Prolonged Catheterization Research Articles

Spontaneous Vesicovaginal Fistula in Neurofibromatosis: A Case Report

clinical presentation. It commonly affects the skin and the nervous system. Involvement of the genitourinary system is rare. The bladder is the most commonly affected organ in the urinary system. Vesicovaginal fistula presenting as continuous leakage of urine per vagina is a rare urogenital manifestation of neurofibromatosis which has not been previously reported to the best of our knowledge. Vesicovaginal fistula is not a usual complication of urethral catheterization. Our aim is to report a rare case of vesicovaginal fistula in a patient with neurofibromatosis. Case presentation: We report a case of a 36 year old nullipara with eighteen years history of multiple features of type 1 neurofibromatosis who presented with continuous leakage of urine per vagina of spontaneous onset. Patient had urinary incontinence following which she was catheterized for 18 years but subsequently started leaking urine despite catheterization five months prior to presentation. There were no other known associated predisposing factors. Important findings on examination were paraplegia, multiple neurofibroma, cafe-au-lait spot and bony deformities including scoliosis. Examination in theatre showed vesicovaginal (juxta-urethral) fistula. Abdominal Computerized tomography scan showed left diaphragmatic crural cyst, dextroscoliosis and cholelithiasis. Pelvic CT scan revealed irregular thickening of the bladder wall, uterine leiomyomata and left hemi pelvic deformity/dysplasia with resultant hip dislocation suggestive of neurofibromatosis of bone. Chest Xray noted a soft tissue mass in the posterior mediastinum. She had surgical repair of vesicovaginal fistula using the vaginal approach. Conclusion: The cause of vesicovaginal fistula in this patient with neurofibromatosis is uncertain. However, it may have resulted from bladder neurofibromatosis or prolonged urethral catheterization or both.

English

Urinary catheters are used to relieve urinary retention. Its prolonged use has been associated with poor quality of life (QoL) and psychosocial distress among patients. We sought to evaluate the QoL and prevalence of depressive symptoms among patients on prolonged indwelling urinary catheters. A cross- sectional study of patients with indwelling urinary catheters at an outpatient urology clinic of a tertiary hospital in South west, Nigeria. One hundred and fifty-six patients completed a structured questionnaire. QoL was assessed with adapted quality of life assessment index question of International prostate symptoms score. Patients were screened for depressive symptoms using Patient Health Questionnaire 9(PHQ-9). Bi-variate analysis of QoL with route of urinary catheterization and type of bladder drainage; and correlation of duration of catheterization, QoL and PHQ-9 scores were done using chi- square and Spearman Rank’s correlation respectively with p value at 0.05. All patients were males with urinary retention as the major indication for urinary catheterization. Average duration of catheterization was 21 months. Poor QoL reported in majority of the patients, worse in younger age group and patients on urethral catheters. The prevalence rate of depressive symptoms was 46.1%. A weak negative correlation exists between duration of catheterization and QoL scores; and between duration of catheterization and depressive symptoms; however, strong correlation existed between QoL scores and depressive symptoms. Prolonged indwelling urinary catheter was related with poor QoL worsened in younger age group and those on urethral catheters with a high prevalence rate of depressive symptoms which correlated with the QoL. Key words:  Urinary catheterization, quality of life, depressive symptoms, Nigeria.

Impact of Resident Involvement on Robot-Assisted Radical Prostatectomy Outcomes.

