Prolonged Catheterization Research Articles

The use of Jackson-Pratt silicone flat drains as prolonged pleural catheters for the management of pleural effusions.

Imbalance between secretion and absorbtion of pleural fluid results in pleural effusion. Emergence of pleural effusion ipsilateral or contralateral to the side drained previously is named recurrent effusion. There is currently no standart approach for the management of recurrent pleural effusions. Eighteen patients, treated between 2011 and 2012 for recurrent pleural effusions due to various etiologies, not considered for surgical or other treatments, and underwent placement of prolonged pleural catheters (Jackson-Pratt drain) were included in this study. Twenty two prolonged pleural catheters were inserted in 18 patients. There were 10 females and 8 males, with mean age 59 (35-77). In 20 patients the catheters were inserted by an anterior approach, and by a posterior approach in one patient. Daily drainage above 1,500 mL was not permitted in order to avoid pulmonary edema. Catheters were removed in patients who had lung expansion and drainage under 50 mL/day. The most common etiology for pleural effusions was extrathoracic malignancy in 9 patients, primary bronchial carcinoma in 5 patients, and benign pleural effusion in 4 patients. Four patients underwent bilateral prolonged pleural catheter insertion. The catheters were retained for a mean period of 19 (10-40) days. Pleural effusion recurred two months after removal of the catheter in one patient with primary bronchial cancer (5%). Only one patient developed a complication (empyema) while under drainage (5%). Two patients died while the catheter was in place. Decreased length of stay and lower costs have enabled prolonged are the major advantages of pleural catheter applications in appropriate patients compared to other treatment methods. We believe that the Jackson Pratt silicone flat drains provide effective pleurodesis along with easy application, and suggest their use as an alternative to pleurodesis in especially malignant pleural effusions and not benign pleural effusions.

Central venous catheter-related blood stream infections in neonatal care unit

Objective: The aim of this study was to detect the rate of catheter-related bloodstream infection (CRBSI) in NICU of Mansoura University Children's Hospital and to focus on possible predictors of infection. Study Design: A cross sectional comparative study to detect rate of CRBSI among neonates with central vascular catheters during the period between January 2009 and April 2012. Then, a nested case control study done among CRBSI cases and central vascular catheters none infected as a control group to detect predictors associated with their occurrence. Patients and Methods: Blood samples were collected from 111 neonates clinically suspected of septicemia and had inserted venous line. Central, peripheral blood and catheter tip cultures were done for each case. Results: CRBSI was confirmed in 69 cases as central blood culture count was ˃ 3 folds of peripheral blood culture count. Catheter tip culture showed ˃ 103 CFU/ ml per catheter of the same organisms. Low birth weight, age below 7 days, prematurity, mechanical ventilation, TPN administration and prolonged hospital stay were predictors of CRBSI. Logistic regression of the studied predictors showed that birth weight, TPN administration and length of central venous catheter stay were significant predictors of CRBSI. Conclusion: CRBSI is a common problem in NICU. Predictors of CRBSI included low birth weight, prematurity and mechanical ventilation. Potential use of TPN, prolonged catheter stay and low birth weight are independent predictors for CRBSI.

Central venous catheter-related blood stream infections in neonatal care unit

The aim of this study was to detect the rate of catheter-related bloodstream infection (CRBSI) in NICU of Mansoura University Children’s Hospital and to focus on possible predictors of infection. A cross sectional comparative study was performed to detect the rate of CRBSI among neonates with central vascular catheters during the period between January 2009 and April 2012. Then, a nested case control study done among CRBSI cases and central vascular catheters none infected as a control group to detect predictors associated with their occurrence. Blood samples were collected from 111 neonates clinically suspected of septicemia and had inserted venous line. Central, peripheral blood and catheter tip cultures were done for each case. CRBSI was confirmed in 69 cases as central blood culture count was more than 3 folds of peripheral blood culture count. Catheter tip culture showed more than 103 CFU/ ml per catheter of the same organisms. Low birth weight, age below 7 days, prematurity, mechanical ventilation, TPN administration and prolonged catheter stay were predictors of CRBSI. Logistic regression of the studied predictors showed that birth weight, TPN administration and length of central venous catheter stay were significant predictors of CRBSI. CRBSI is a common problem in NICU. Predictors of CRBSI included low birth weight, prematurity and mechanical ventilation. Potential use of TPN, prolonged catheter stay and low birth weight are independent predictors for CRBSI.

