal side effects, complications and satisfaction of digital compared to speculum-guided Foley catheter placement have not been evaluated in a large trial involving primigravida. ObjectivesThe study aimed to compare the insertion failure rate of digital and speculum-based transcervical Foley catheter placement in primigravida. The co-primary outcome was insertion-associated pain. The secondary outcomes were time required for successful insertion, maternal satisfaction, and maternal complications within 24 hours of Foley insertion. MethodsThis randomized, open-label, parallel-arm, non-inferiority clinical trial was performed in a large tertiary care university hospital. Primigravida >18 years of age with term gestation (≥37 weeks) were included in this study. Additional inclusion criteria for enrolment in this study were singleton pregnancy with a cephalic presentation, intact membrane, Bishop score ≤5 and reassuring pre-induction foetal heart rate tracing. All women planned for cervical ripening were assessed for eligibility and were randomized into digital or speculum arms. Foley catheter insertion was performed in a supine lithotomy position. Vaginal and cervical cleaning were performed before insertion. A 22-French Foley balloon catheter was guided digitally or via speculum to position the bulb at the level of the internal os using water-soluble lubricant. Insertion-associated pain was measured using visual numeric rating scale (VNRS) and maternal satisfaction was assessed using a set of questions. Results469 pregnant women were assessed for eligibility, and 446 patients were enrolled and randomized. The median age of the parturients was 24 (19-40) and 24 (18-38) years, respectively. The body mass index, gestational age at randomization, incidence of post-dated pregnancy and pre-randomization Bishop scores were comparable. Insertion failure was observed in 24 (10.8%) and 17 (7.6%) of women in digital and speculum arm, respectively (RR= 1.41; 95% CI, 0.78-2.55; P=0.25). Requirements of more than one attempt (5.4% vs 3.6%) followed by change in hands (3.6% vs 2.7%) were the most common reasons for insertion failure. The median (interquartile range) VNRS was comparable (6.00 (2-9) vs 5.00 (2-10); p=0.15). The time taken for successful insertion was similar (58 (12-241) vs 54 (10-281); p=0.30). 9.4% and 10.8% of women required additional methods of cervical ripening. More women in the speculum group (41.7% vs 33.2%; P=0.06) felt a medium level of discomfort than digital group. ConclusionInsertion failure and insertion-related pain in the digital approach were comparable to the speculum-guided approach for transcervical Foley catheter insertion in primigravida for cervical ripening. Nevertheless, maternal satisfaction was higher in the digital group due to a lesser level of discomfort.

Comparison of Vaginal Dinoprostone Pessary With Transcervical Balloon Catheter Plus Vaginal Misoprostol for Pre-induction Cervical Ripening: A Randomized Trial.

Aims and Objectives To compare the safety and efficacy of dinoprostone pessary with Foley plus vaginal misoprostol for cervical ripening. Materials and Methods We randomized 115 women to the pessary or Foley plus misoprostol group. Pessary was inserted for 24 hours, and in the Foley plus misoprostol group, intravaginal misoprostol 25 mcg was administered along with trans-cervical Foley insertion and repeated every six hours to a maximum dose of 100 mcg. Singleton pregnancies requiring labor induction at more than 34 weeks with a Bishop score of <6 were included. Study outcomes included induction-delivery interval (IDI), mode of delivery, change in the Bishop score, need for oxytocin augmentation, and patient discomfort as assessed by visual analog score. Results The IDI was similar between the groups (pessary vs Foley plus misoprostol; 21.27 vs 21.10 hours, p = 0.9). The mean change in the Bishop score and need for augmentation with oxytocin was significantly more in the Foley plus misoprostol group compared to pessary (2.72 vs 1.94, p = 0.001; 89.7% vs 57.9%, p = 0.0001). Pessary was better tolerated compared to Foley plus misoprostol (VAS 7.8 vs 6.68, p = 0.0001). Mode of delivery and maternal and neonatal outcomes showed no difference. Conclusion There was no significant difference between pessary and Foley plus misoprostol in the IDI and mode of delivery. Pessary was better tolerated, andaugmentation with oxytocin was required less often. Foley plus misoprostol caused a faster change in the Bishop score, but oxytocin augmentation was used more often. Maternal and neonatal outcomes were similar.