This study examines perioperative outcomes of resident involvement during various steps of robot-assisted radical prostatectomy (RARP). The RARP procedure was divided into seven steps: bladder takedown (BTD), endopelvic fascia, bladder neck (BN), seminal vesicle/vas deferens, pedicle/nerve sparing, apex, and anastomosis. Three hundred seventy-two RARPs performed by a single surgeon were analyzed. Resident console time during each of the seven steps was recorded. Perioperative variables were compared to surgeon-only cases. Residents performed on the console for 232 of 372 cases (62.4%). Estimated blood loss (p = 0.09), transfusion (p = 0.11), and complications (p = 0.33) were no different between surgeon-only and resident-involved cases. Mean operating room time (ORT) was less for the surgeon-only cases (190.4 vs 206.4 minutes, p = 0.003). There was no difference in positive margins (p = 0.79), length of stay (LOS) (p = 0.30), catheter days (p = 0.17), readmission (p = 0.33), or reoperation (p = 0.73) when comparing surgeon-only to resident-involved cases. Residents performing the BN step had no effect on BN margins (p = 0.73) or prolonged catheterization (p = 0.62). ORT was significantly prolonged if BTD was performed by a resident (233.0 vs 191.7 minutes, p < 0.0001). Residents performing anastomosis had no effect on prolonged catheter time (p = 0.62) or LOS (p = 0.20). Residents were more likely to be involved in at least one portion of RARP following the purchase of a Mimic simulator (Mimic Technologies, Inc., Seattle, WA) in January 2012. Supervised resident console involvement in RARP does not affect perioperative outcomes, although, it prolongs ORT, with the BTD step having the most effect on ORT.

Efficacy of continuous epidural block in acute herpes zoster: Incidence and predictive factors of postherpetic neuralgia, a retrospective single-center study.

The aim of the present study was to investigate efficacy of continuous epidural block for prevent postherpetic neuralgia (PHN) progression in cases of acute herpes zoster with severe pain and also to identify predictive factors for PHN in such conditions.We retrospectively analyzed the clinical data of patients with herpes zoster who underwent continuous epidural block between March 2013 and October 2015. Time points were set as 1 month, 3 months, and 6 months after zoster onset. PHN was defined as the presence of pain with NRS ≥3 at certain time points.The incidence of developing PHN was 38.1%, 27.0%, and 19.0% 1 month, 3 months, and 6 months after zoster onset, respectively. Age and duration of catheterization were predictive factors for PHN at 1 month. Age, duration of catheterization, and NRS at first visit were identified as predictive factors for PHN at 3 months. Presence of diabetes, duration of catheterization, and NRS during catheterization were significant predictive factors for PHN at 6 months.The incidence of PHN is higher in zoster patients with severe pain that requires continuous epidural block compared to incidence in the general population. Advanced age and severe initial pain intensity were predictive factors of PHN development. Prolonged catheterization resulting from weak response to treatment strongly suggested progression to PHN.

Retrograde pericatheter urethrography (RPU) technique and its clinical use after urethroplasty: A single center experience

ObjectiveTo describe our technique of retrograde pericatheter urethrography (RPU) and its clinical use after urethroplasty. Subjects and methodsBetween January 2008 and December 2013, 387 patients with urethral stricture underwent urethroplasty at our center. A total of 343 of these patients underwent RPU 3 weeks post-operatively. For this retrospective study their files were evaluated with regard to: demographics, duration of symptoms, site, mean length of stricture, type of surgery, RPU findings, contrast-medium related complications and need of re-intervention. The eventual surgical success was defined as asymptomatic voiding with no clinical evidence of residual stricture (good flow rate and no residual urine) until the last follow up. ResultsFollow up ranged from 8 to 41 (mean 28) months. The mean duration of symptoms was 4.8 months. The mean stricture length, as seen on radiography, was 2.1cm. 183 patients (53.3%) underwent anastomotic urethroplasty, while 160 (46.6%) underwent substitution urethroplasty. RPU showed urethral healing in 292 (85.2%) and contrast extravasation in 51 (14.8%) patients. No contrast-medium related complications were reported. Re-intervention was needed in 7.2% (21/292) of the patients who showed normal urethral healing and in 74.5% (38/51) of the patients who showed contrast extravasation on RPU. By the time of the last follow up the overall success rate was 82.7% (284/343 patients). ConclusionRPU is the most useful radiological diagnostic method for evaluating the appropriate time for catheter removal after urethroplasty. It helps to assess urethral healing and patency after urethroplasty. Prolonged catheterization in patients showing contrast extravasation may be helpful.

Video-based Assessment of Peripheral Intravenous Catheter Insertion in the Resuscitation Area of a Pediatric Emergency Department.