P267: Current aspects of acquired infection in maternity Issaka Gazobi hospital – Niamey, Niger

Results After analyzing the data, it appears that: The prevalence of nosocomial infections was 7.2%, including 0.7% of endometritis, urinary tract infection 0.7% and 5.8% of surgical site infection distributed as follows: 3.5% and 2.2% of deep and superficial infections respectively. Nearly eight out of 10 patients were from the urban community of Niamey and 70% of infected patients are housewives. Prolonged urinary catheterization, as well as antibiotic misuse were the main contributing factors. In newborns, the prevalence of nosocomial infections was 5% of which 1.4% were skin infections and 3.6% eye infections, no umbilical cord infection was recorded. The mortality rate of newborns was 14.4%. Nosocomial infections are and remain a public health problem.

Does prolonged urinary catheterisation following labour epidural analgesia delay discharge?

Does prolonged urinary catheterisation following labour epidural analgesia delay discharge?

Nerve-oriented mesorectal excision (NOME): autonomic nerves as landmarks for laparoscopic rectal resection

We have developed nerve-oriented mesorectal excision (NOME) as a novel concept in rectal cancer surgery by which autonomic pelvic nerves serve as landmarks for a standardized navigation along fascial planes. This article describes the technique step by step and presents our results from 2008 to 2012. The key steps are: preparation of the splanchnic nerves at the mid-posterior sidewall, the hypogastric nerves at the upper sidewall, and the urogenital nerve branches (Walsh) at the caudal-anterior sidewall. The dissection of the lateral ligament is strictly performed as the last step. NOME was applied in 274 consecutive mesorectal excisions (partial 20.4%, total 79.6%); a subgroup of 42 male patients underwent a questionnaire-based interview on sexual activity. The conversion rate was 0.7%. High (complete) specimen quality and circumferential margin negativity were achieved in 90.1% and 95.3%, respectively. Anastomotic leaks occurred in 13 (4.7%) patients. Mortality was 1.8%. The frequency of prolonged urinary catheter was 1.8%. Of 22 sexually active males interviewed, 18 (81.8%) maintained activity postoperatively. NOME achieves high-quality mesorectal specimens and a high rate of preservation of autonomic nerve function. The concept of using nerves as laparoscopic landmarks may help to standardize and master laparoscopic rectal cancer surgery.

4:18 PM Abstract No. 51 - Single-incision technique for internal jugular vein tunneled vascular access in the pediatric population

Purpose To describe the technical success and outcomes of a single incision technique for placement of internal jugular (IJV) tunneled vascular access devices in children. Materials and Methods A retrospective 4 year review was performed of 15 children (8 males, 7 females) who underwent placement of single incision IJV tunneled vascular access catheters. The single incision technique was defined as utilizing one incision with an ultrasound guided long needle tunneled venipuncture to create both the subcutaneous tunnel and the venous access. Radiologic and medical records were reviewed for technical success, early and delayed mechanical and infectious complications. The mean age of the children was 11.0 yrs (range 1.0 - 18.7) and the mean weight was 44.2 kg (range 9.6 - 99.0). Indications for the vascular access as per SIR criteria included; TPN and medications (8), antibiotic therapy (5), chemotherapy (2), immunotherapy (1), and dialysis (1). Results 17 primary insertions were performed in 15 patients. Technical success was 100%. Catheter types included non cuffed central line (14), cuffed hemodialysis catheter (1), cuffed central line (1), and a port (1). One catheter was placed in 14 patients and 3 catheters in 1 patient. There were no procedure related complications. The mean fluoroscopy time was 5.3 mins (0.7-14.7). The total catheter days for initial insertions was 1265 catheter days (mean 74.4 days, range 3 - 502 days). Mechanical and infectious complications occurred at a rate of 0.29 and 0.14 per 100 total catheter days respectively. The rate of removal for mechanical and infectious complications was 0 and 0.07 per 100 total catheter days respectively. Non-IR salvages (tPa) (75% of salvages), and IR salvages (25% of salvages) prolonged catheter days by an average of 28.5 days (range 10 - 81 days). Three catheters were still in use at the end of this study. Conclusion Radiologically guided single-incision technique is a safe and technically feasible method for insertion of central venous access devices in pediatric patients. Placing them in children has appeal when the conventional double-incision technique may be challenging, such as in those with a tracheostomy.

