Clinical application of nurse-led catheter extraction assessment model in children / 中国实用护理杂志

Objective:To evaluate the application effect of the nurse-led catheter extraction assessment model for children in PICU.Methods:From January to May 2020, 100 children with short-term catheter in PICU of Guangzhou Women and Children Medical Center were selected by convenient sampling method as the experimental group, the need for urethral catheter indwelling was assessed daily using an evidence-based assessment scale in PICU children, and the unnecessary indwelling catheters were removed timely, and 109 children with indwelling urethral catheters from August to December 2019 were collected as the control group, the catheter was removed by the nurse on medical advice, recorded and compared days of indwelling of catheters, the incidence of patients with catheter-associated urinary tract infection , resetting of catheters and the length of stay in ICU between the two groups.Results:The median and interquartile spacing of the days with indwelling catheter were 5.0 (6.0) days in the experimental group and 6.0 (6.0) days in the control group ( Z=-2.01, P<0.05) . In the experimental group, the incidence of catheter-associated urinary tract infection was 1.000 percent (1/100), and in the control group, the incidence of catheter-associated urinary tract infection was 1.835 percent (2/109); in the experimental group, 2 cases of urethral catheter were reset, and in the control group, 2 cases of urethral catheter were reset; the median and interquartile spacing of the length of stay in ICU was 6.5 (7.0) days in the experimental group and 7.0 (8.0) days in the control group. The differences of the above three indexes between the two groups were statistically significant ( χ2=0.26, 0.01, Z=-0.96, all P>0.05). Conclusions:The nurse-led catheter extraction assessment model for children can effectively shorten the catheter indwelling days for children in PICU, which has certain clinical practice significance for reducing the incidence of catheter-associated urinary tract infection.

Catheter induced hypospadias, urethral trauma and penile abscess in completely recoverable neurological afflictions: preventable entities

Background: Catheter associated complications are very common in the emergency departments of medicine, general surgery, orthopaedics and in community. They mostly occur in patients with neurological afflictions because of inexperience of the first handlers as they lack the insight of altered physiology and anatomy in the lower urinary tract because of neurological lesions and also because of an inadequate advice at the time of discharge regarding the catheter care. Objectives of this study were to find the prevalence of per-urethral catheter associated injuries in patients with neurological lesions in a tertiary care centre of south-eastern Punjab and their prevention in completely recoverable neurological afflictions.Methods: This is a cross-sectional observational study conducted in urology department from 1st August 2017-31st August 2018. The data was taken from medicine, general surgery and orthopedic emergency departments. A total of 82 patients were taken from 19-78 years and 49 patients had per-urethral catheter placement. Analysis was done using Statistical Program of Special Sciences, version 20.Results: It was observed that overall neurological lesions are more common in males (80.48%) as compared to females (19.51%) and distributed over an age range of 19-84 years in both sexes. Out of total patients, 59.75% required per urethral catheterization. The prevalence of per-urethral catheter associated complications was 20.40%.Conclusions: Insertion of per-urethral catheter is a simple procedure but an error of omission on the part of health professionals’ results in a serious complication in a neurological patient. Proper insertion technique and catheter care are to be followed to prevent avoidable complications in this subset of patients.

Prognosis of Patients with Indwelling Urethral Catheters Admitted to the Convalescent（Kaifukuki）Rehabilitation Ward / The Japanese Journal of Rehabilitation Medicine

Purpose：This study examined functional outcomes and discharge disposition in patients with and without indwelling urethral catheters, who were admitted to a convalescent (Kaifukuki) rehabilitation ward (KRW) following an acute care hospital stay.Subjects and Methods：We retrospectively reviewed the medical records of 113 patients with cerebrovascular disease and traumatic brain injury who had indwelling urethral catheters at the time of admission to the KRW of our hospital between April 1, 2012 and March 31, 2015. We studied the motor score of the Functional Independence Measure (FIM-M) and discharge disposition from our KRW in patients without indwelling urethral catheters.Results：The ratio of patients without indwelling urethral catheters was 75.2％ (85 cases：catheter-free group). The catheter-free group had higher FIM-M scores and a higher rate of living at home, compared to the 28 patients with indwelling urethral catheters. The average duration until urination independence after catheter removal was 17.3 (standard deviation：21.1) days. Urination independence recovered in 80.9％ of the catheter-free group within 4 weeks after catheter removal.Conclusion：Indwelling urethral catheter should be removed to enable discharge to home.