The objective was to describe the frequency of and factors associated with prolonged peripheral intravenous catheter (PIV) insertion in the resuscitation area of a pediatric emergency department (PED). Video-based study of a consecutive sample of nontrauma patients undergoing PIV insertion in the resuscitation area of a PED. Preexisting videos were the main data source. The primary outcome was patients with prolonged duration of PIV insertion (>90 seconds from start of first attempt to successful flush/blood draw). Logistic regression identified variables independently associated with prolonged PIV insertion. A total of 151 consecutive nontrauma patients underwent PIV insertion during a 2.5-month period. Sixty-nine patients (46%) had prolonged PIV insertion, including 14 for whom PED providers failed to insert PIVs. For patients with successful PIV insertion by PED providers, median duration was 48 seconds (interquartile range [IQR] = 23 to 295 seconds). Vascular access was ultimately achieved for 13 patients (93%) with initial insertion failure by the PED team (10 non-PED personnel, three intraosseous lines), with a median duration of 26.7 minutes (IQR = 19.9 to 34.2 minutes). Age ≤ 2 years (ORadj = 6.9; 95% confidence interval [CI] = 2.9 to 16.1) and musculoskeletal contractures (ORadj = 5.3; 95% CI = 1.6 to 17.2) were independently associated with prolonged PIV insertion. Prolonged PIV insertion is common in a PED resuscitation area. When PED providers could not insert a PIV, time to insertion was very long. Young patients and those with contractures were at particular risk for prolonged and failed PIV placement. When emergent vascular access is required, alternative approaches should be considered early for these patients.

MP11-02 IMPACT OF RESIDENT TRAINEE INVOLVEMENT ON ROBOT ASSISTED RADICAL PROSTATECTOMY (RARP) OUTCOMES.

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2016MP11-02 IMPACT OF RESIDENT TRAINEE INVOLVEMENT ON ROBOT ASSISTED RADICAL PROSTATECTOMY (RARP) OUTCOMES. Eric Schommer, Kolbi Tonkovich, Zhou Li, and David Thiel Eric SchommerEric Schommer More articles by this author , Kolbi TonkovichKolbi Tonkovich More articles by this author , Zhou LiZhou Li More articles by this author , and David ThielDavid Thiel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2373AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study examines peri-operative outcomes of RARP and their association with resident trainee involvement in different steps of RARP. METHODS RARP was divided into 7 steps: bladder takedown (BTD), endopelvic fascia, bladder neck (BN), seminal vesicle/vas deferens (sv/vas), pedicle/nerve sparing, apex, and anastomosis. 372 RARP performed by a single surgeon from July 2007 to February 2015 were analyzed. Resident console time (RCT) during each of the 7 key steps was recorded. Peri-operative variables were compared between surgeon-only (SO) and resident-involved (RI) cases. Vital outcomes of trainee performance on the key steps were compared using two sample t-test or Wilcoxon rank sum test. RESULTS Residents performed on the console for 232 of 372 cases (62.4%). Preoperative BMI (mean 28.4), PSA (mean 6.7), Gleason score (6-7 88.7%, 8-10 11.3%), ASA score (mean 2.4), AUA score (mean 8.9) and SHIM score (mean 15.9) were similar between SO and RI cases. 2nd year resident status (P <0.0001) and pre-operative PSA > 10 (P=0.0093) were associated with no RCT. Estimated blood loss (P=0.09), transfusion (P=0.11), and complications (P=.33) were no different between SO and RI cases. Mean OR time (ORT) was less for the SO cases (190.4 vs. 206.4 min, P=0.003). There was no difference in positive margins (P=0.79), length of stay (LOS) (P=0.30), catheter days (P=0.17), readmission (P=0.33), reoperation (P=0.73), home with drain (P=0.88), or undetectable 6 month PSA (P=0.07) when comparing SO to RI cases. Residents performing BN step had no effect on BN margins (P=0.73), prolonged catheterization (P=0.62), home with drain (P=0.4121), or 6 month undetectable PSA (P=0.1070). ORT was not affected by resident performing anastomosis (P=0.08) or sv/vas (P=0.82), but was significantly prolonged if BTD performed by trainee (233.0 vs. 191.7min, P <0.0001). Residents performing anastomosis had no effect on prolonged catheter time (P=0.62), home with drain (P=0.41), or LOS (P=0.20). Residents were more likely to be involved in at least one portion of the case (74.0% vs. 56.6%, P=0.0012), in BN (63.4% vs. 30.6% P <0.0001), and anastomosis (48.0% vs. 15.3%, P <0.0001) following purchase of Mimic simulator (Mimic Technologies, Inc., Seattle, WA, USA) in January 2012. CONCLUSIONS Supervised RCT in RARP does not negatively affect peri-operative patient outcomes although it prolongs ORT compared to SO cases with the BTD step adding the most operative time. The acquisition of a robotic simulator appears to have increased RCT in various steps of RARP. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e111 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Eric Schommer More articles by this author Kolbi Tonkovich More articles by this author Zhou Li More articles by this author David Thiel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