Prolonged use of indwelling urinary catheter following acute urinary retention in a tertiary care centre in sub-Saharan Africa: Causes, costs and concerns

ObjectivesTo evaluate the causes, estimate out-of-pocket payments and assess concerns associated with prolonged use of urinary catheters following acute urinary retention secondary to benign prostate enlargement (BPE) and urethral stricture disease (USD) in men attending the urology out-patient clinic of a tertiary referral centre in North-central Nigeria. Patients and methodsThis was a cross-sectional survey of men attending urology clinic and who are using indwelling urinary catheter for >3 months following acute urinary retention due to BPE or USD. The study was conducted over a six-month period (1st March 2012 to 31st August 2012) at a tertiary hospital in North-central Nigeria using interviewer administered questionnaires. ResultsOf seventy-six men, 36/76 (47.4%) had BPE and 40/76 (52.6%) had USD. Median age, median duration of catheter use and median out-of-pocket payment per catheter change was 65 years (range 20–90 years), 12 months (range 3–120 months) and US$9.31 (range $3.63–18.75) respectively. There was no significant difference in the duration of catheter use and out-of-pocket payments between men with BPE and USD; however, men with USD were significantly younger than those with BPE.One-fifth and half of the men with BPE and USD, respectively attributed inability to pay for surgery as the reason for prolonged use of catheters. The second common reason was long waiting list for surgery. Men with BPE had their sexual relationships disrupted significantly more than those with USD and unexpectedly, we found that men using catheters for less than 6 months describe themselves as unhappy significantly more than those using the catheters for longer periods (p=0.033). ConclusionsInability to pay for definitive surgery and long waiting lists are the leading causes of prolonged use of indwelling urinary catheters in men with BPE and USD in our sub-Saharan setting. Prolonged catheter use adversely affected quality of life disrupting sexual relationships especially of men with BPE. Recommendations made to reduce out-of-pocket payments and shorten waiting times may help to improve access to urologic surgical care for these men.

Prospective study of transobturator mesh kit (Prolift™) in pelvic reconstructive surgery with vaginal hysterectomy after 3 years’ follow-up

This study is to analyze prospectively the anatomical and functional outcomes of transvaginal pelvic reconstructive surgery using the Prolift™ system for pelvic organ prolapse (POP) with hysterectomy. A prospective, observational, noncomparative study was conducted in 80 patients with prolapse ≥ 2. Postoperative pelvic organ prolapse quantification stage was the main outcome measure. Anatomical cure was defined as vaginal vault stage 0 and improvement as stage 1. Secondary outcomes include pelvic floor distress inventory-20, incontinence impact questionnaire short form-7, and pelvic floor impact questionnaire short form-7. A total of 80 patients were recruited. The cure and improvement rates were 96.3 % (77/80) and 3.7 % (3/80) respectively at 1 year. At the follow-up of 3-years, the cure rates were 93.3 % (70/75). Among the five patients, three had stage 2 anterior wall prolapse, two had stage 2 posterior wall prolapse. Only one patient with intraoperative adverse event (rectal perforation) was encountered. Postoperative complications included prolonged catheterization in three patients (3.7 %), postoperative stress urinary incontinence in five patients (6.25 %) and asymptomatic mesh extrusions in five patients (6.25 %). All of them occurred within 1 year follow-up. Significant improvements in quality of life were detected at 1 and 3 years compared with baseline. The total Prolift™ system surgery represents a safe, simple and useful treatment for severe POP with satisfactory objective clinical outcomes.