Patient Pain and Satisfaction With 10, 30, and 70 mL Transcervical Foley Balloons for Cervical Ripening During Induction of Labor.

Objective To assess patient pain and satisfaction and time to delivery following transcervical Foley catheter balloon inflation to 10, 30, or 70 mL with simultaneous administration of oxytocin. Methods We performed a randomized prospective study with 30 or 70 mL transcervical Foley balloon catheters in combination with oxytocin during labor induction at term. A 10 mL group was included as a sham control group. Time to delivery was measured, and a patient questionnaire was administered at the time the catheter was expelled to determine patient pain and satisfaction. Results In 120 enrolled patients, there was a non-significant trend towardreduced time to delivery in the large Foley balloon group (10 mL: 30:45 ± 38:53, 30 mL: 26:41 ± 20:53, and 70 mL 22:40 ± 15:35, hh:mm, P = 0.412). The pain score at the time the balloon was expelled was significantly higher in the 70 ml group compared to the 10 ml and 30 ml groups (P = 0.004 and P = 0.034, respectively). We found no other differences in patient satisfaction or pain scores at the time of placement of the Foley catheter for the three groups. Conclusion Small gains in time to delivery should be balanced against patient experiences, and expectations of pain during the ripening process should be addressed at the time of Foley insertion.

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

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

Povidone-iodine irrigation reduces infection after total hip and knee arthroplasty.

One of the most important challenges faced by orthopedic surgeons is periprosthetic joint infection (PJI). PJI is a common cause for total joint arthroplasty failure with an incidence of 0.3-1.9%. PJI can be devastating for the patient and extremely costly for the healthcare system. There is concern that a major cause of PJI is intra-operative colonization and recent studies have shown a decrease in PJI with the use of dilute povidone-iodine (Betadine®, Avrio Health L.P, Stamford, CT) irrigation prior to wound closure. This study presents our experience with the use of dilute Betadine® irrigation prior to wound closure and its effect on our post-operative hip and knee arthroplasty acute infection rate. Retrospective chart review performed at our hospital looking at PJI amongst patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2013 and 2017 comparing different irrigation methods (n = 3232). The study group (n = 1207) underwent irrigation prior to wound closure with dilute Betadine for 3min and the control group (n = 1511) underwent irrigation using normal saline (NS). Using a logistic regression model where the following variables were adjusted for; ASA, age, sex, foley insertion, surgical duration and diabetes mellitus status a statistical significant reduction was seen in any infection (OR 0.45 [0.22; 0.89], p value < 0.05) and SSI (OR 0.30 [0.13; 0.70], p value 0.01) with the Betadine group. No significant reduction was seen with deep infections with the Betadine group compared to the NS group. PJI is a devastating complication following total joint arthroplasty and we found Betadine compared to NS irrigation provides an inexpensive and simple method to lower any PJI and more specifically SSI in THA and TKA. III.

Value of Crossover Sign in Anticipating Under-8-week Cesarean Scar Pregnancy Treatment by Foley Insertion Combined with Suction Curettage in Vietnam.

Objectives:An earlier study completed at TuDu Hospital presented the efficacy of Foley insertion combined with fetal suction curettage at a high rate of success in treatment of cesarean scar pregnancy (CSP) of < 8 weeks, but the efficacy of prognosticating factors for this approach has not been specifically addressed yet, especially crossover sign (COS) on ultrasound. We aimed to investigate the correlation between COS on ultrasound and the treatment results of CSP using Foley insertion combined with fetal suction.Materials and Methods:A case–control study of CSPs ≤ 8 weeks treated at TuDu Hospital during September 2017–April 2019 included 63 failures in the case group and 98 successes in the control group.Results:COS-2 + increased the likelihood of treatment success by 4.9 times (95% confidence interval: 1.8–13.5) compared with COS-1 cases. In addition, other factors favoring treatment success with statistical significance included no vascularization at cesarean scar on ultrasound (odds ratio [OR] = 7.1), gestational mass volume ≤4 cm3 (OR = 3.7), and β-human chorionic gonadotropin at hospital admission ≤ 10,000 mIU/mL (OR = 6.1).Conclusion:COS imaging played an important role in the prediction of treatment outcomes for CSP ≤ 8 weeks by the combined approach of Foley insertion and fetal suction curettage.