8: Use of suprapubic carter-thomason needle to assist in cystoscopic excision of intravesical foreign object

We present a video of a minimally-invasive technique using the Carter-Thomason Needle Suture Passer for suprapubic assistance in the cystoscopic removal of the intravesical eroded suture. Suture injury to the bladder occurs in 0.6% of cases of retropubic bladder neck suspension procedures (1). These injuries can occur from inadvertent placement of the sutures through the bladder at the time of surgery or postoperative erosion or migration of the sutures into the bladder, and can lead to chronic inflammatory reaction in the wall of the bladder and stone formation. Common symptoms are of urinary frequency, urgency, urinary tract infection, voiding difficulty and pelvic pain. Intraoperative cystoscopy detects some, but not all, suture bladder injuries. It is therefore important to exclude intravesical foreign body in patients with lower urinary tract symptoms and a history of bladder neck suspension. We describe a case of a 63 year old woman with symptoms of recurrent urinary tract infections, urinary frequency, urgency, hesitancy, dysuria, microscopic hematuria and pelvic pain. She underwent a ‘bladder suspension’ 23 years prior for stress urinary incontinence, which she reported as being uncomplicated. Pelvic ultrasound demonstrated a 2cm bladder calculus. Office cystoscopy revealed a 3cm stone-encrusted suture erosion of the bladder. The use of a Carter-Thomason Needle Suture Passer for suprapubic assistance in the cystoscopic removal of intravesical suture is a minimally invasive surgical technique that can be applied to removal of other foreign objects, such as mesh. Compared to suprapubic trocars, prolonged catheterization and follow-up cystogram are not necessary.

19: Predictors of early postoperative voiding dysfunction and other complications following a midurethral sling