Effects of ureteral stents on risk of bacteriuria in renal allograft recipients

Placement of ureteral stents at the time of renal transplantation is thought to decrease the incidence of postoperative complications, such as anastomotic leakage and stenosis. However, stents may also predispose to post-transplantation urinary tract infection, which can lead to increased risks of graft dysfunction, sepsis, and death. The aim of this study was to analyze the risk of post-transplantation bacteriuria with ureteral stent placement in renal allograft recipients. A retrospective single-center analysis was conducted to investigate the incidence of bacteriuria in all renal allograft recipients transplanted between January 2007 and March 2009. Recipients were categorized as in the nonstent group (NSTG) or the stent group (STG). Stent removal was performed per protocol at 6weeks, and all patients were followed for at least 1year post transplantation. In the NSTG, the incidence of bacteriuria was assessed at 0-6, 6-12, and 12weeks to 1year post transplantation. In the STG, bacteriuria was assessed prior to stent removal, 6weeks after stent removal, and thereafter until 1year post transplantation. A total of 395 renal allograft recipients, 183 in the NSTG and 212 in the STG groups, were studied. The overall incidence of bacteriuria within 1year post transplantation was similar between NSTG and STG (28.0 vs. 24.0%, P=0.38). No difference was found in the incidence of bacteriuria when NSTG and STG were compared at 0-6weeks or prior to stent removal (9.7% vs. 9.1%, P=0.81), at 6-12weeks, or 6weeks after stent removal (6.7% vs. 5.8%, P=0.75), and thereafter for 1year post transplantation (13.3% vs. 10.8%, P=0.46). The incidence of graft failure at 1year was similar in NSTG and STG (6.2% vs. 4.9%, P=0.6). Urinary anastomotic leakage occurred in none of the NSTG and 2 of the STG recipients. On multivariate analysis, risk factors for bacteriuria were female recipient gender (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.3, P=0.001), delayed graft function (DGF) (OR 2.1, 95% CI 1.2-3.8, P=0.01), and postoperative Foley catheterization for >5days (OR 4.7, 95% CI 1.3-17.6, P=0.02). Independent risk factors for bacteriuria following kidney transplantation include DGF, prolonged postoperative Foley catheterization, and recipient female gender, but not placement of ureteral stents.

Expectant management of cystotomy at the time of midurethral sling placement: a retrospective case series

Cystotomy is one of the most common complications of retropubic midurethral sling placement. Some centers manage cystotomy with prolonged catheter drainage, and there are few published studies evaluating this practice. The purpose of this study is to review postoperative outcomes of patients who experienced cystotomy at the time of sling placement and did not undergo prolonged catheter drainage. This is a retrospective review of all patients undergoing midurethral sling placement complicated by a cystotomy at the University of Rochester between 2004 and 2009. Outpatient and inpatient records were reviewed and data collected include demographics, intraoperative details, voiding trial results, postoperative complications, and voiding function. Descriptive statistics were performed. Between 2004 and 2009, 30 subjects experienced a cystotomy of the 374 subjects that had a midurethral sling placed, all by a suprapubic approach. There were 25 patients who underwent a voiding trial on the day of surgery and 20 (80 %) were discharged home without prolonged drainage. Five subjects (20 %) had urinary retention and were discharged with an indwelling catheter. All five successfully voided within 4 days of discharge. No subject required subsequent catheterization for any reason and at the 6-week postoperative evaluation all subjects denied voiding dysfunction or irritative bladder symptoms. No subject required additional intervention and postoperative complications were rare. In this study, the majority of subjects experiencing a cystotomy during midurethral sling placement were successfully discharged home the day of surgery without catheter drainage. The results suggest that prolonged catheter drainage after a cystotomy during midurethral sling placement may be unnecessary.

