Red Rubber Catheter Research Articles

The Routine Bridling of Nasojejunal Tubes Is a Safe and Effective Method of Reducing Dislodgement in the Intensive Care Unit

To determine if the routine bridling of nasoenteric feeding tubes in the intensive care unit is a low-morbidity, cost-effective method of decreasing tube dislodgement. Data were prospectively collected from 62 consecutive bridled patients and compared with that from 172 consecutive unbridled patients for differences in tube dislodgement, nasal ulceration, and estimated cost. Bridled patients demonstrated significantly less tube dislodgement (6.5% vs 32.6%, P < .0001). Bridling resulted in 4 cases of nasal ulceration per 800 tube feeding days, all of which were associated with red rubber catheter bridles. Conversion to 1/8-in umbilical tape bridles eliminated ulceration and further reduced dislodgement from 10% to 4.8%. Implementation of bridling saved an estimated $4038 over 3 months. Nasal bridling is a simple, cost-effective practice that may reduce the rate of nasoenteric tube dislodgement. The use of 1/8-in umbilical tape may be more effective and safer than 8-Fr red rubber catheters for this purpose.

Treatment of pancreatitis‐associated extrahepatic biliary tract obstruction by choledochal stenting in seven cats

To report the clinicopathological findings and outcome in cats with pancreatitis-associated extrahepatic biliary tract obstruction (EHBO) treated by choledochal tube stenting. Medical records of cats with EHBO secondary to pancreatitis that underwent choledochal stenting were reviewed. Information on outcome was obtained by re-examination of the cat or by telephone interview with the owners. All cats had pancreatitis confirmed by histopathological examination of biopsy samples (n=6) or suspected based on gross examination at surgery (n=1). In six cats, a section of 3.5 to five French gauge red rubber catheter and in one cat a section of 22 G intravenous catheter were used as a choledochal stent. Two cats developed re-obstruction of the biliary tract within a week of the original surgery. One cat had confirmed episodes of ascending cholangitis postoperatively. Two cats had chronic intermittent vomiting in the postoperative period. Two cats died during the perioperative period. Five cats survived to discharge, three of which died seven to 24 months postoperatively and two of which remain alive to date. Choledochal stenting is an alternative to biliary diversion for management of feline pancreatitis-associated EHBO in select cases. However, there may be greater morbidity with this technique in cats compared with dogs.

Intrapartum transcervical amnioinfusion for meconium-stained amniotic fluid

Objective To assess the rates of cesarean deliveries and perinatal outcome following intrapartum transcervical amnioinfusion in women with meconium-stained amniotic fluid (MSAF) in a setting with no electronic fetal monitoring or specialized neonatal care. Materials and methods In this prospective comparative study with 150 women who were in labor and had MSAF, 50 of the women received a transcervical amnioinfusion and the remaining 100 women received standard care. The inclusion criteria were a pregnancy of at least 37 weeks' duration, a single live fetus in cephalic presentation, no major medical or obstetric complications, and no known fetal malformation. The amnioinfusion was performed with 1000 mL of normal saline solution through a red rubber catheter. Results Amnioinfusion was associated with a significant decrease in the incidence of low Apgar score (< 7) at 1 min (12% vs. 47%; relative risk [RR], 0.26; 95% confidence interval [CI], 0.12–0.56); low Apgar score at 5 min (4% vs. 23%; RR, 0.17; 95% CI, 0.04–0.71); and meconium aspiration syndrome (4% vs. 18%; RR, 0.22; 95% CI, 0.05–0.92). There was also a trend towards a lesser incidence of cesarean deliveries (18% vs. 30%; RR, 0.6; 95% CI, 0.31–1.16) and perinatal deaths (4% vs. 13%; RR, 0.31; 95% CI, 0.07–1.31). The incidence of maternal hospital stays longer than 3 days was significantly lower in the amnioinfusion than in the control group (24% vs. 48%; RR, 0.5; 95% CI, 0.29–0.85). There were no major complications related to amnioinfusion. Conclusions Intrapartum amnioinfusion for MSAF is a simple, safe, effective, and inexpensive procedure feasible in settings where intrapartum monitoring is limited. It is associated with improved perinatal outcome and could lower cesarean delivery rates in low-resource countries.