Aquablation for benign prostatic obstruction: Single center technique evolution and experience.

PurposeAquablation is a new technology that relies on real-time ultrasound guidance to ablate prostatic tissues using high velocity pressurized water. We hereby present our data and experience in this technique by exploring the perioperative surgical and functional outcomes.Materials and MethodsThis is a prospectively filled study including consecutive patients who underwent aquablation at our Middle Eastern tertiary care center. Patient demographics, voiding parameters, and prostate disease specific variables were collected. We reported on the surgical and functional outcomes as well as the 3-month adverse events. We also explored the trend in hemoglobin drop and hemostasis method by dividing the consecutive cases into four temporal periods.ResultsFifty-nine patients underwent aquablation between March 2018 and March 2020. Mean time from transrectal ultrasound to Foley insertion was 48.5±2.5 minutes. Cautery was performed in 35 patients (59.3%) and a catheter-tensioning device was mounted in 50 patients (84.7%). On average, the hemoglobin dropped by −1.7±0.2 ng/dL (p<0.0001). The average length of catheterization and hospital stay were 2.1±0.3 days and 2.2±0.1 days, respectively. Only three patients (5.1%) were re-hospitalized. At three months, the average drop in serum prostate-specific antigen was −36.6±6.0% (p<0.0001) and functional outcomes considerably improved. We also recorded 14 adverse events in 13 patients (overall rate of 22.0%), with grade 1 and grade 2 complications comprising 71.4% of all adverse events.ConclusionsOur study results confirm the safety and efficacy of the aquablation procedure in the adoption phase.

Core temperature monitoring during cesarean delivery under spinal anesthesia: a quality improvement descriptive study.

Aim: To analyze intraoperative temperature change over time following spinal anesthesia for cesarean delivery using temperature enabled Foley catheters. Materials & methods: 512 records of women who underwent scheduled cesarean deliveries were retrospectively identified from January 1, 2018 through September 9, 2018 using our anesthesia information management system. Results: Median minimum temperature at min1 following foley insertion was 35.24°C (interquartile range: 1.43), with an average of 12minutes until temperature equilibration at median maximum temperature of 36.54°C (interquartile range 0.39). Temperature dropped to a nadir of 35.9°C at the 45minmark, reflecting an average 0.64°C decline in temperature. Conclusion: Bladder temperature is a useful surrogate for core temperature and offers a practical solution to continuous temperature monitoring in awake patients.

Catheter-Associated Urinary Tract Infections (CAUTIs) Reduction: A Multidisciplinary Approach