Different clamping choices for patients with indwelling urethral catheter:a Meta analysis / 中国实用护理杂志

Objective To evaluate the effect of three different choices of indwelling urethral catheter clamping. Indwelling urethral catheter clamping choices included according to patients′complaints to clamp the catheter (Group A), released as schedule (Group B),and smooth passway of indwelling urinary catheter all the way (Group C). Methods We searched RCT about the effect of different choices of indwelling urethral catheter clamping from CNKI, VIP database,Wanfang database, PubMed on line. Literatures were searched from the database had been established till now. Two reviewers evaluate the literatures independently according to the RCT authentic assessment manual of Cochrane Collaboration. Other than different results, negotiation took as the measure to attach an agreement. No agreement reached, consult the opinion of the third person. RevMan5.2 was used to analyses the result of the study. Results Statistical difference between three clamping choice on the rate of successful in autonomous urination after catheter removed: both group A and group B preceded group C (Z=2.97, Z=4.34, P < 0.05), mean well group A preceded group B (Z=5.30, P < 0.05). Statistical difference did not found on the rate of urinary tract irritation after catheter removed between three choices. Conclusion Clamping indwelling urethral catheter according to patients′ complaints seems useful in bladder reconditioning before indwelling urethral catheter removal.

Experience on Early Urethral Catheter Removal Following Radical Prostatectomy

PURPOSE: To assess outcomes from patients who underwent radical prostatectomy and had their indwelling urinary catheter removed on postoperative day (POD) 4 or 7. MATERIALS AND METHODS: The medical records of 107 consecutive patients receiving radical prostatectomy (RP), were retrospectively reviewed. Patients were categorized into two groups according to length of catheterization. Group 1 (n=40) had the urethral catheter removed on postoperative day (POD) 4, and group 2 (n=67) had the catheter removed on POD7. Group 1 had urethral catheter removal following no leakage on intraoperative leak testing and POD4 cystography, whilst group 2 exhibited leakage at POD4 and instead had routine POD7 urethral catheter removal if there was evidence of no leakage of POD7 cystography. Incontinence was checked according to the use of protective pad. RESULTS: The mean age of the study population was 67.0 years. acute urinary retension (AUR) following catheter removal occurred in 6 of the cohort (5.6%); 3 patients (7.5%) from group 1 and 3 (4.5%) from group 2 (p=0.669). The overall continence rate was 39.3%, 68.2%, 80.4%, and 91.6% at 1, 3, 6, and 12 months respectively. Importantly, the incontinence recovery pace of group 1 was notably higher than that of group 2 (p=0.001). Neither group exhibited bladder neck contracture. Intraoperative factors influencing the decision to remove catheter at POD4 following RP, are bladder neck reconstruction (OR=3.792, p=0.010) and nerve sparing (OR=6.646, p=0.008). CONCLUSIONS: Selective early urethral catheter removal may shorten the length of incontinence recovery, without increasing the risk of AUR and bladder neck contracture.

Effect of multiple treatments on cystospasm after transurethral resection of prostate / 局解手术学杂志

Objective To investigate the effect of multiple treatments on cystospasm after transurethral resection of prostate(TURP). Methods From 2006 to 2013, 663 patients who had received TURP for BPH were civided into 6 groups:2 were treated by kieselgel or lac-toprene urethral catheter,defined as catheter observe group. 2 were treated by warmed or ordinary temperature douche,defined as temperature observe group. 2 were treated by dicaine mixed or normal douche,defined as mixed douche observe group. The incidence rates and duration of cystospasm and visual analogue scores of pain were observed and the diversities were measured by statistics within each pair groups. Results The incidence rates and duration of cystospasm and visual analogue scores of pain of groups treated by kieselgel urethral catheter,warmed douche and dicaine mixed douche were obviously lower than the groups treated by lactoprene urethral catheter,ordinary temperature douche and normal douche. The kieselgel urethral catheter and warmed douche decreasing the irritation on mucous membrane of bladder,the dicaine decreasing the sensibility of bladder nerves may be the mechanism. Conclusion The incidence rates and duration of cystospasm and visual analogue scores of pain can be obviously decreased by treatments of kieselgel urethral catheter,warmed douche and dicaine mixed douche.