Telescoping Tracheal Tubes into Catheters Minimizes Epistaxis during Nasotracheal Intubation in Children

Numerous strategies have been used to reduce epistaxis after nasotracheal intubation. The authors compared the severity of epistaxis after nasotracheal intubation in children with tubes at room temperature, warm tubes, and tubes telescoped into catheters. Children who were scheduled for elective dental surgery were randomly assigned to undergo nasotracheal intubation using a tube at room temperature (control), warmed in saline, or whose distal end had been telescoped into a red rubber catheter. After an inhalational induction and intravenous propofol, a lubricated tube or red rubber catheter was inserted into the right naris. Tracheal intubation was achieved by direct laryngoscopy and tube placement using Magill forceps. The pharynx was swabbed for blood by an observer who was blind to the treatment. The severity of bleeding was rated using reference figures. Data were analyzed using Kruskal-Wallis and Fisher exact tests. P < 0.05 was accepted. The demographics of the three groups were similar. The estimated median area of the gauze in the catheter group that was covered with blood (0%) was significantly less than the areas in the control (40%) and warm (20%) groups. The incidence of clinically relevant bleeding (>or= 40% of the gauze area covered in blood) in the catheter group (5%) was significantly less than in the control (56%) and warm (39%) groups. The incidence of no detectable blood in the catheter group (59%) was significantly greater than in the control (21%) and warm (26%) groups. Telescoping the endotracheal tube into a catheter significantly reduces epistaxis in children undergoing nasotracheal intubation.

PERCUTANEOUS NEPHROLITHOTOMY FOR CALICEAL DIVERTICULAR CALCULI: A NOVEL SINGLE STAGE APPROACH

Current percutaneous treatment of symptomatic caliceal diverticular calculi involves renal access, stone removal, dilation of the diverticular communication, fulguration of the cavity and placement of a nephrostomy tube. We reviewed the outcomes of patients undergoing a novel single stage percutaneous nephrolithotomy technique for radiopaque caliceal diverticular stones that eliminates ureteral catheterization and entry into the renal collecting system. A total of 21 patients (8 male and 13 female including 1 bilateral) with a mean age of 42.4 years underwent percutaneous nephrolithotomy for caliceal diverticular stones from February 2001 to May 2003. Of the diverticula 12 were upper pole, 4 were interpolar and 6 were lower pole. Infracostal access was established by the urologist directly onto the radiopaque stones without the aid of a ureteral catheter. After balloon tract dilation a 30Fr Amplatz sheath was placed and following stone removal the diverticulum was fulgurated. The infundibulum was neither cannulated nor dilated. A 20Fr red rubber catheter or an 8.5Fr Cope loop was placed into the diverticulum. Stone-free status was assessed by noncontrast computerized tomography on postoperative day 1 (POD1). The drainage tube was removed if there was no urine drainage and the kidney was stone-free. Excretory urography was performed at 3 months to evaluate diverticular resolution. Of 21 patients 20 were discharged home tubeless on POD1 and 18 of 21 (85.7%) renal units were stone- free on POD1 noncontrast computerized tomography. Mean operative time was 58.5 minutes and mean stone burden was 138.9 mm. Mean stone diameter was 11.6 mm and mean diverticular diameter was 15.3 mm. Of 22 renal units 16 had followup excretory urography. All diverticula decreased in size and 14 (87.5%) had complete resolution. In patients with symptomatic radiopaque caliceal diverticular stones, a single stage procedure without the need for ureteral catheterization combined with direct infracostal diverticular puncture allows for a rapid procedure with little morbidity.