Background: CAUTIs remain one of the most common hospital-acquired infections (HAIs) accounting for prolonged hospital stay and increased healthcare costs. According to the NHSN, the standardized infection ratio (SIR) at our institution was 1.6 compared to national average of 0.84 in 2018. We highlight the interventions implemented in our institution to prevent CAUTIs. These interventions have shown a reduction in the rate of CAUTIs, the SIR, Foley catheter days, and institutional cost. Methods: In addition to standard CAUTI prevention practices, we hypothesized that we could decrease CAUTIs through the daily implementation of specific practices. We developed a comprehensive interdisciplinary team which included the staff or charge registered nurse (RN), the unit manager, an infection preventionist, an advanced practice registered nurse (APRN), a pharmacist with an antimicrobial focus, and a physician from the infectious disease department who would conduct daily rounds on different units in the institution for education and assessment of catheter indications. A detailed review and analysis of the urine culture orders for patients with a Foley catheter was performed. A nurse-driven Foley catheter removal protocol before urine culture collection was initiated. We implemented a Foley catheter bundle that has guidelines for Foley insertion, best practice competency, and urinary catheter best practice algorithm and advocated alternative use of male or female external catheter. We educated physicians about ordering a reflexive urine analysis test followed by urine culture instead of testing either individually after removal of a Foley catheter. Lastly, we performed a root-cause analysis on all reported CAUTIs. These policies were implemented in a 435-bed tertiary-care center in November 2018, and we present data from 1-year before and after the interventions. Results: At our institution, we had 71 CAUTIs, with an SIR of 1.6, a standardized utilization ratio (SUR) of 0.92, 27,621 Foley days, and institutional cost of $979,303 compared to 40 CAUTIs with an SIR of 1, an SUR of 0.88, 24,193 Foley days, and institutional cost $537,927 after implementing our interventions. Conclusions: CAUTIs can be reduced by implementing specific measures that include infection control team rounds, nurse-driven protocol, and the use of Foley catheter bundles. Measures should be undertaken to prioritize these practices as part of a protocol. We advocate further studies to evaluate these measures. Education programs for healthcare professionals concerning CAUTIs and its complications can be implemented to carry out the prevention methods efficiently.Funding: NoneDisclosures: None

A Multidisciplinary Approach to Leveraging Data and Implementing Change: A Reduction in Emergency Department Foley Catheter Insertions

<h3>Background</h3> Foley catheter (FC) insertions in the Emergency Department (ED) create inherit infectious and non-infectious risks to patients due to the chaotic environment. Numerous FCs are placed in the ED due to convenience, lack of patient diagnosis and urgency. The objective of this study was to reduce the amount of FCs that are inserted in the ED, by utilizing a multidisciplinary team to implement practice changes based on real time data. <h3>Methods</h3> A cross-sectional study was performed from January 2018 – November 2019 in a Level I Trauma hospital. A multidisciplinary team including Infection Prevention (IP), Clinical Data Analytics and ED leadership developed a dashboard to determine FC insertions in the ED/1000 patients and common indications for Foley placement in the ED. Additionally, every FC that was placed in the ED was reviewed by IP and ED leadership for appropriateness. Any FC that were deemed inappropriate were then discussed with physicians and staff. Weekly and monthly reports were reviewed with ED leaders for trends. The number of FC insertions in the ED/1000 patient days in the pre-intervention period (January 2018 – December 2018) was compared to post-intervention (January 2019 – November 2019). A T-test was used to determine statistically significant change. <h3>Results</h3> A 22% reduction of FC insertions in the ED occurred between the pre- and post-intervention. During the pre-intervention period, the FC insertion rate was 11.62 FC insertions /1000 patients compared to 9.33 during the post intervention period (p < 0.01). The indication for Foley insertion was labeled as "other" decreased by 73.7% between pre- (19%) and post-intervention (5%) periods. <h3>Conclusions</h3> An engaged ED staff and clinical data analytics team were able to reduce risk to patients by decreasing FC insertions in the ED. Next steps will be to determine non-infectious poor outcomes to further reduce FC insertions in the ED.

Comparison of outcomes of Foley's induced labors with different sonographic floater densities in fore-water