Urethral catheter knotting: an avoidable complication

Abstract: Urethral catheterisation is a common and safe procedure performed routinely. The small size of the urethra in a child necessitates the use of an infant feeding tube (Size 5 to 8 F) for catheterisation. Knotting within the bladder is a rare complication with significant morbidity often necessitating surgical or endoscopic removal. Insertion of an excessive length of tube contributes to coiling and knotting. We report an instance of knotting of an infant feeding tube in the proximal penile urethra of a 4 year-old male child requiring urethrotomy to remove it. Awareness of the risk and proper technique can reduce this complication

Nursing of complications in patients with balloon urethral catheter in department of neurosurgery / 中国实用护理杂志

Objective To study the nursing method of complications caused by balloon urethral catheter in department of neurosurgery and its nursing effect.Methods 82 patients with complications caused by balloon urethral catheter in department of neurosurgery were divided into group A (routine nursing method group)and group B (strengthening nursing intervention group)with 41 cases in each group according to random number table,then the time for improvement of complications,satisfaction degree and SAS score,SDS score,compliance of treatment and nursing,master situation of complication preventive knowledge before and after the nursing were analyzed and compared between two groups.Results The time for improvement of complications in group B was shorter than that of group A,satisfaction degree was higher than that of group A,SAS score,SDS score,compliance of treatment and nursing,master situation of complication preventive knowledge at the third and sixth day after nursing were all better than those of group A.Conclusions The patients with complications caused by balloon urethral catheter in department of neurosurgery should be given strengthening nursing intervention,and it can improve the state of physiology and psychology.

Intraperitoneally Placed Foley Catheter via Verumontanum Initially Presenting as a Bladder Rupture

Since urethral Foley catheterization is usually easy and safe, serious complications related to this procedure have been rarely reported. Herein, we describe a case of intraperitoneally placed urethral catheter via verumontanum presenting as intraperitoneal bladder perforation in a chronically debilitated elderly patient. A 82-yr-old male patient was admitted with symptoms of hematuria, lower abdominal pain after traumatic Foley catheterization. The retrograde cystography showed findings of intraperitoneal bladder perforation, but emergency laparotomy with intraoperative urethrocystoscopy revealed a tunnel-like false passage extending from the verumontanum into the rectovesical pouch between the posterior wall of the bladder and the anterior wall of the rectum with no bladder injury. The patient was treated with simple closure of the perforated rectovesical pouch and a placement of suprapubic cystostomy tube.

Urethral catheter insertion forces: a comparison of experience and training

Purpose: This study was undertaken to evaluate the insertion forces utilized during simulated placement of a urethral catheter by healthcare individuals with a variety of catheter experience. Materials and Methods: A 21F urethral catheter was mounted to a metal spring. Participants were asked to press the tubing spring against a force gauge and stop when they met a level of resistance that would typically make them terminate a catheter placement. Simulated catheter insertion was repeated fives times, and peak compression forces were recorded. Healthcare professionals were divided into six groups according to their title: urology staff, non-urology staff, urology resident/ fellow, non-urology resident/ fellow, medical student, and registered nurse. Results: A total of fifty-seven healthcare professionals participated in the study. Urology staff (n = 6) had the lowest average insertion force for any group at 6.8 ± 2.0 Newtons (N). Medical students (n = 10) had the least amount of experience (1 ± 0 years) and the highest average insertion force range of 10.1 ± 3.7 N. Health care workers with greater than 25 years experience used significantly less force during catheter insertions (4.9 ± 1.8 N) compared to all groups (p < 0.01). Conclusions: We propose the maximum force that should be utilized during urethral catheter insertion is 5 Newtons. This force deserves validation in a larger population and should be considered when designing urethral catheters or creating catheter simulators. Understanding urethral catheter insertion forces may also aid in establishing competency parameters for health care professionals in training.

Laparoscopic Single-point Anastomosis of the Fallopian Tube:Report of 31 Cases / 中国微创外科杂志

Objective To evaluate the outcomes of single-point anastomosis of the fallopian tube under a laparoscope.Methods Totally,31 patients(58 fallopian tubes)were treated with laparoscopic single-point anastomosis using 3-mm laparoscopic instruments after ligation(17 cases)or failed hysteroscopic recanalization(14)of the fallopian tubes.Ureteral catheter or transcervical guidewire or stents were used if the sizes of the tubes were irregular.Results The 58 fallopian tubes were anastomosed successfully by a single operation.Radiography performed 3 months postoperation showed bilateral fallopian tube occlusion in 2 patients,and lateral tube occlusion in 5.The postoperative patency rate was 84.5%(49/58).A 6-to 36-month follow-up was carried out in 26 of the 31 patients.Among the 26 patients,17 had uterine pregnancy with a pregnancy rate of 65.4%(17/26),2 patients had fallopian tubal pregnancy,and 7 had no pregnancy.Conclusions Laparoscopic single-point anastomosis is feasible after ligation or failed recanalization of the fallopian tube.Patients have less surgical trauma,faster recovery and less intra-abdominal injury by treating with the procedure.

