Long-term Catheters Research Articles

#2868 Clinical outcomes of octogenarians starting haemodialysis: a single center experience

Abstract Background and Aims Simultaneously with the aging of the general population, the number of patients with ESRD is also increasing. The question of the most favorable dialysis treatment arises, but the most frequently used method is still haemodialysis (HD). Method Retrospective data from patients aged 80 years or older treated with chronic HD treatments in our Dialysis Center and followed between 2009 and 2023. were studied. Results This study included 33 octogenarians (83.5 ± 5.4 years, 25M, 8F) Underlying renal diseases were hypertensive/ischaemic nephropathy (76%), diabetic nephropathy (10%), obstructive nephropathy (4%) and UN in 3 (10%). Vascular access was AV fistula in 72%, AV graft in 4%, long-term HD catheter in 17%, temporary catheter in 7%. Over half of them (i.e., 55%) were mobile, 35% mobile with assistance and 10% were immobile. Out of thirty-three, 3 died during the first 90 days of HD therapy and they were excluded from further analysis. During the observation period, 19 of 30 have died (63%). There was no statistically significant difference between those who were still alive and who died regarding their vascular access status, though all four of our patients with temporary catheters died (21% of all died, p 0.26). Also, their age (82.8±2.5 vs. 83.5±3.3 y), Charlson score (8.4±1.7 vs. 8.4±1.2), their Kt/V (1.45±0.24 vs. 1.43±0.31), Hb (104.4±6.2 vs 106.1±7.9 g/L) or albumin level (37.8±5.3 vs. 36.9±4.6 g/L) and other of blood analysis did not differ significantly between live and died patients. The only 2 parameters that were statistically significantly different were their HD vintage (34.3±21.0 vs. 57.1±39.2 p 0.05) and the last obtained lean tissue index (LTI, assessed by “Body Composition monitor” bioimpedance apparatus). Namely, their LTI was less than 10 kg/m2 BSA (present in 6 of 19, i.e. 32% of died patients and in none of the survivors, p<0.05) The 1-year, 2-year, 5-year survival has a favorable rate, i.e. 86%, 77%, 42% respectively (Figure:). The main causes of death were cardiovascular disease (47%), COVID (26.3%), sepsis, gastrointestinal bleeding, disseminated malignancy, stroke (1 case each) and 1 patient decided not to continue his HD treatments. Conclusion With careful clinical assessment and timely created vascular access, HD is a good choice for the treatment of very old ESKD patients. The outcomes in observed population would probably be better without pandemic COVID scenario.

Vascular rehabilitation in children with chronic intestinal failure reduces the risk of central-line associated bloodstream infections and catheter replacements

Background & AimsChildren with chronic intestinal failure (IF) require a long-term central venous catheter (CVC) for provision of parenteral nutrition. Vascular, mechanical and infectious complications such as central line-associated bloodstream infections (CLABSI) may lead to progressive loss of venous access sites. Handling and management of CVCs therefore play an important role. Our vascular rehabilitation concept (VRC) is a core component of our intestinal rehabilitation program (IRP) and consists of an education program, optimization of skin care, catheter fixation and lock solution, and the use of hybrid technique for catheter placement.Aim of this study is to analyse the effectiveness of our VRC on CLABSI rates and need for CVC replacements. MethodsRetrospective analysis of all children treated in our IRP that were followed up between 2018 and 2023. ResultsA total of 117 children with chronic IF could be included for analysis of 248864 catheter days (CD). 91 patients were referred from other hospitals (127117 CD before and 89359 CD after entry into our IRP). Children receiving primary care at our IRP (32388 CD) showed a significantly lower CLABSI and line replacement rate than patients referred from external centers (p<0.001). After entering our IRP, CLABSI rates and need for CVC replacements per 1000 CD decreased significantly in referred patients: 1.17 to 0.26 and 1.75 to 0.59, respectively (p<0.001). ConclusionManagement of paediatric chronic IF patients by an IRP with a vascular rehabilitation concept significantly lowers the rate of CLABSI episodes and the need for catheter replacements.