Background: Onset of spontaneous labor occurs on completion of fetal functional maturity at amniotic fluid optical density (AFOD) 0.98 ± 0.27 (mean ± SD). All three events occurring together at any time from 35 weeks to 42 weeks indicate the individualized term for each fetus. No failures of induction of labor were reported when labors induced at AFOD 0.98 ± 0.27. As AFOD estimation needs invasive amniocentesis, we tried to induce women with liquor with mature AFOD by observing the sonographic appearances of fore-water by transvaginal sonography. Methods: In this comparative study, three groups of gestational age and parity matched uncomplicated singleton term pregnant women, underwent fore-water trans-vaginal sonography before induction of labor with Foley's catheter. Sonographic images were divided into three grades based on floating particle densities. Each group consisted of 20 women with each grade of sonographic images. Uncentrifuged fresh AF samples collected at amniotomy were used for AFOD measurement with colorimeter at 650 nm in all groups. After Foley's expulsion, labor was augmented with vaginal misoprostol. The mean AFOD values, Foley's insertion expulsion intervals, Foley's insertion delivery intervals (FIDI), T misoprostol required, and neonatal respiratory distress were recorded in each group and compared. Results: In groups 1, 2, and 3, the mean AFOD was found to be 0.29 ± 0.09, 0.68 ± 0.14, and 1.15 ± 0.20, respectively. Mean Foley's insertion expulsion intervals were 10.57 ± 3.76 h, 5.83 ± 2.24 h, and 4.08 ± 0.86 h, respectively. Mean FIDI were 20.00 ± 6.20 h, 11.22 ± 4.20 h, and 8.95 ± 2.98 h, respectively. The mean numbers of T misoprostol required in each group was 3 ± 1, 2 ± 1, and 2 ± 1, respectively. Significant differences were observed in all outcomes between groups (P Conclusion: Labor induction with Grade 3 sonographic images of fore-water was successful in all women with shorter FIDI, and with better perinatal outcomes.

Use of a Foley Insertion Gap Analysis to Reduce Incidence Rates of Catheter-Associated Urinary Tract Infections

Background: During Fiscal Year 2015 a significant increase was observed in our Catheter Associated Urinary Tract Infection (CAUTI) incidence rate. Concerns were raised regarding staff insertion practices which prompted a Foley insertion gap analysis to determine the most common areas of error procedurally and in aseptic technique. By utilizing the results of the gap analysis to educate staff on proper insertion techniques we will reduce our incidence rate.

Foley catheter for cervical priming in induction of labour at University Obstetrics Unit, Colombo, Sri Lanka: a clinical audit with a patient satisfaction survey

BackgroundIntracervical insertion of a Foley catheter (FC) has shown to be a safe, effective and relatively feasible mechanical method of cervical priming in induction of labour (IOL). We evaluated indications, effectiveness, patient acceptability and outcomes of FC use in IOL adhering to the ward protocol in our unit.MethodsA clinical audit with a patient satisfaction survey conducted between July and September 2013 in University Obstetric Unit, Colombo, Sri Lanka. Patients selected for IOL for obstetric reasons were primed with Foley as per ward protocol. All had singleton pregnancies with cephalic presentation, intact membranes and period of gestation of 37 weeks or above. Women with a history of more than one caesarean section or uterine surgery, low-lying placenta and fetal growth restriction were excluded. Subjects who had a Modified Bishop Score (MBS) of less than 3, a 16Fr FC was inserted into cervical canal. Catheter was left undisturbed until spontaneous expulsion or no longer than 48 h. In women with MBS of less than 6 at 48 h after FC insertion, 3 mg prostaglandin E2 vaginal tablet was used subsequently. Artificial membrane rupture with or without oxytocin was used if MBS of 6 or more and in women not in labour 24 h after prostaglandins. Patient satisfaction for Foley insertion was assessed with regards to the degree of comfort using a validated visual analogue scale (0–10).ResultsThere were a total of 910 deliveries during the study period. Fifty-six women were primed with FC. Thirty-two (57%) were nulliparous. During induction of labour, 53(95%) reported mild or no discomfort. MBS of 6 or more was achieved in 36/56 (64%) Foley insertions. Twenty needed further intervention with prostaglandins. FC only group had 5 caesarean sections and 31 vaginal deliveries and Foley/prostaglandin group had 7 caesarean sections and 13 vaginal deliveries. Of the 24 women who were induced due to completion of 41 weeks of gestation with otherwise uncomplicated pregnancies, 17 had MBS >6 post priming with Foley and 20 (83%) delivered vaginally. Subjects who had Foley only had a lesser chance of having a caesarean delivery compared to subjects who had Foley followed by prostaglandin (relative risk = 0.40, 95% CI = 0.15–1.09, P = 0.09).DiscussionFC is a good choice for pre-induction cervical priming with high patient comfort. FC becomes more important in IOL cost reduction in our setting. FC alone seems to be an effective for IOL in women who have completed 41 weeks of gestation with otherwise uncomplicated pregnancies.