Minimally Invasive Atrial Fibrillation Ablation Combined with a New Technique for Thoracoscopic Stapling of the Left Atrial Appendage: Case Report

Surgical therapy for atrial fibrillation (AF) is becoming increasingly popular in the concomitant setting. Minimally invasive techniques are being developed for management of the patient with stand-alone AF. We report on our first case of a patient undergoing thoracoscopic microwave epicardial AF ablation combined with the incorporation of a new device for left atrial appendage (LAA) exclusion. The patient is a 62-year-old man with a 10-year history of drug-resistant paroxysmal AF. He had failed multiple electrical cardioversions, as well as a percutaneous attempt at left and right superior pulmonary vein (PV) isolation. On October 8, 2003, he was admitted to undergo an off-pump thoracoscopic epicardial microwave ablation. While the patient was under general anesthesia, 3 thoracoscopic access ports were created in the right chest. The pericardium was widely opened. Red rubber catheters were positioned in the transverse and oblique sinuses. The 2 catheters were retrieved on the left side and tied together, forming a guide to the Flex 10 microwave ablation probe (Guidant Corporation, Fremont, CA, USA). The Flex 10 sheath was positioned to encircle all 4 pulmonary veins. The position of the ablation catheter was confirmed visually to be behind the LAA. Sequential ablation was then performed in the segments of the Flex 10 to create a continuous ablation line around the PVs. A connecting lesion to the base of the LAA was then performed. The LAA was then stapled using the SurgASSIST computer-mediated thoracoscopic stapling system (Power Medical Intervention, New Hope, PA, USA). The procedure was uneventful and lasted for a total of 2.5 hours. The patient was discharged home on postoperative day 2 in rate-controlled AF. He was successfully electrically cardioverted to normal sinus rhythm (NSR). At latest follow-up he remained in NSR and continued to take dofetilide (Tikosyn). Thoracoscopic epicardial microwave ablation of AF is a technically feasible procedure with minimal risk. The computer deployment and motion controlled stapling system that we used in this case has the potential to become a safe and reliable alternative to conventional stapling instruments.

Total thoracoscopic pneumonectomy: indications and technical considerations

Although descriptions of series of thoracoscopic wedge resections and lobectomies have been published, with increasing frequency and encouraging results, only a handful of individual reports of minimally invasive pneumonectomy are available. The authors of these publications unanimously have used a limited 6to 16-cm thoracotomy to allow the introduction of traditional surgical instruments and to provide some direct visualization of the surgical field, especially the hilar structures. This has been traditionally accepted as the method of choice in video-assisted thoracic surgery (VATS). However, it is arguable, that the requirement for a minithoracotomy, particularly if rib spreading or rib resection is used, reduces the benefits of minimal trauma associated with the smaller incisions. VATS wedge resections and anatomic lobectomies are frequently performed. The indications, preoperative patient workup, postoperative care, and basic oncologic principles are essentially the same as with open thoracic surgery. We use preoperative mediastinoscopy before any lung cancer resection. We discuss here our initial experience with entirely videothoracoscopic pneumonectomy, such as has not been reported to date.

Pediatric-Nasotracheal Intubation Made Atraumatic

Acting Assistant Professor (Elwood)Acting Assistant Professor (Parker)Associate Professor; Department of Anesthesiology and Critical Care Medicine; Seattle, Washington (Ramamoorthy)To the Editor:- Bleeding is a troublesome complication of nasotracheal intubation that can both promote laryngospasm and impair subsequent attempts at laryngoscopy. Even when preventive measures are used (oxymetazoline nasal drops, tube lubrication, smaller tubes) bleeding complications can occur. In a prospective study, a “globule” of tissue was present on the tube tip in 33 of 100 patients after nasotracheal intubation. [1]More dramatic reports such as avulsion of the turbinate [2]or retropharyngeal dissection [3]have been described.Local practice at our hospital is a simple modification of the technique for nasotracheal intubation that may decrease the incidence of bleeding. An entire red rubber catheter (size 10 - 12 French for pediatric patients) is fitted over the end of the nasotracheal tube before its advancement, by placing the end of the endotracheal tube into the flared end of the catheter. This presents a smooth noncutting surface to the nasal mucosa as the tube-catheter combination is advanced. Using direct laryngoscopy and a McGill's forceps, the catheter is removed in the oropharynx before final advancement of the nasotracheal tube. This technique is simpler to perform than a previously suggested technique in which orotracheal intubation precedes the nasotracheal catheter-tube combination. [4]This technique is also simpler and cheaper than serial dilations with nasal trumpets [5]and avoids the risk of losing a small foreign body in the airway when a finger glove is used to cover the tube tip. [6]Tom ElwoodActing Assistant ProfessorSally ParkerActing Assistant ProfessorChandra RamamoorthyAssociate Professor; Department of Anesthesiology and Critical Care Medicine; Seattle, Washington(Accepted for publication April 24, 1998.)

