Retention Balloon Research Articles

Intravesical Nitric Oxide Delivery for Prevention of Catheter-Associated Urinary Tract Infections

The use of indwelling urinary catheters is a major risk factor for urinary tract infection; and despite the availability of numerous preventive regimens, this condition is still extremely common. In earlier studies we have demonstrated the inhibitory effects of nitrite and ascorbic acid on bacterial growth in urine. When combined, these compounds generate antibacterial reactive nitrogen species, including the gas nitric oxide. We have now tested in a laboratory model of the urinary bladder whether filling of the catheter retention balloon with nitrite and ascorbic acid would generate measurable amounts of NO outside the membrane and whether this would affect bacterial growth in the surrounding urine. Two strains of Escherichia coli, one strain isolated from a patient (U1106024) and one reference strain (ATCC 25922), were tested. Nitric oxide gas was generated in the silicone balloon and readily diffused into the urine. When control catheters with ascorbic acid but without nitrite were used, bacterial counts increased from 9.0 x 10(5) to 2.0 x10(8) CFU/ml (strain U1106024) and from 2.5 x 10(6) to 2.7 x 10(8) CFU/ml (strain ATCC 25922) after 24 h. In contrast, in test catheters with ascorbic acid and nitrite, both strains tested were effectively killed. The NO donor {DETA NONOate, (Z)-1-[N-(2-aminoethyl)-N-(2-ammonioethyl)amino]diazen-1-ium-1,2-diolate} also showed antibacterial activity in the same model, thereby supporting a central role of NO in achieving the observed effects. Future clinical trials will reveal whether this novel approach for the intravesical delivery of an antibacterial gas could be used to prevent catheter-associated infections.

Adenomatous Polyp Obscured by Small-Caliber Rectal Catheter at Low-Dose CT Colonography: A Rare Diagnostic Pitfall

Pickhardt PJ, Choi JR bscuration of rectal lesions by the rectal catheter or its retention balloon at air–contrast barium enema represents a known diagnostic pitfall. By comparison, the preferred rectal catheter used for gaseous distention of the colon at CT colonography (CTC) is smaller in caliber and does not necessarily require a retention balloon. If a balloon is used, it is generally much smaller than those used for barium enemas. Furthermore, a significant rectal polyp is less likely to be missed at CTC, not only because a less obtrusive catheter is used, but also because both supine and prone scans are obtained and both cross-sectional and volume-rendered displays are evaluated. We report a case of a 10-mm rectal tubulovillous adenoma that was missed prospectively at CTC due to inopportune positioning of the rectal catheter. This false-negative CTC finding may have been avoided by less advanced placement of the catheter tip beyond the anal verge.

Use of a balloon catheter during conformal prostate irradiation allows high dose rectal-sparing and results in reduced late rectal bleeding

Use of a balloon catheter during conformal prostate irradiation allows high dose rectal-sparing and results in reduced late rectal bleeding

Retention balloon catheters and barium enemas: Attitudes, current practice and relative safety in the UK

Balloon catheters have been associated with increased morbidity and mortality leading some to believe they should be banned, yet others find them both useful and safe if used properly. Questionnaires were sent to all Consultant Radiologists in the UK to document current practice. Particular attention focused on whether eight safety aspects are considered during their use. In this entirely retrospective study complications with both balloon and standard tip catheters were recorded during the 3-year-period 1992 to 1994 to assess their relative safety. Twenty-two percent of UK Radiologists routinely used a rectal balloon. This was not associated with any increase in mortality, but extraperitoneal rectal perforation was increased by a factor of 2.5. The routine use of retention balloon catheters may not be justified.

Barium enema retention balloon: an additional note of caution.

HomeRadiologyVol. 199, No. 3 PreviousNext LettersBarium enema retention balloon: an additional note of caution.D J DiSantisD J DiSantisD J DiSantisPublished Online:Jun 1 1996https://doi.org/10.1148/radiology.199.3.8638021MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1996 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 199, No. 3 Metrics Altmetric Score PDF download