Identify preoperative predictors for failed voiding trial (VT) following isolated midurethral sling (MUS). Following IRB approval, we performed a comparative study on a retrospective cohort including all isolated MUS procedures performed between 1/1/10 to 6/30/15 at 5 academic centers. We collected demographics, medical and surgical histories, voiding symptoms, urodynamic evaluation (UDE), type of MUS and surgical time from the medical record. We excluded intraoperative complications requiring prolonged catheterization. Cases failed a postoperative VT and were discharged with an indwelling catheter or taught intermittent self-catheterization (ISC); controls passed a VT. We also recorded any adverse events such as UTI or voiding dysfunction up to 6 weeks after surgery. Bivariate analyses were completed using Student’s t-test or Mann-Whitney and Pearson chi-square as appropriate. Multivariate stepwise logistic regression was used to determine predictors of failing a VT. Four hundred two patients had an isolated MUS (317 retropubic, 82 transobturator, 3 single-incision); 22.4% failed the initial VT. At follow-up visits, 90.5% passed a second VT, and 41.7% of the remainder passed on third attempt. Bivariate analyses: Prior prolapse or incontinence surgery was similar between cases and controls (24% vs 20%, p=0.347) as were age, race, BMI, and operative time. Sense of incomplete emptying prior to surgery was noted in 33% vs 26%, p= 0.204, and recurrent UTIs were reported by 14% vs 10%, p=0.297. Overactive bladder symptoms and urge incontinence were similar in both groups, but detrusor overactivity (DO) was more common in cases (32% vs 23%, p=0.088). Mean(SD) bladder capacity was similar in both groups [406(148)mL vs 385(121)mL, p=0.203] as was max flow with uroflowmetry (UF) and pressure flow studies (PFS). Postvoid residual (PVR) with UF was 28.5(49.3)mL vs 19.2(29.1)mL, p=0.126; and on PFS was 61.6(133.8)mL vs 35.8(68.8)mL, p=0.112. Cases were significantly more likely to have a voiding type other than detrusor contraction: 41% vs 29%, p=0.044, OR 1.72 (95% CI: 1.01-2.93). There was no difference in VT failures between retropubic and transobturator routes (22% vs 24%, p=0.656). Within 6 weeks of surgery, the frequency of UTI in cases was greater than controls [22.1% vs 7.6%, p<0.001; OR 3.45 (1.78 to 6.70)]. After passing a repeat VT, cases were more likely to present with acute urinary retention [11.8% vs 3.3%, p=0.004; OR 3.91 (1.57-9.73)]. Multivariate analyses: In women with complex UDE (84% of patients), presence of DO (p=0.037, OR 1.85, 1.04-3.28) and increased PVR on PFS (per 10mL increase, OR 1.03, 1.003-1.058) predicted increased likelihood of VT failure. We did not identify any demographic or historical information among patients who did not undergo UDE that reliably forecasted VT failure. The majority of women will pass a VT on first attempt after isolated MUS. Presence of DO or increasing PVR on PFS predicted increased probability of failing initial VT while demographic and other findings were not predictive. Patients failing the initial VT are at increased risk of postoperative UTI or developing acute retention after passing a subsequent VT.

Knowledge of Infection Related to Prolonged Catheter among the B.Sc Nursing Students of Hi-Tech College of Nursing

Knowledge of Infection Related to Prolonged Catheter among the B.Sc Nursing Students of Hi-Tech College of Nursing

Heparin-bonded expanded polytetrafluorethylene grafts in hemodialysis access.

When options for autologous arteriovenous (AV) fistulas have been fully exhausted, AV grafts continue to play an important role in access creation for hemodialysis, offering long-term hemodialysis access that is a better alternative to central vein catheters. The drawbacks of AV grafts are their poor patency, infection and higher cost. Their main advantages are that they are widely available, are easy to create, and mature early. In the context of the "Fistula First" initiative, many patients with low quality veins suffer from fistula failure and non-maturation resulting in prolonged catheter days that would otherwise be prevented by initial creation of an AV graft. Endeavors to improve graft patency include administration of pharmacological agents, changing graft configuration, altering graft biology, and altering the graft surface. In this review, the current status of heparin-bonded AV grafts for hemodialysis is discussed.

Clinical Manifestation, Diagnosis, and Surgical Treatment of Chronic Radiation Ulcers Related to Percutaneous Coronary Intervention.

Chronic radiation ulcers that develop after cardiac catheterization have become common recently because of the rapid increase in the use of diagnostic and interventional cardiac catheterization procedures. However, their diagnosis and treatment remain difficult. We encountered 10 patients with National Cancer Institute grade 4 radiation ulcers related to prolonged percutaneous coronary intervention. Data of these 10 patients, including clinical presentations and treatments, were collected and analyzed. A quality-of-life questionnaire was administered to the patients preoperatively and postoperatively. Most of the lesions (8/10 patients) were located on the back. All of the patients received prolonged cardiac catheterization lasting for more than 3 hours, at least once, and all of the coronary artery lesions showed chronic total or near-total occlusion. The surgical procedures included complete resection of the lesion followed by fasciocutaneous flap coverage (9/10) or skin grafting (1/10). The mean ± SD follow-up time was 23.3 ± 19.79 months, and the wounds in all the patients healed well without complications. After the surgery, the symptoms reduced and the quality of life improved significantly according to the scores in the quality-of-life questionnaire. In conclusion, the early diagnosis of chronic ulcers related to prolonged percutaneous coronary intervention depends on careful history taking and a highly suspicious clinical presentation. For National Cancer Institute grade 4 radiation ulcers, complete resection and immediate reconstruction with flaps or grafts may improve the symptoms and achieve reliable wound coverage without complications.