Short term versus conventional Catheterisation after Genital Prolapse Surgery

This Randomised controlled clinical trial was undertaken to determine the suitable time of catheter removal after urogenital prolapse surgery in order to reduce the catheter related UTI and its long term sequel. Method: Total 80 patients undergoing vaginal hysterectomy with pelvic floor repair were enrolled and randomised into two equal groups by lottery method. Trans-urethral catheter was removed on 2nd & 5th post operative day in group I (n=40) and in group II (n=40) respectively. Post voidal residual urine volume before operation and after removal of catheter was measured in all patients by ultrasound scanning. Re-catheterisation was done for three more days if residual volume > 200ml after removal of catheter. Urine samples were taken before removal of catheter and send for routine microscopic examination and culture & sensitivity test to detect UTI.Results: Removal of catheter on 2nd post-operative day lead to significant reduction of rate of UTI. The rate of UTI following removal of catheter was 7.5% versus 42.5% in group I and in group II (p<0.001). But need for recatheterisation was significantly higher in group I (15%) than in group II (2.5%). The mean duration of catheterisation was 47.63 (±0.628) and 119.35 (±0.864) hours in group I and group II respectively. Majority of the patients in group I did not require prolongation of catheterisation. Mean duration of hospital stay after operation was 5 days in group I and 7.95 days in group II (p<0.001). Conclusion: Short period catheterisation is associated with lower rate of UTI and shorter hospital stay. Disadvantages of prolonged catheterisation outweigh the advantages. Therefore removal of the catheter on the 2nd post-operative day after genital prolapse surgery is preferable than 5 days catheterization DOI: http://dx.doi.org/10.3329/bjog.v26i2.13782 Bangladesh J Obstet Gynaecol, 2011; Vol. 26(2) : 68-71

Prevention and Treatment of Urinary Catheter-Associated Infections

Catheter-associated urinary tract infections (CA-UTIs) are the most common nosocomial infection worldwide. Prolonged catheterization is the most important risk factor for CA-UTIs. As is the case with all device-related infections, the biofilm plays a central role in the pathogenesis of CA-UTIs. The diagnosis is often difficult, given the lack of good diagnostic tests. The most effective way to prevent infection is to limit catheter use and discontinue the catheter when no longer needed. Catheter removal or exchange is also useful in management. This review summarizes and analyzes the results of published studies of CA-UTIs and assesses the role of prevention approaches and management strategies.

Purple Urine Bag Syndrome

Purple urine bag syndrome (PUBS) is a rare condition, in which the patient has a purple-colored urine tubes or bags following urinary catheterization for hours to months. It is usually associated with elderly females, prolonged urinary catheterization, some bacterial infections that produce sulphatase/phosphatase, chronic debilitated state, and chronic constipation. We present a case report of this rare phenomenon occurring in a 73-year-old woman.

When Should a Patient Receive an Arteriovenous Graft Rather Than a Fistula?

There has been a dramatic increase in the placement and use of arteriovenous fistulas (AVF) in US patients with chronic kidney disease over the past few years, in accordance with strong recommendations by Fistula First Initiative and KDOQI guidelines. However, AVF nonmaturation remains a substantial obstacle to achieving functional AVFs in a subset of patients, despite the widespread use of preoperative vascular mapping to assist surgeons in planning access surgery, and the growing use of interventions to salvage nonmaturing AVFs. In the right patient, aggressive efforts result in a functioning AVF, which provides adequate dialysis with relatively few interventions required to maintain its long-term patency for dialysis. In the wrong patient, aggressive efforts to achieve a mature AVF may result in numerous failed surgical and percutaneous procedures and prolonged catheter dependence, with all its associated complications. Thus, strict recommendations to place an AVF in all dialysis patients might not benefit every patient, and may actually harm some patients. There are no randomized clinical trials to address which patients are more suitable for placement of an arteriovenous graft (AVG), rather than an AVF. However, there is a wealth of observational studies, which taken cumulatively, may assist clinicians in identifying those patients who should receive an AVG. In this article, we review the relevant published literature regarding this topic and provide suggestions for stratifying patients who should receive each type of vascular access.

Acquired urethral diverticulum in a man with paraplegia presenting with a scrotal mass: a case report

IntroductionMale urethral diverticula are rare. Patients with paraplegia may present with acquired diverticula as a result of prolonged catheterization. Diverticula may be asymptomatic or lead to lower urinary tract symptoms. Rarely, the diverticulum may initially present as a scrotal mass.Case presentationWe report the case of a male 45-year-old Arab with paraplegia who presented with a mass in the peno-scrotal junction. He had in his medical history iterative prolonged urethral catheterizations associated with urine leakage through the urethral meatus upon applying compression. Diagnosis confirmation of urethral diverticula is obtained by retrograde urethrography. The patient underwent a diverticulectomy with urethroplasty.ConclusionMale acquired urethral diverticula can be found in patients who have a spinal cord injury because of prolonged urethral catheterization. Clinical presentations are different and sometimes can be misleading. Retrograde urethrography is the key to diagnosis and open surgery is the treatment of reference.