Piezoelectrically-activated antibacterial catheter for prevention of urinary tract infections in an on-demand manner

Catheter-associated urinary tract infection (CAUTI) is a common clinical problem, especially during long-term catheterization, causing additional pain to patients. The development of novel antimicrobial coatings is needed to prolong the service life of catheters and reduce the incidence of CAUTIs. Herein, we designed an antimicrobial catheter coated with a piezoelectric zinc oxide nanoparticles (ZnO NPs)-incorporated polyvinylidene difluoride-hexafluoropropylene (ZnO-PVDF-HFP) membrane. ZnO-PVDF-HFP could be stably coated onto silicone catheters simply by a one-step solution film-forming method, very convenient for industrial production. In vitro, it was demonstrated that ZnO-PVDF-HFP coating could significantly inhibit bacterial growth and the formation of bacterial biofilm under ultrasound-mediated mechanical stimulation even after 4 weeks. Importantly, the on and off of antimicrobial activity as well as the strenth of antibacterial property could be controlled in an adaptive manner via ultrasound. In a rabbit model, the ZnO-PVDF-HFP-coated catheter significantly reduced the incidence CAUTIs compared with clinically-commonly used catheters under assistance of ultrasonication, and no side effect was detected. Collectively, the study provided a novel antibacterial catheter to prevent the occurrence of CAUTIs, whose antibacterial activity could be controlled in on-demand manner, adaptive to infection situation and promising in clinical application.

Transurethral Resection of Necrotic Tissue in the Bladder Caused by Emphysematous Cystitis

Emphysematous cystitis is a relatively rare form of urinary tract infection. A 72-year-old man with diabetes mellitus and long-term indwelling urethral catheterization was diagnosed with emphysematous cystitis. The clinical findings were resolved by conservatively managing the patient with antibiotics. However, cystoscopy subsequently revealed a yellowish-white soft tissue mass in the bladder, which was unlikely to be a bladder tumor. The mass could not be removed easily and frequently caused urinary catheter obstruction. We successfully removed this mass by performing transurethral resection twice. Through histopathological examination, the mass was identified as necrotic tissue comprising bacteria, fibrin, and suspected bladder mucosa.

A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer® Polyhexanide 0.02%

IntroductionHistorically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment.Case presentationThese case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms.DiscussionCatheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm.This case report was prepared following the CARE Guidelines (supplementary file 1).

Long-Term Tunneled Hemodialysis Catheters: Achieving Efficiency Through Tip Position Optimization

This retrospective study assesses the influence of tunneled hemodialysis catheter tip location and lateralization on catheter-related complications, including dysfunction and catheter-related bloodstream infection. Using data from 162 patients who underwent catheter placement between January 2017 and December 2020, postoperative chest X-rays and clinical records were reviewed. Outcomes were assessed based on catheter removal duration and complication incidence. Out of 177 catheter placements, 56 (32%) patients experienced complications during an average 530-day follow-up. Catheters placed in the superior vena cava (SVC) exhibited more severe complications with shorter dwell times compared with those in the pericavoatrial junction (pCAJ) or right atrium (RA). Moreover, complication rates were significantly higher (P<0.01) in the SVC (1.91 per 1000 catheter days) compared with the pCAJ (0.54) or RA (0.47). Lateralization (right or left internal jugular vein) did not significantly affect the complication rates (0.60 vs. 0.58; P=0.90). However, in subgroup analysis, a significantly higher complication rate was observed for catheters with tips inserted from the left side into the SVC than for those inserted from the right side (6.6 vs. 1.5; P<0.01). Catheters with tips in the SVC exhibited more severe complications than those in the pCAJ or RA, with left-side insertion of SVC-tipped catheters resulting in significantly higher complication rates compared with right-side insertion. These findings highlight the importance of optimal catheter tip positioning in long-term hemodialysis care to minimize complications and enhance patient outcomes.

Successful management of fatal cardiac tamponade resulting from intravascular intervention for central vein occlusion in hemodialysis patients: A case report.