Is ERAS in laparoscopic surgery for colorectal cancer changing risk factors for delayed recovery?

There is evidence that implementation of enhanced recovery after surgery (ERAS) protocols into colorectal surgery reduces complication rate and improves postoperative recovery. However, most published papers on ERAS outcomes and length of stay in hospital (LOS) include patients undergoing open resections. The aim of this pilot study was to determine the factors affecting recovery and LOS in patients after laparoscopic colorectal surgery for cancer combined with ERAS protocol. One hundred and forty-three consecutive patients undergoing elective laparoscopic resection were prospectively evaluated. They were divided into two subgroups depending on their reaching the targeted length of stay—LOS (75 patients in group 1—≤4 days, 68 patients in group 2—>4 days). A univariate and multivariate logistic regression analysis was performed to assess for factors (demographics, perioperative parameters, complications and compliance with the ERAS protocol) independently associated with LOS of 4 days or longer. The median LOS in the entire group was 4 days. The postoperative complication rate was higher (18.7 vs. 36.7 %), and the compliance with ERAS protocol was lower (91.2 vs. 76.7 %) in group 2. There was an association between the pre- and postoperative compliance and the subsequent complications. In uni- and multivariate analysis, the lack of balanced fluid therapy (OR 3.87), lack of early mobilization (OR 20.74), prolonged urinary catheterization (OR 4.58) and use of drainage (OR 2.86) were significantly associated with prolonged LOS. Neither traditional patient risk factors nor the stage of the cancer was predictive of the duration of hospital stay. Instead, compliance with the ERAS protocol seems to influence recovery and LOS when applied to laparoscopic colorectal cancer surgery.

Challenges in the Caesarean Section of a Severely Kyphotic Parturient.

Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful.

Predictors for Voiding Trial Failure after Minimally Invasive Sacrocolpopexy

Introduction: Catheter associated urinary tract infections (CAUTIs) due to indwelling catheters pose a serious health and financial burden in the US. Patients who undergo reconstructive pelvic surgery experience postoperative voiding dysfunction at a significant rate, requiring prolonged catheterization. The preoperative identification of patients at highest risk of failing a backfill trial of void (TOV) would allow for selected instruction in self-catheterization techniques and minimize the prevalence in dwelling catheters. Objective: To identify predictors for voiding trial failure after minimally-invasive (laparoscopic or robot-assisted) sacrocolpopexy for surgical correction of prolapse in patients who did not undergo a concomitant urinary anti-incontinence procedure. Methods: All subjects undergoing minimally-invasive sacrocolpopexy without concomitant anti-incontinence surgery from October 2006 to July 2010 at our institution were included. Patient characteristics including basic demographics, medical and surgical history, operative characteristics, and baseline preoperative urodynamic testing were included. The data was analyzed with logistic regression for continuous variables and Pearson chi-squared test for dichotomous variables (Stata IC-13). Results: 56 subjects were identified. Of those, 5 subjects (8.9%) failed a postoperative voiding trial. No significant association between examined variables and failure of trial of void were observed. Concomitant vaginal surgery approached significance with a p-value of 0.058. Conclusion:The percentage of subjects that failed a voiding trail was comparable to that described in the minimally invasive literature. Providers should educate all patients undergoing minimally invasive sacrocolpopexy as to self-catheterization techniques given the inability to identify preoperative risk factors.