Recognition and prevention of barium enema complications

The barium enema is a safe and accurate diagnostic study of the colon but, in rare cases, complications may result. Many of these can be prevented by proper equipment and careful attention to technique. When a complication does occur, prompt recognition and management is vital in decreasing morbidity and mortality. Perforation of the bowel is the most frequent serious complication, occurring in approximately 0.02% to 0.04% of patients. Rarely the colon may burst due to excessive transmural pressure alone. However, a colon weakened by iatrogenic trauma or disease is more likely to perforate during an enema than is a normal healthy bowel. Injury to the rectal mucosa or anal canal due to the enema tip or retention balloon is probably the most common traumatic cause of barium enema perforation. Inflation of a retention balloon within a stricture, neoplasm, inflamed rectum, or colostomy stoma is particularly hazardous. Recent deep biopsy or polypectomy with electrocautery makes the bowel more vulnerable to rupture. The tensile strength of the bowel wall is impaired in elderly patients, patients receiving long-term steroid therapy, and in disease states including neoplasm, diverticulitis, inflammatory bowel disease, and ischemia. Intraperitoneal perforation leads to a severe, acute peritonitis with intravascular volume depletion. The ensuing shock may be rapidly fatal. Prompt fluid replacement and laparotomy are essential. If the patient survives the initial shock and sepsis, later complications caused by dense intraperitoneal adhesions may develop. Extraperitoneal perforation is usually less catastrophic but may result in pain, sepsis, cellulitis, abscess, rectal stricture, or fistula. Intramural extravasation often forms a persistent submucosal barium granuloma which may ulcerate or be mistaken for a neoplasm. The most dramatic complication of barium enema is venous intravasation of barium. Fortunately, this is quite rare as it may be immediately lethal. Most cases have been attributed to trauma from the enema tip or retention balloon, mucosal inflammation, or misplacement of the tip in the vagina. Bacteremia has been found in as many as 23% of patients following barium enema and, in rare cases, may cause symptomatic septicemia. Other less common complications include barium impaction, water intoxication, allergic reactions, and cardiac arrhythmias. Preparatory laxatives and cleansing enemas have been implicated in some instances of dehydration, rectal trauma, water intoxication, and perforation. Careful review of the indications for examination, previous radiographs, and clinical history will identify many of the patients at greater risk for complications so that appropriate precautions may be observed. Toxic megacolon is a contraindication to the procedure. In cases of recent deep biopsy, polypectomy, or myocardial infarction, the examination should be delayed. In all cases, a safe tip-balloon design should be used and inserted by a physician after a careful digital rectal examination. A retention balloon should be inflated only under fluoroscopic monitoring. Use of a retention balloon is best avoided in infants, within a colostomy stoma, or in rectal neoplasms or strictures. To limit the intraluminal pressure during the examination, the barium reservoir should be no more than four feet above the table unless an extremely viscous barium suspension is used. Rapid insufflation of air can generate transient high intraluminal pressure or induce spasm and should therefore be avoided. Overdistention can be avoided by fluoroscopic monitoring during filling. Adequate hydration should be encouraged during preparation, especially in the elderly. Ready availability of resuscitation equipment and medications in the radiology department may be life-saving in case of a rare allergic or cardiac reaction.

Rectal Injury During Barium Enema Examination

To the Editor.— In TOPICS IN RADIOLOGY (1982;248:1375), Walker and colleagues describe massive extravasation of extraperitoneal air in an elderly woman after double-contrast barium enema (DCBE) examination. Although the authors note a low reported incidence (0.02%) of rectal injury from DCBE examination and allude to wide variations in quantities of extraperitoneal and intraperitoneal air that may accumulate, they conspicuously underemphasize the potential lethality of this complication. Because these patients have fortuitously been thoroughly cleansed of stool by preexamination enemas and laxatives, such injuries may be treated expectantly. Nevertheless, as the following case report exemplifies, rectal tear from DCBE examination endangers life and may require prompt aggressive treatment. Report of a Case.— A 51-year-old asymptomatic woman underwent DCBE examination for follow-up of a benign polyp removed from the sigmoid colon three years earlier. Toward the end of the examination, the retention balloon suddenly ruptured, expelling the catheter. Although no immediate discomfort

Prevention of injury to urethra by Foley catheter.

To the Editor:— Identification of certain hemorrhagic lesions of the urinary bladder, resulting from the use of unvented indwelling catheters, 1 whet my interest in other potential dangers inherent in the ever increasing use of indwelling catheters. One that has been observed elsewhere, though I have not seen it, results from the inflation of the retention balloon of a Foley catheter while it is in the urethra and before the tip of the catheter and the balloon have passed into the bladder. The increasing use of ancillary personnel, not always knowledgeable in the hazards of the procedures they are called upon to perform, makes this an accident waiting to happen. I reproduced this situation in a fresh male cadaver by inflating the balloon of a standard Foley catheter as it rested in the pars membranacea. The shaft of the penis was dissected free, and the distention of the urethra by

Removal of the Indwelling Catheter

To the Editor:— With respect to Dr. Kelley's method ( 196 :599, 1966) for deflating the retention balloon of a urethral catheter, we have employed a similar procedure for the past 20 years. We have used 2 cc of chloroform, and to prevent any discomfort the bladder is distended with water prior to the injection.