Laparoscopic creation of a continent cecal tube for antegrade colonic irrigation

Objectives The antegrade continence enema (ACE) procedure has been used for the treatment of overflow fecal incontinence or constipation in patients with spina bifida. The procedure requires an appendiceal reimplantation into the cecum with creation of a continent abdominal stoma for antegrade colonic washout. To preserve the appendix for potential use in urinary diversion, we developed two surgical techniques for tubularizing an antimesenteric cecal segment to use in place of the appendix. Methods The surgery was performed in 6 dogs. The first two procedures used an open surgical technique through a 10-cm midline laparotomy. The cecum was isolated, and a small cecotomy was made. A 10F red rubber catheter was introduced into the cecotomy, and a 4-cm length of cecum was tubularized along its antimesenteric border with a gastrointestinal anastomosis stapler over the catheter. A nipple was created at the base of the tube to enhance continence, and the tubular segment was brought through the lower abdominal wall to create a catheterizable stoma. After our success, four subsequent procedures were performed laparoscopically to create the same tubularized cecal segment. A 4-cm antimesenteric tubularized cecal segment with sufficient lumen to accommodate a 10F to 12F catheter was constructed using a laparoscopic gastrointestinal anastomosis stapler. Rather than creating a nipple at the base of the tubular segment, continence of the stoma was achieved by tunneling the cecal tube through a 2-cm lower quadrant subcutaneous tunnel. A flush stoma was then created and secured to the skin. Results Stoma viability was grossly confirmed in all 6 dogs during the postoperative period, with no incidence of bowel obstruction. Slight fecal leakage through the stoma was observed in 1 dog with a laparotomy but not in those with laparoscopy. Catheterization was easily performed in all dogs with a 10F red rubber catheter during the postoperative period. The dogs were killed on postoperative day 10, and gross anatomic and histologic examination of the cecal segment confirmed luminal patency and viability. Conclusions Open and laparoscopic continent cecostomies were successfully constructed in a canine model and are likely to be applicable to humans with neuropathic constipation.

Improved continence with tubularized bladder neck reconstruction following radical retropubic prostatectomy

Incontinence after radical retropubic prostatectomy remains a common problem. This study determines the efficacy of a tubularized bladder neck reconstruction for improving the time to continence and also the total rate of continence following radical retropubic prostatectomy. Tubularized bladder neck reconstruction was performed in 29 patients by creating a trapezoidal-shaped anterior bladder flap and performing tubularization over a 30 F red rubber catheter prior to urethrovesical anastomosis. This flap measured approximately 5 cm at its base and 3 cm at its apex. Continence rates of these patients were compared to results of 30 randomly selected patients in whom a bladder flap was not used. Seven of 29 (24%) patients with tubularized bladder neck reconstruction were fully continent within 24 hours of catheter removal and 27 of 29 (93%) were fully continent by 3 months follow-up. An additional patient was continent at 6 months for a total continence rate of 28 of 29 (97%). These continence rates were significantly higher at all follow-up times than for patients in whom an anterior bladder flap was not used. One patient developed a bladder neck contracture and was successfully managed with visual urethrotomy. He is fully continent. Tubularized bladder neck reconstruction following radical prostatectomy may both increase the successful achievement of postoperative continence and decrease the time needed to achieve full continence without increasing morbidity.