The Severity of Urinary Tract Infection according to Duration of Indwelling Urethral Catheter and the Effect of Antibiotic Therapy in Rabbit / 대한비뇨기과학회지

PURPOSE: The incidence and severity of catheter associated bacteriuria might be dependent on the catheterized duration and route, although this has not been clearly established yet. We evaluated the severity of urinary tract infection according to the duration of the indwelling urethral catheter and the effect of antibiotic therapy in rabbits. MATERIALS AND METHODS: A total of 54 rabbits were divided into one control group and two experimental groups; antibiotic and no antibiotic group, which were subdivided according to catheterized period(1, 4, 7 and 14-day). We examined the urinalysis, urine culture, qualitative biofilm culture and scanning electro-microscopy of the urethral catheter. RESULTS: 1. In the urinalysis, pyuria developed significantly both in 4, 7, 14-day group of no-antibiotic and in 14-day of antibiotic group compared to the control group(p<0.05). In the no antibiotic 7-day group, pyuria developed significantly as compared to that of the antibiotic group(p<0.05). 2. In the urine culture, positive urine culture was increased significantly in 7, 14-day of no-antibiotic group and 14-day of antibiotic group compared to the control group(p<0.05). In the no antibiotic 7-day group, positive urine culture developed significantly as compared to the antibiotic group(p<0.05). 3. In the qualitative biofilm culture of the urethral catheter, positive culture developed significantly in the no antibiotic 7, 14-day group and the antibiotic 14-day group as compared to the control group(p<0.05). Positive biofilm culture was developed significantly in the no antibiotic 7, 14-day group as compared to the antibiotic group(p<0.05). 4. In scanning electro-microscopy, bacterial biofilm of the urethral catheter was similar to the qualitative biofilm culture, and increased with increasing duration of the catheterization. CONCLUSIONS: It is suggested that the early removal of the urethral catheter is important for the reduction of chance of urethral catheter associated urinary tract infection. In case of a long-term indwelling urethral catheter(more than 2 weeks), prevention of urinary tract infection was very difficult despite antibiotic administration.

The Effect of Urethral Catheter on Pressure-Flow Study / 대한비뇨기과학회지

PURPOSE: The effect of a urethral catheter on pressure-flow study has important implications for the practice and interpretation of pressure flow studies. We wonder which catheter would be adequate for pressure flow study. We report 3 different size of catheters(4Fr, 10Fr, 12Fr) effects on urinary flow rate, voiding pressures and pressure flow plot. MATERIALS AND METHOD: Pressure flow studies were carried out on 141 patients(male;88, female;53), whose diseases were BPH in 22, prostatodynia in 37,urethral syndrome in 36, Hinman syndrome in 2, neurogenic bladder in 28, unstable bladder in 10, urethral stricture in 2 and bladder stone in 2. RESULTS: There was no significant difference between pre- and postcatheterization maximum flow rate in 4Fr group. But there were significant difference between pre- and post-catheterization maximum flow rate in 10Fr and 12Fr group. The detrusor pressure was significantly higher in 10Fr and 12Fr group than in 4Fr group. The larger size of catheter groups had more obstructive patterns in pressure flow plot. CONCLUSIONS: These results showed 4Fr catheter had less effect on pressure flow study than 10Fr, 12Fr catheter.

Early Catheter Removal Following Transurethral Prostatectomy : A Prospective Study of 101 Consecutive Patients / 대한비뇨기과학회지

We managed 118 patients with benign prostatic hyperplasia by transurethral resection during January 1994 and December 1995 in Eul Ji Medical Center and all patients were operated upon by 2 staff doctors. Among 118 cases, 7 cases with intraoperative complications such as bladder injury or severe prostatic capsule injury and 8 cases with combined neuropathic bladder or chronic urinary retention and 2 cases with urethral stricture were excluded. The average age of 101 cases were 66.4 years old (50-92), and average weight of resected adenoma was 10.0 gm (2-32). We categorized these patients randomly into 2 groups. In group I (n=48), we removed the urethral catheter within 2 days after TURP and in group II (n=53), we removed it after 3 days (mean 4.2 days) following surgery. The average hospital stay postoperatively was4.1 days in group I and 7.4 days in group II. Recatheterization rate was 8.3% (4/48) in group I and 5.6% (3/53) in group II (p>0.05). There was no statistical difference in other complication including failure to void, intraoperative bleeding, urethral stricture, incontinence and TUR syndrome. This study supports early catheter removal after TURP would become an accepted and routine postsurgical practice following uncomplicated TURP.