Lower Extremity Vascular Access in Neonates and Infants: A Single Institutional Experience

PurposeTo demonstrate feasibility and evaluate outcomes of direct-stick saphenous and single-incision tunneled femoral noncuffed central venous catheters (CVCs) placed in a large series of neonates and infants at a single institution. Materials and MethodsA retrospective review was performed for all neonates and infants receiving a lower extremity CVC by interventional radiology between 2007 and 2012. Technical success, mechanical and infectious complications, and catheter outcomes were recorded. ResultsThere were 271 primary insertions performed in 243 children by interventional radiologists in the interventional radiology suite or at the bedside. CVCs were placed via the femoral vein with single-incision technique (84.9%) or the saphenous vein via a direct-stick technique (15.1%), with a technical success rate of 100%. The total number of catheter-days was 7,917 days (median, 19 d; range, 0–220 d). The number of primary catheter-days was 5,333 days (median, 15 d; range, 0–123.0 d), and salvage procedures prolonged catheter life by 2,584 days (median, 15 d; range, 1.0–101.0 d). The mechanical and adjusted infectious complication rates were 1.67 and 0.44 per 100 catheter-days. ConclusionsImage-guided placement of saphenous or tunneled femoral catheters using a single incision is a safe and feasible method for vascular access in neonates and infants.

Increase in catheter associated urinary tract infections in intensive care units at a tertiary care centre: a cause of concern

Aim: Health-care associated infections (HAIs) affect 5-20% of patients admitted in the hospitals. Catheter-associated urinary tract infections (CAUTI) are the commonest HAIs accounting for about 35-45% of these nosocomial infections due to lack of aseptic procedures and prolonged catheterization. The spectrum and antimicrobial resistance pattern of micro-organism that cause CAUTIs vary among institutions and can change from year to year. Materials and Methods: A retrograde analysis was performed on patients with indwelling catheters admitted in medical and surgical ICU. The patient’s demographic details (name, age,sex), date of hospital admission, provisional diagnosis, treatment details, time and date of catheter insertion and removal were recorded as per CDC criteria. CAUTI was diagnosed as per CDC guidelines. Results and Conclusions: A total of 687 patients were catheterized in ICU for an aggregate of 2748 patient days. The device utilization rate was 0.66. The prevalence of CAUTI per 1000 device days was 8.73.The causative uropathogens included Candida , E.coli , Enterococcus spp . A high degree of resistance was observed in all the isolates. There is a need to introduce appropriate measures aimed at proper use of catheters, to organise more frequent suitable personnel training and emphasis on hand washing procedures.

Clinical Manifestation, Diagnosis, and Surgical Treatment of Chronic Radiation Ulcer Related to Percutaneous Coronary Intervention

INTRODUCTION: Chronic radiation ulcers that develop after cardiac catheterization had become more common nowadays because of the rapid increase in the use of diagnostic and interventional cardiac catheterization procedures1-3. However, diagnosis and treatment remain difficult. MATERIALS AND METHODS: We present 10 patients with National Cancer Institute (NCI) grade 4 radiation ulcers related to prolonged percutaneous coronary interventions. Collected data, including clinical presentations and treatments, were analyzed. A quality-of-life questionnaire was scored by patients preoperatively and postoperatively. RESULTS: Most of the lesions (8/10 patients) were located at the back. All of the patients received prolonged cardiac catheterization of more than 3 hours, at least once. The coronary artery lesions all included chronic total or near-total occlusion. The surgical procedures were complete resection of the lesion followed by fasciocutaneous flap coverage (9/10) and skin grafting (1/10). The mean follow-up time was 23.3 months. All of the wounds healed well without complications. After the operation, the symptoms were relieved and quality of life improved significantly according to the scoring of the quality-of-life questionnaire (Figures 1 and 2).Figure 1: Left elbow lesion in case 5.Figure 2: En bloc excision of the lesion and pedicled forearm fasciocutaneous flap reconstruction.CONCLUSION: Early diagnosis of chronic ulcers related to prolonged percutaneous coronary interventions relies on careful history taking and highly suspicious clinical presentation. Complete resection and immediate reconstruction with flaps or grafts for NCI grade 4 radiation ulcers achieved improved symptomatology and reliable wound coverage without complications.