Effects of ciprofloxacin and protamine sulfate combinations against catheter-associated Pseudomonas aeruginosa biofilms

Infection is a common complication associated with the use of transcutaneous and implanted medical devices. These infections are generally difficult to treat and frequently require removal of the biomaterial before the infection can be completely eradicated. The presence of a bacterial biofilm recalcitrant to treatment often mediates these infections. We studied the influence of a polycationic protein, protamine sulfate, on the efficacy of the fluoroquinolone ciprofloxacin against a clinical isolate of Pseudomonas aeruginosa. A P. aeruginosa biofilm was developed on 1-cm sections of red rubber catheter material and then treated with various combinations of protamine sulfate and ciprofloxacin. The present work demonstrated that ciprofloxacin in combination with protamine was more effective against biofilms than was ciprofloxacin alone. Protamine sulfate at 50 micrograms/ml combined with antibiotic at 0.5 microgram/ml reduced the number of viable cells by an average of 98.97%, while protamine sulfate at 50 micrograms/ml alone resulted in an average 107.8% increase and antibiotic alone resulted in an average 58.6% reduction after 24 h. Furthermore, protamine sulfate, in combination with ciprofloxacin, inhibited P. aeruginosa in a dose-dependent fashion. It was further observed that treatment with the combination of protamine sulfate and ciprofloxacin had a more drastic effect on planktonic organisms as compared with the P. aeruginosa biofilms; the MBC was reduced to < 0.05 microgram/ml in the presence of 25 micrograms of protamine sulfate per ml. These findings were substantiated by ultrastructure studies of treated cells using scanning and transmission electron microscopy. The synergism between ciprofloxacin and protamine sulfate significantly enhanced the efficacy of ciprofloxacin against planktonic and biofilm P. aeruginosa.

Gastrostomy: evaluation of a new tube using an old technique.

Formerly, for gastrostomy, we passed a No. 18 French red rubber catheter through the antrum of the stomach with the tip directed toward the fundus. We used this method with great success, both for decompression and feeding. Recently, a tube made of silicone rubber and thus resistant to gastric secretions was manufactured for us by the Medical Innovations Corporation of Milpitas, Calif. The tip of the tube is long enough to reach to within 3 cm of the fundus. A doughnut-shaped inflatable balloon fits nicely against the gastric mucosa, and a "Secur-Lok" ring external to the abdominal wall slides down to the skin, allowing the tube to be held in position without the use of sutures. We believe that the tube placed using the above technique is effective, comfortable, and reliable. This study was done to evaluate its efficacy. We report a series of 90 patients in whom this new gastrostomy tube was placed. We discuss the lasting qualities of the tube, the function of the doughnut-shaped balloon, the hypothesis we have developed to explain why there has been no esophageal reflux with this tube, and the efficacy of the Secur-Lok ring in holding the tube in position without the use of sutures.

An aid to nasotracheal intubation in orthognathic surgery.

An atraumatic and reliable technique of nasal intubation in patients with previous pharyngoplasty or pharyngeal flap is presented. Using the tight and smooth fit of the fluted end of a red rubber catheter over the end of a nasotracheal tube is the technique described.

An Aid to Nasotracheal Intubation in Orthognathic Surgery

Abstract An atraumatic and reliable technique of nasal intubation in patients with previous pharyngoplasty or pharyngeal flap is presented. Using the tight and smooth fit of the fluted end of a red rubber catheter over the end of a nasotracheal tube is the technique described.

Adherence to urethral catheters by bacteria causing nosocomial infections

Previous clinical studies of catheters with hydrophilic coating have, in some instances, shown a delay in the onset of significant bacteriuria, while others reported no such effect. To attempt to determine reasons for these differences we decided to study bacterial adherence of bacteria obtained from nosocomial urinary tract infections associated with catheters. Almost all strains adhered to the silicone catheter and none of them adhered to the catheter with the hydrophilic surface whether incubated in urine or serum. When incubated in urine, all strains adhered to the red rubber catheters. Adherence was variable to the Teflon and elastomer surfaces.