The Effect of a Urethral Catheter on the Uroflow and its Correction / 대한비뇨기과학회지

The technique of synchronous pressure-flow studies requires the use of either a transurethral or a suprapubic catheter. Although the flow is impaired by the presence of catheter, the use of transurethral catheter can eliminate unnecessary cystostomy procedure. We evaluated the effect of urethral catheter on the roflow. The maximal and average urinary flow rates of healthy volunteer of 24 male and 7 female were measured in the presence and absence of a 5Fr. and 8Fr. urethral catheter. A comparison of these flow rates showed that those measured with the catheter in situ were lower than those in the absence of a catheter. There was an insignificant decrease in maximal flow rate(MFR) from 20.8+/-6.3(ml/sec) to 20.4+/-4.9 and 19.0+/-5.2 with 5Fr. and 8Fr. urethral catheter, respectively The average flow rate(AFR) was also decreased insignificantly from 10.7+/-3.8(ml/sec) to 9.5+/-2.3 and 8.8+/-2.3 with 5Fr. and 8Fr. urethral catheter, respectively. The followings are correlation formulae of AFR and MFR according to diameter of urethral catheter in situ. MFR=0.79xMFR(5Fr.) + 4.71 (R square=0.37), MFR=0.74xMFR (8Fr.) + 6.92 (R square=0.32), AFR=1.00xAFR(5Fr.) + 1.48 (R square=0.35), AFR=1.23xAFR(8Fr.) - 0.15 (R square=0.59) (MFR : maximal flow rate, AFR : average flow rate).

Nonoperative Management of Extraperitoneal Bladder Rupture / 대한비뇨기과학회지

During last two year and seven month, We have seen 38 patients bladder rupture due to 34 blunt trauma, 2 penetrating injuries and 2 iatrogenic causes. There were 13(34.2%) intraperitoneal and 25(65.8%) extraperitoneal injuries. Nonoperative( catheter ) management was used in 21 patients with extraperitoneal rupture of the bladder with extravasation of dye found by retrograde cystogram and successfully treated by urethral catheter drainage only. We excluded 4 patients coexisting urethral rupture and significant intraabdominal injury. Complication occurred in 8 of the 2l patients but all were treated spontaneously during catheter drainage. It seemed obvious that nonoperative management will give a satisfactory result and would not be necessarily benefit from an operation to closing the bladder.

A Study for Clarifying the Necessity of Additional Antibiotic Therapy in Patients Undergoing TURP, Given Antibiotics During Catheter-indwelling and Showing Sterile Urine after Catheter-removal / 대한비뇨기과학회지

Faced with patients who underwent TURP and who were given antibiotics until catheter-removal, usually complain of urinary frequency or burning on ruination and showing sterile urine (less than l00 bacteria per ml., in clean-caught midstream about 24 hours after catheter-removal), we often hesitate to make a decision whether they should be given antibiotics or not. So we divided 27 such patients into three groups : group l ; 7 patients, no additional antibiotics after catheter-removal, group 2; 12 patients, antibiotics for one week after catheter-removal and we performed weekly urine culture for clarifying the necessity of additional antibiotic therapy and its appropriate duration, if necessary. The following results and conclusions were obtained. I. Group l showed bacteriuria in 86%(6 of 7 patients). 2.Group 2 and 3 showed bacteriuria 5%(1 of 20 patients). 3. These data suggested that additional antibiotic therapy rather than stopping antibiotic therapy might be justified(P : less than 0.001). 4. Group 2 showed no bacteriuria and group 3 showed bacteriuria in one patient which disappeared promptly. Namely, there was no practical difference in the incidence of bacteriuria between the two groups. 5. 9 cases of fungiuria were found, all of which developed in patients given antibiotics perioperatively for more than 2 weeks. 6. Considering the above items and cost-effectiveness, a week`s additional antibiotic therapy is probably an appropriate answer to treating the above-mentioned patients. 7. Main causative organism in post-TURP bacteriuria was Pseudomonas spp(4of 7 cases).