This case report highlights the successful management of fatal cardiac tamponade caused by intravascular intervention for central vein occlusion in hemodialysis patients. Prompt diagnosis and treatment are essential for patient prognosis in such cases. We present a case involving a challenging surgical procedure to address multiple complications, emphasizing the importance of early detection and appropriate interventions. The patient, who had a history of long-term central venous catheter use for hemodialysis, was diagnosed with central vein stenosis in addition to superior vena cava occlusion, hemodialysis catheter rupture, hypertension, and end-stage renal disease. Urgent ultrasound examination during surgery revealed pericardial effusion, prompting immediate pericardial drainage for stabilization. To overcome the complex challenges, we successfully performed an innominate vein-right atrial appendage bypass to restore vascular access and salvage the patient's life. The timely use of echocardiography for diagnosis and pericardial drainage contributed to stabilizing the patient's vital signs, providing an opportunity for subsequent surgical intervention. The innominate vein-right atrial appendage bypass procedure successfully relieved central vein stenosis and saved the patient's life. Although this surgical technique is not widely documented in hemodialysis patients with central venous involvement, it show cases the potential benefits for clinicians managing vascular access in this patient population. This case report underscores the need for awareness among clinicians regarding the risk of cardiac tamponade associated with intravascular intervention for central vein stenosis in hemodialysis patients. Minimizing central venous catheterization and prioritizing autogenous arteriovenous fistulas are crucial principles in preparing vascular access for hemodialysis patients. Early detection, timely interventions, and consideration of alternative surgical techniques can improve outcomes and prevent life-threatening complications.

The stuck haemodialysis catheter—a case report of a rare but dreaded complication following kidney transplantation

BackgroundTunnelled cuffed haemodialysis catheters are at increased risk of incarceration or becoming ‘stuck’ via fibrotic adhesion to the central veins when left in situ for prolonged periods of time. Stuck catheters cannot be removed using standard techniques such as bedside dissection of the cuff. Whilst there are several strategies published for the removal of these incarcerated lines, there is no consensus on the best approach. Here we present a challenging case of a stuck haemodialysis catheter in the acute post transplantation period.Case PresentationA 66-year-old female on haemodialysis presented for kidney transplantation with a tunnelled-cuffed haemodialysis catheter in situ for five years. Following transplantation, removal of the line was unsuccessful despite dissection of the cuff, with traction causing a choking sensation with tracheal movement. Eventually, the line was removed without complications utilising sequential balloon dilatation by interventional radiology and the patient was discharged without complications.ConclusionsThis case serves as a timely reminder of the risks of long-term tunnelled haemodialysis catheters and as a caution towards proceeding with kidney transplantation in those with long-term haemodialysis catheters in situ. Greater nephrologist awareness of interventional radiology techniques for this challenging situation will help to avoid more invasive strategies. The risks of a stuck catheter should be included in the discussions about the optimal vascular access and transplantation suitability for a given patient.

Purple Urine Bag Syndrome: a Rare Manifestation of Urinary Tract Infection

Purple urine bag syndrome (PUBS) is rare manifestation of urinary tract infection (UTI). Epidemiological study showed the prevalence of purple urine bag syndrome about 8.3%-16.7% worldwide. There are some factors which lead to the disease including female, long-term urinary catheter, bedridden or immobile for long time, constipation, and urinary tract infection. The mechanism of this condition involves the tryptophan in intestine that is degraded into indole. In the liver, indole is conjugated into indoxyl sulphate. This conjugate product then is excreted into urine by the kidney. In the infected urinary tract, some gram-negative bacteria produce enzymes called sulphatase and phosphatase. It converts the conjugated product, indoxyl sulphate into pigments, red indirubin and blue indigo. The two pigments-combination produces purple pigment which appears in urine. We present a-61-year-old female who has history of cerebrovascular accident who came to our emergency room with purple urine over the previous seven days.

Polyzwitterion coating based on PDMAEMA-block-PAAc for catheters with antibiofilm activities

Patients with long-term indwelling urinary catheters suffer from complications like infection and encrustation, which are dealt with by catheter replacement or antibiotic therapy inevitably resulting in the emergence of drug-resistant bacteria. Development of antibiofilm catheter coatings with biocompatible materials is considered a practical way to address these issues. Therefore, in the present work, a polyzwitterion coating based on Poly(2,2-dimethylaminoethyl methacrylate)- block-Polyacrylic acid) (PDMAEMA-block-PAAc) was designed on the catheter surface. Herein, following the activation of the catheter silicone surface by UV/Ozone, it was functionalized with α-bromoisobutyryl bromide (BIBB), then 2,2-dimethylaminoethyl methacrylate and acrylic acid monomer were polymerized in situ on the surface. Coated catheters were evaluated by attenuated total reflection-fourier transform infrared (ATR-FTIR), scanning electron microscope (SEM), thermal gravimetric analysis (TGA), and atomic force microscopy (AFM). The hydrophilic PDMAEMA-block-PAAc-coated catheter was developed with high antibacterial and antibiofilm properties against Escherichia coli and Pseudomonas aeruginosa during 24 and 48 hours and also long-term biocompatibility with L929 fibroblast cells. In this study, a polyzwitterion polymer based on PDMAEMA-block-PAAc was coated on catheters to endow anti-fouling and antibacterial activity, in order to tailor the catheter surface to meet the specific requirements that support further clinical investigations.