Feeding Jejunostomy for Post Operative Nutritional Support M. CARMON, D. SEROR, R. UDASSIN, ET AL. Clinical Nutrition 10:298–301, 1991

The authors describe their experience using jejunostomy tubes placed during a primary surgical procedure in 19 adult patients during a 2‐year period. All but one patient underwent a laparotomy (the one exception had a thoracotomy) for gastrointestinal cancer, peptic ulcer disease, or trauma. Large‐bore (16 or 18 French) red rubber catheters were used for feeding jejunostomies. Patients were fed according to a standard protocol that included (1) use of commercially available formulas, (2) infusion pumps, (3) liberal use of antidiarrheal agents, and (4) initiation of feeding on the second postoperative day. Patients were fed by tube for a mean of 22 days and received a mean of 1850 calories with 62 g of protein per day. Feeding tubes remained in place (insertion to removal) for an average of 59 days. Seven of the 19 patients had the tubes removed during hospitalization; for the remaining patients, tubes were removed after discharge. After removal of the tube, the tract closed spontaneously and uneventfully in all patients.No mortality was associated with feeding tube insertion. One patient developed intestinal obstruction believed to be due to angulation of the bowel caused by the jejunostomy tube; the obstruction resolved after removal of the tube. Another patient exhibited paralytic ileus that necessitated discontinuation of the formula; upon resolution of the ileus, administration of the formula resumed. Five patients (26%) developed diarrhea, and two patients had clogged feeding tubes (one had the tube removed and a new tube was inserted under fluoroscopy). Four patients (21%) had inadvertent removal of their tubes, and all tubes were immediately reinserted. Three patients required home enteral support; one experienced a minor skin irritation at the catheter site that resolved by replacement with a larger feeding tube.In conclusion, the authors have successfully employed enteral feeding in the hospital setting with low morbidity. They selected jejunostomy feeding tubes rather than gastrostomy tubes for patients requiring prolonged enteral nutrition support because of the reduced risk of aspiration of gastric contents.

Pneumothorax following feeding tube placement

To the Editor. — The article by Wendell et al 1 regarding pneumothorax complicating small-bore feeding tube placement is enlightening and useful. We, too, have had difficulty with this situation in lethargic or comatose patients who need nasogastric or nasoenteral feeding, and we have recently adopted a technique that was described by Harris and Huseby. 2 A 26-F red rubber catheter is inserted transnasally into the stomach and an 8-F feeding tube subsequently is inserted through the catheter. The feeding tube is advanced the appropriate distance, and the larger external catheter is then cut longitudinally leaving only the feeding tube in place. Following this technique, the likelihood of pulmonary insertion of the feeding tube has been significantly reduced. Another technique that we have recently reviewed——but not gathered significant data on, but which appears promising—is the use of a pH-sensitive gastric or enteral probe that allows localization within the gastrointestinal tract

Tracheoesophageal Fistula, Esophageal Atresia, and Left Pulmonary Agenesis

Tracheoesophageal Fistula, Esophageal Atresia, and Left Pulmonary Agenesis

Recurrent Urethral Stricture Disease Managed by Clean Intermittent Self-Catheterization

We studied 41 patients with urethral stricture who had failed at least 1 operation, and were being maintained with filiform and follower dilation every 6 to 12 weeks. The patients were instructed in clean intermittent self-catheterization with a 16F red rubber catheter, which was performed every 1 to 30 days. Followup from 9 to 36 months revealed excellent compliance and average peak uroflow rates increased from 5.5cc per second before dilation to 17.1cc per second at the last followup visit. Clean intermittent self-catheterization is a simple method to maintain a patent urethra and obviates the need for further operations or painful dilations. (J. Urol., 144: 1142–1143, 1990)

Bacterial Adherence to Urethral Catheters

Closed sterile catheter drainage has markedly reduced the incidence of nosocomial urinary tract infections. Infections that occur during closed drainage must ascend by colonizing the catheter or urethra. Our study compared adherence by different bacterial species to different catheter surfaces. We found no bacteria adhering to the hydrophilic catheter surface. Of the gram-negative bacteria Proteus mirabilis showed the greatest adherence to the other catheters and it, like most bacteria, showed the most marked adherence to the red rubber catheter.