Purple urine bag syndrome in elderly woman with nutritional supplements

The purple urine bag syndrome is a rare entity which typically affects elderly women with prolonged urinary catheterization and weakening chronic diseases. Other predisposing factors are previous urologic pathology, immobility syndrome and chronic constipation. The purple color is due to the presence of high loads of bacteria with sulphatase--phosphatase activity which develop in an alkaline environment as well as the presence of other factors. In the case we present the administration of nutritional supplements containing tryptophan conditioned the generation of this syndrome.

Indwelling urinary catheterization after acute stroke

Prolonged indwelling urinary catheterization (IUC) increases risk of urinary tract infection. We aimed to investigate the incidence and risk factors associated with IUC following acute stroke, and its impact on stroke outcome. We prospectively enrolled stroke patients hospitalized within 10 days after onset from August 2006 to December 2008. Kaplan-Meier method was used to estimate the cumulative incidence of IUC, and Cox regression analysis to evaluate the independent predictors. The impact of IUC on poor outcome (modified Rankin Scale >2 or dead) at 3 months was studied by logistic regression. Of 2,803 patients, 697 (25%) received indwelling urinary catheters. Catheterization was carried out mostly within 1-2 days of admission (86%), with estimated cumulative incidence of 13% (95% confidence interval, 11-14%) at 2 days in patients with ischemic stroke (IS), and 57% (53-61%) in patients with intracerebral hemorrhage (ICH). In IS patients, IUC was significantly associated with increasing age, baseline stroke severity, and neurological deterioration. In ICH patients, stroke severity on admission was the only significant predictor after adjustment. We assessed the 3-month outcome in 2,388 patients, after excluding 177 (6%) dead at discharge, 164 (6%) without providing informed consent, and 74 (3%) lost to follow-up. IUC during acute hospitalization was significantly associated with unfavorable 3-month outcome after adjustment. IUC was common in acute stroke care and associated with unfavorable outcome at 3 months. Whether judicious use of urinary catheters in acute stroke patients would improve outcomes may warrant further studies.

Patients' perspectives on timing of urinary catheter removal after surgery

A prolonged catheter duration is a major risk factor for catheter-associated urinary tract infection, with bacteriuria increasing by 5% per day (Gokula et al, 2004). In this study, the authors explored patients' perceptions of the care process relating to peri-operative catheterisation to identify patient factors that encourage early removal. Semi-structured interviews, incorporating a grounded theory approach, were performed on three men and seven women during 2010. Interviews were transcribed and analysed using constant comparative method and thematic framework analysis. Catheter duration ranged 1-10 days. Main themes elicited included: lack of understanding of the purpose and catheterisation process; loss of patient autonomy and dignity; and impact of environmental factors. Lack of knowledge of the catheterisation process among participants led to fears and concerns that may have contributed to delayed catheter removal. Changes to patient care that are likely to reduce catheter duration include ensuring the provision of pre-operative information, greater patient involvement in catheter removal decisions, and provision of easily accessible toilet facilities.

Fluoroscopy-Induced Chronic Radiation Dermatitis

A 62-year-old man with a history of 2 previous cardiac catheterizations presented with an itchy, nontender skin lesion over his right scapula. The skin lesion had been present for >5 years. Review of the medical records found evidence of a prolonged and complicated cardiac catheterization 8 years previously. Physical examination revealed an 8 × 6 cm, well-demarcated, erythematous reticulated atrophic plaque with telangiectasias and ulceration. Biopsy confirmed histologic changes consistent with radiation dermatitis. In conclusion, the characteristic histologic findings of radiation dermatitis, along with the location over the right scapula and the history of prolonged fluoroscopic exposure during cardiac catheterization, led to the clinical diagnosis of fluoroscopy-induced chronic radiation dermatitis.