V11-06 STEP BY STEP ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY: A SINGLE HOSPITAL EXPERIENCE

You have accessJournal of UrologyUrolithiasis1 Apr 2017V11-06 STEP BY STEP ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY: A SINGLE HOSPITAL EXPERIENCE Yite Chiang and Kaiyi Tzou Yite ChiangYite Chiang More articles by this author and Kaiyi TzouKaiyi Tzou More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2995AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy is effective for patient who has large renal stone > 2cm in size. Ultrasound-guided percutaneous nephrolithotomy can be performed safely without radiation exposure. We describe how we performed ultrasound-guided percutaneous nephrolithotomy step by step according to our experience. METHODS We conducted a retrospective study of patients received percutaneous nephrolithotomy from January 2012 to October 2016. In total, 205 patients were enrolled. One-hundred and thirty-six patients received ultrasonic-guide operation and 69 received fluroscopic-guided operation. Patients’ clinical characteristics, operation time, hospital stay, complication, hematocrit and renal function data were recored and analyzed. We performed ultrasound-guided by following steps:(1) Double-J catheter insertion (2) Three-way Foley insertion (3) Normal saline instillation and Foley clumping (4) Needle puncture (5) Incision and Dilatation (6) Balloon dilatation and insert sheath. RESULTS Among two groups, the patient clinical characteristics do not have significant difference. There were also no difference during hospital stay, hematocrit and renal function change. However, shorter operation time (62mins vs. 87mins, p< 0.05), was noted in ultrasound-guided group maybe due to shortened puncture time. In the other hand, complete stag-horn stone patients had higher stone free rate (75% vs 90%, p< 0.05) in fluroscopic group. Complication rate is similar in two groups but one patient in ultrasound-guided group had developed bladder rupture while normal saline instillation by pressure pump. CONCLUSIONS ultrasound-guided percutaneous lithotomy is feasible for patient who has large renal stones. The outcome is similar compared to traditional fluroscopic-guided procedure. In our experience, ultrasound-guide may shorten puncture time and decrease the radiation exposure to patients and staffs. Double-J catheter insertion before puncture to create dilated calyces may help puncture easier. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1283 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yite Chiang More articles by this author Kaiyi Tzou More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

New device for temporary hemorrhage control in penetrating injuries to the ventricles.

BackgroundThe best way to control hemorrhage from cardiac injuries is through digital occlusion followed by suture. However, this is difficult to accomplish in the emergency department (ED) setting. Generally, temporary control is obtained in advance of definitive treatment in the operating room. Despite safety and efficacy concerns, balloon Foley catheter insertion through the injury is still an option following ED thoracotomies. We developed a new device for temporary hemorrhage control in cardiac injuries and compared it to the Foley.Methods6 adult swine (n=6) underwent full-thickness (1.5 cm) injury along the longitudinal axis of the right ventricle (RV). After 5 s of bleeding, hemorrhage control was attempted with either the device or the Foley, and blood loss quantified. Subsequently, the wound was sutured and mean arterial pressure was restored to baseline with lactated Ringer's infusion. Subsequently, another injury 2 cm apart in the same ventricle was managed with apparatus not employed in the first injury. The same followed in the LV totaling 4 injuries per animal, 2 in each ventricle. Intraoperative echocardiogram, laboratory test and final wound sizes assessed.ResultsThe device resulted in less bleeding than the Foley; RV 58.7±11.3 vs 147.7±30.9 mL, LV 81.7±11.9 vs 187.5±40.3 mL (p<0.05). Percent change in tricuspid regurgitation was less with the device than FO, 66.6% vs 400%. Mitral regurgitation increased 16% with Foley, but remained unchanged with the device. Changes in stroke volume and LV ejection fraction were less with the device than with Foley; SV 2.09% vs 12.48%, left ventricular ejection fraction 0.46% vs 5.45%. Foley insertion enlarged the wounds. Platelet count, complete blood count, prothrombin time, activated prothrombin time and fibrinogen decreased, whereas troponin and lactate increased compared with baseline, underscoring the magnitude of shock.ConclusionsCardiac hemorrhage was effectively controlled with the new device. The low-profile collapsible blocking membrane interfered less with cardiac function than did the balloon of the Foley, an important asset in the context of shock.