Therapeutic strategy for taking care of perineal pressure ulcers in spinal cord injury (SCI) patients

The perineal pressure ulcer is, from the outset, a serious bedsore as it exposes the patient to the risk of fistula in addition to the regular complications associated with bedsores. Treatments reported in the literature couple recovery by musculocutaneous flap combined either with urethroplasty or urinary diversion [1] , without decision-making criteria. The objective of this study is to analyze the management of perineal pressure ulcers in SCI patients and suggest a suitable therapeutic strategy. Retrospective, observational study of a group of SCI patients picked up at the Garches hospital and in the urology department at the Pitié-Salpêtrière, between 2002 and 2014. The study includes 20 patients, of which 15 show urethrocutaneous fistula. Following a musculocutaneous flap combined or not with an urethroplasty, but without joint urological care, no patient recovered. None of the two urethral reconstructions have helped to heal the bedsores or enabled the reuse of urethra for self-catheterization. After cystoprostatectomy and Bricker, only 2 out of 15 patients relapsed, given a follow-up period between 1 and 6 years. Like any pressure ulcer, the treatment of perineal pressure ulcer requires a careful evaluation of the circumstances of occurrence and risk factors (history of ischiectomy, proximal hip removal, prolonged indwelling catheter), and a neuroperineal (bladder balance and voiding mode), skin, nutrition, neuro-orthopedic, seat, and socio-psychological assessment. In the presence of urethrocutaneous fistula, a urinary diversion seems absolutely necessary: usually a non-continent bypass with cystoprostatectomy and Bricker which remains surgically heavy and may negatively affects self-image exceptionally, a continent diversion may be considered with closure of the bladder neck. The urethroplasty by experienced urologists associated with bedsores surgery could have been discussed but was not be performed for technical reasons (surgeries on 2 different hospitals). In the absence of fistula, but the presence of chronic perineal maceration with bad management of bladder, trans-ileal cutaneous ureterostomy with cystoprostatectomy ensures the complete drying of the perineum.

The dynamics of biofilm overgrowth of Enterococcus faecalis

The nature of microorganisms can exist in two physiological forms that allow microbes to preserve livelihoods and continue their life cycle. The first is the population of planktonic forms of microorganisms which live freely in the environment with the developed systems of active and passive mobility, contributing to the rapid spread of a liquid medium. The second forms are those expressing specific mechanisms of adhesion, and able to aggregate on biogenic and abiogenic surfaces. Even in the deep sea vast number of species of bacteria live in their inherent horizons. Thus, the study of biofilms tube life support systems, diagnostic, laparoscopic devices during prolonged catheterization of the urinary system is of great practical, theoretical and biological significance in medicine and biology. For almost 20% of catheter-associated infections antibiotic therapy is uneffective, particularly through the formation of microbial biofilms on the surface of urinary catheters. We characterized the dynamics of biofilm growth of Enterococcus faecalis on fragments ofsilicone catheter. The study was conducted using bacteriological and electron microscopic techniques. Study of the dynamics of biofilm formation was performed using E. faecalis strain 49, which is isolated from the urine of persons who are not the patients of the urological department of resuscitation and intensive therapy. Using scanning electron microscopy we have established dynamics and phase attachment ofE. faecalis bacteria and subsequent overgrowth of silicone catheter surface. Aftercalculations, index of adhesion on the turbulent wall amounted to 0,49 microbial cells. That is, every other cell of the monolayer adhered on the catheter. Area of biofilm growth of E. faecalis after 24 hour incubation was equal to 51.5 μm2, in 48 hours it increased to 231.5 μm2. After 72 hours of incubation we recorded the increase in biofilm growth of E. faecalisto 1922,8 μm2. The results were obtained on fragments of catheters, immersed in broth in vertical position. This orientation has excluded the deposition of germs by sedimentation, i.e. by gravity. It is known that after the logarithmic phase and achieving M-concentration for a few hours microbes starttodie and their possible deposition mayoccur. Therefore, our results confirm the formation of biofilm, instead of sedimentation of dead microbes. Our study shows that biofilm is “the way of overgrowth on artificial and natural surfaces by microorganisms that are kept on them by exopolymer membranes”.