Determining the Spiritual Care Needs of Patients with Indwelling Urinary Catheterization: A Cross-Sectional Descriptive Study in Turkey

This study was undertaken to ascertain the spiritual care requirements of patients undergoing indwelling urinary catheterization. Identifying the spiritual care needs of patients with indwelling urinary catheterization is crucial for fortifying their resilience and fostering positive health behaviors. Furthermore, it proves pivotal in devising customized nursing interventions. A descriptive cross-sectional study involving 122 participants (50 female, 72 male) undergoing indwelling urinary catheterization within the inpatient clinics of a state hospital in Turkey was conducted. Data were meticulously gathered through a participant information form and the Spiritual Care Needs Scale. The subsequent analysis employed the Kruskal-Wallis and Mann-Whitney U tests, facilitated by the SPSS 22.0 program. This study adhered to the STROBE recommendations in reporting. The findings indicated that individuals with indwelling urinary catheters exhibit spiritual care needs exceeding the norm, with heightened scores in subdimensions such as meaning and hope, caring, and respect. A statistically significant positive association was identified, revealing a difference in spiritual care needs between women and men. Similarly, a positive association, statistically significant, was observed in the spiritual care needs of patients aged 72–98 compared to those aged 41–71. Furthermore, a positive and statistically significant difference surfaced in the spiritual care needs of patients with long-term indwelling urinary catheters as opposed to those with medium and short-term urinary catheters. Therefore, it is imperative to consider the spiritual care needs of patients undergoing indwelling urinary catheterization.

Novel surface biochemical modifications of urinary catheters to prevent catheter-associated urinary tract infections.

More than 70% of hospital-acquired urinary tract infections are related to urinary catheters, which are commonly used for the treatment of about 20% of hospitalized patients. Urinary catheters are used to drain the bladder if there is an obstruction in the tube that carries urine out of the bladder (urethra). During catheter-associated urinary tract infections, microorganisms rise up in the urinary tract and reach the bladder, and cause infections. Various materials are used to fabricate urinary catheters such as silicone, polyurethane, and latex. These materials allow bacteria and fungi to develop colonies on their inner and outer surfaces, leading to bacteriuria or other infections. Urinary catheters could be modified to exert antibacterial and antifungal effects. Although so many research have been conducted over the past years on the fabrication of antibacterial and antifouling catheters, an ideal catheter needs to be developed for long-term catheterization of more than a month. In this review, we are going to introduce the recent advances in fabricating antibacterial materials to prevent catheter-associated urinary tract infections, such as nanoparticles, antibiotics, chemical compounds, antimicrobial peptides, bacteriophages, and plant extracts.

A study protocol of a comparative mixed study of the T-Control catheter.

Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. T-Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterization by a multifactorial approach. The general purpose of this study is to determine the effectiveness, comfort, and experience of the patient catheterized with T-Control® compared with patients with a conventional Foley catheter. This trial is a mixed-method study comprising a two-arm, pilot comparative study with random allocation to T-Control catheter or traditional Foley catheter in patients with long-term catheterization and a study with qualitative methodology, through discussion groups. The comfort and acceptability of the T-Control® device (qualitative) and the quality of life related to self-perceived health (quantitative) will be analysed as primary endpoints. As secondary endpoints, the following will be analysed: magnitude and rate of infections (symptomatic and asymptomatic); days free of infection; indication of associated antibiotic treatments; determination of biofilm; number of catheter-related adverse events; use of each type of catheterization's healthcare resources; and level of satisfaction and workload of health professionals. Eligible patients are male and female adults aged ≥18 years, who require a change of long-term bladder catheter. The estimated sample size is 50 patients. Patient follow-up includes both the time of catheter insertion and its removal or change 4 weeks later, plus the time until the discussion groups take place.