5-154 - Reducing Catheter Associated Urinary Tract Infections Through Foley Insertion Competency Assessment upon Hire

5-154 - Reducing Catheter Associated Urinary Tract Infections Through Foley Insertion Competency Assessment upon Hire

Implementation of the FIRM (Foley Insertion, Removal, and Maintenance) protocol in skilled nursing facilities

The purpose of this study was to determine the feasibility and outcomes of the implementation of an evidence based protocol, Foley Insertion Removal and Maintenance (FIRM) for the use and care management of indwelling urinary catheters (IUC) for skilled nursing facilities (SNF). The protocol consists of an order set for insertion, maintenance, and removal complemented with an education program for health care providers of SNF. It was implemented over a six month period in two SNF. Prospective chart review following implementation revealed an 11.3 rate of IUC per month. Documentation of the indication for placement of an IUC was 98.5%. Retrospective chart review revealed a lower use of IUC prior to implementation of the protocol but the lack of documentation of orders for IUC artificially reduced the rate. FIRM protocol is advocated as a facility policy with a nurse champion to facilitate implementation and surveillance.

Implementation of an Evidence Based Protocol to Reduce Use of Indwelling Urinary Catheters in the Long Term Care Environment

The use of indwelling urinary catheters (IUC) has been documented between 5-15% in long term care (LTC) even though the CMS requires a valid medical justification for use. A major complication of IUCs is UTIs which contributes to the problems of urinary incontinence, falls and delirium and are the primary cause of hospitalization of patients from LTC facilities. IUCs are an added concern as they are one point restraints. Purpose of this project was to implement the evidence based FIRM (Foley Insertion, Removal, and Maintenance) Protocol aimed at the reduction of infections and other complications by reduction of indwelling urinary catheter use in the LTC environment. The protocol was a revision of an acute care protocol developed, implemented and evaluated by the authors. Larrabee’s model of evidence-based practice change guided the implementation of the study along with Model of Technology, Nursing and Patient Safety.

Real-Time Digital 3D Ultrasonographic Characteristics of Recurrent Leiomyomatosis

A woman aged 42 years, gravida 2, para 1, presented with a palpable abdominal mass found during a pelvic examination in our hospital. She had experienced intermittent low abdominal discomfort during the last several months. Her medical history included myomectomy for uterine fibroid, a total abdominal hysterotomy, a left salpingooophorectomy for recurrent multiple uterine fibroids with severe menorrhagia, and a large left ovarian tumor. The histologic examination from the surgical specimen confirmed a diagnosis of leiomyomatosis with left ovarian borderline mucinous tumor. One year later, she underwent debulking surgery for a retroperitoneal tumor and a ureteroneocystostomy with a double J tube and a suprapubic Foley insertion. Her left ureter was engulfed into a retroperitoneal tumor near the lower-third. During the laparotomy, multiple grey-whitish, firm, and solid retroperitoneal tumors were scattered in the paravesical space and deep within the pelvic cavity. They varied in size, ranging from 1.5e5.0 cm. The microscopic findings showed that there were leiomyomas with moderate to marked hypercellularity and mild nuclear pleomorphism. Occasional mitoses (0-1/10 HPF) were noted, but there was no evidence of necrosis. The pelvic lymph node demonstrated reactive hyperplasia and the fibroid proliferation of smooth muscle cells in the vascular wall and lumen. Six weeks later, the double J tube was removed using