Long-term catheter management in the community: a population-based analysis of user characteristics, service utilisation and costs in England.

Long-term urinary catheters are problematic and burdensome for patients, carers and health services. Nursing practice to improve the management of long-term urinary catheters has been held back by a lack of evidence to support policy and practice. Little is known about who uses a catheter long term and the resources and costs needed for their management. Understanding these costs will help to target innovations to improve care. There have been no substantial innovations to urinary catheters or their management recently and no publications to characterise users and costs. To describe long-term catheter users and explore catheter-related service use and costs in England. Descriptive information on the characteristics of catheter users and their use of services was obtained from: General Practice records (n = 607), district nursing records (n = 303), questionnaires to patients (n = 333) and triangulated, 2009-2012. Annual service costs (British pounds 2011) were computed. Most catheter users (59.6%) were men, nearly three-quarters (71.2%) were over 70 years and 60.8% used a urethral catheter. Women tended to be younger than men and more likely to use a suprapubic catheter. The services used most frequently over 12 months were general practitioner (by 63.1%) and out of hours services (43.0%); 15.5% accessed Accident and Emergency services for urgent catheter-related care. Hospital use accounted for nearly half (48.9%) of total health service costs (mainly due to inpatient stays by 13.6% of participants); catheter supplies/medications were next most costly (25.7%). Half of all costs were accounted for by 14.2% of users. The median annual cost of services used was £6.38, IQR: £344-£1324; district nursing services added approximately a further £200 per annum. Finding better ways to reduce catheter problems (e.g. blockage, infection) that cause unplanned visits, urgent or hospital care should be a priority to improve quality of life for long-term catheter users and reduce health service expenditure.

Catheter-associated meatal pressure injuries (CAMPI) in patients with long-term urethral catheters-a cross-sectional study of 200 patients.

Indwelling urethral catheters (IDC) are ubiquitous to healthcare settings, and are associated with many familiar risks like haematuria, infections, bladder spasms and stones. However, a less known complication is catheter-associated meatal pressure injury (CAMPI), especially in those with long-term IDCs. The objective of this study was to explore the prevalence, associated features and management of CAMPI in adults with a long-term IDC. A cross-sectional multi-centre study was undertaken of 200 adults with a long-term IDC across regional south-west Queensland, Australia between June 2019 to June 2021. The prevalence of CAMPI was determined by clinical examination, voluntary surveys completed by participants and documentation in medical records. Key IDC statistics included total duration of IDC, location of IDC changes, IDC size, type and fixation. Out of 200 adults with a long-term IDC, 9% (18/200) had a CAMPI. There was a higher prevalence of male CAMPI (17/169, 10%) compared to female CAMPI (1/31, 3%). The median time to identification of a CAMPI after initial IDC insertion was 12 weeks (2-136 weeks), but occurred as soon as 2 weeks. CAMPI formation was associated with IDC changes in the community, impaired mobility and congestive cardiac failure (CCF). CAMPI were mostly treated by conservative means given the frailty of the population. Poor mobility, community-managed IDCs, and CCF were all found to have statistically significant associations with the development of CAMPI. CAMPI represents an important and underserved iatrogenic complication within urology practice, and greater awareness is needed to prevent it in vulnerable patients with long-term IDCs.

Cerebral air embolism following a hemodialysis session successfully treated with hyperbaric oxygen: a case report

We describe here the first case of cerebral air embolism (CAE) due to a dysfunctional long-term central venous catheter for hemodialysis in a 39-year-old woman with a history of lung transplantation. Air emboli are rare but potentially fatal complications of hemodialysis, in particular, when they involve the brain. Early management with hyperbaric oxygen therapy (HBOT) is critical to prevent deterioration of the patient’s condition. In this case, our patient presented her first symptoms, likely a seizure due to multiple cerebral air emboli, during her hemodialysis session. She was then monitored in the Nephrology Intensive Care Unit in accordance to the medical reference center (with HBOT). Twelve hours later, she experienced secondary deterioration, presenting with acute aphasia, left hemineglect syndrome, and hemiplegia. She was rapidly transferred to the medical reference center for HBOT. The patient fully recovered after receiving three sessions of HBOT. She also presented a seizure during each HBOT session, attributed to hyperoxia. She never experienced another seizure after the episode of CAE. This case highlights the importance of considering patients who have a lung transplant to be at increased risk for air emboli during hemodialysis and the need to rapidly recognize symptoms and start treatment, including HBOT, to optimize recovery.

Molecular study of hpmA and ureR genes among Proteus mirabilis isolates inpatient with urinary tract infection

The most frequently occurring human bacterial infections are urinary tract infections (UTIs). P. mirabilis is one of the common causes of UTIs in humans with complicated UTIs, the formation of stones in the kidney, and long-term indwelling catheters. This study aims to isolate, and identify Proteusmirabilis from patients with UTIs using traditional methods and 16s rRNA gene sequencing techniques, as well as detect some virulence genes (hpm A and ureR) in Proteus mirabilis by using polymerase chain reaction (PCR). A total of five isolates of Proteus mirabilis were isolated from patients with urinary tract infections in June 2022. Identification of isolates depends on microscopic and cultural characteristics and traditional biochemical tests, finally, isolates are identified by target gene 16s rRNA using PCR technique, in addition, this study investigates the genes responsible for virulence factors such as hpmA and hpmR.In this study laboratory diagnosis and molecular analysis (16s rRNA gene) revealed that the five isolates are Proteus mirabilis also this study shows the presence of the hpmAgenes by PCR techniques in the isolates 100%. Our study has shown that 16s rRNA was a strong eclectic power and an excellent method for the identification of bacteria also these study frequency ofureR and hpmA in P.mirabilis isolated from UTIs and these genes have a manifest role in the infection.

Breakage and dislocation of the Hickman catheter in pediatric patient

Introduction. The Hickman catheter is a tunneled, open-type catheter often implanted in children for long-term intravenous treatment. Their application can cause numerous complications. Catheter breakage and dislocation of fragments to the intravascular system is a rare but life-threatening condition. When a complication occurs, depending on the patient's clinical condition, the first step is transcutaneous endovascular removal of the catheter's fragment. If this is not possible, surgical thoracotomy is necessary. The objective of this article was to present a case of breakage and dislocation of Hickman catheter in pediatric patient, as well as the diagnostic and therapeutic approach to complications. Case outline. We report a 14-month-old child who had a Hickman catheter because he was undergoing treatment for acute juvenile myelomonocytic leukemia. Due to a malfunction of the catheter, the existing catheter had to be removed. During the surgical procedure, a breakage and dislocation of the catheter fragment occurred. A chest x-ray and an echocardiography confirmed the position of the catheter fragment in the right atrium. A transcutaneous endovascular procedure was successfully performed to remove part of the catheter. Conclusion. Numerous complications can occur during the insertion, management, and removal of long-term catheters. It is necessary to periodically control the catheter's position by chest x-ray and ultrasound of the heart and neck. If a particular complication is detected, an individual approach to treatment with the lowest risk to the patient should be chosen. Dislocated fragments of the Hickman catheter can be safely removed by endovascular transcatheter procedures.

Spontaneous Bladder Perforation in a Patient with a Long-Term Intraurethral Catheter

Spontaneous Bladder Perforation in a Patient with a Long-Term Intraurethral Catheter

A Peculiar Manifestation of Urinary Tract Infection in a 76-year-old Female

Purple Urine Bag Syndrome (PUBS) is a rare and benign clinical phenomenon associated with urinary tract infections, characterized by the distinctive purple discoloration of a urinary catheter bag. The underlying cause of PUBS is related to bacterial activity involved in the breakdown of tryptophan, mainly in individuals with predisposing factors such as long-term catheterization, constipation, alkaline urine, and being female. We present the case of a 76-year-old female patient with a history of tuberculous spondylitis who developed PUBS during her hospital stay. The patient had been bedridden for three years and had been given a urinary catheter, which was routinely replaced by a non-medical family member and without a proper antiseptic procedure. A urine culture revealed the presence of Proteus mirabilis, and the patient was treated with intravenous antibiotics while also replacing the urinary catheter and bag. After five days of treatment, the urine bag and catheter remained clear, and the patient was discharged. PUBS is a significant indicator of urinary tract infection, necessitating prompt medical intervention to prevent complications. Healthcare professionals should be aware of this syndrome to enable early detection and appropriate management.