THE THREE-CIRCLE SINGLE J CATHETER A MORE STABLE URETHRAL CATHETER FOR PRESSURE FLOW STUDIES

We describe a single J urethral catheter which has been specially designed to facilitate stabilization during voiding in pressure flow studies. It has a tip with three circles, which prevents the catheter from slipping out even when there is a sudden increase in intra-abdominal pressure.     

An indwelling urinary catheter for the 21st century

What's known on the subject? and What does the study add? A vast literature has been published on the prevalence, morbidity and microbiology of catheter‐associated urinary tract infections. Research and development in recent years has focused on producing antibacterial coatings for the indwelling Foley catheter with insufficient attention to its design. This article provides a critical examination of the design of the indwelling Foley catheter. Design specifications are outlined for a urine collection device that should reduce the vulnerability of catheterised urinary tract to infection. The indwelling urinary catheter is the most common cause of infections in hospitals and other healthcare facilities 1 . As long ago as 1958, Paul Beeson 2 warned ‘… the decision to use this instrument should be made with the knowledge that it involves the risk of producing a serious disease which is often difficult to treat’. Since then, scientific studies have progressed revealing a greater understanding of the bladder's defence mechanisms against infection and how they are undermined by the Foley catheter 3 - 5 . In addition, the complications caused by the development of bacterial biofilms on catheters have been recognised and the ways in which these bacterial communities develop on catheters have become clear 5 , 6 . It is now obvious that fundamental problems with the basic design of the catheter, which has changed little since it was introduced into urological practice by Dr Fredricc Foley in 1937 7 , induce susceptibility to infection. These issues need to be addressed urgently if we are to produce a device suitable for use in the 21st century.     

Study of three urethral pressure recording devices: Theoretical considerations

Summary Using a bladder-urethra model, 2 perfusion catheters (open side and open tip) were compared to the balloon catheter. The most accurate results were obtained using the balloon catheter. Based on the law of continuity and Bernouilli's law, the disadvantage of the open side catheter is due to the inconstant diameter of the sum of the side holes. Therefore, the measured pressure is not necessarily identical to the real pressure. The open tip catheter measures the opening pressure and the recorded pressure does not necessarily reflect the pressure at the site of the tip hole. The balloon catheter has elastic and plastic characteristics. Optimum results were obtained only with prestretch of the balloon and with calibration before and after each study. This catheter was the most complicated, but produced the best results and gave rise to the least irritation.     

Peritoneal dialysis catheter insertion strategies and maintenance of catheter function

It has been more than 40 years since permanent peritoneal dialysis (PD) access with the Tenckhoff catheter was first described, and despite much experimentation with catheter design and insertion techniques, access to timely and skilled PD catheter insertion remains a barrier to more widespread PD use in many centers. This article reviews different insertion techniques with a focus on both mechanical outcomes as well as logistic advantages associated with the embedded catheter and percutaneous techniques. Maintenance of catheter function is discussed with a focus on an organized and evidence-based approach to preventing and treating mechanical catheter problems.     

Analysis of a new technique to stabilize the chronic peritoneal dialysis catheter

A significant cause of morbidity for peritoneal dialysis patients is catheter dysfunction. In our experience, the most common cause of catheter dysfunction was cephalad migration of the catheter tip out of the true pelvis. A new technique for catheter placement that reduces catheter migration from 35% to 6% (P less than .01 chi 2) is described. Our results demonstrate that peritoneal catheters which dysfunction because of catheter flip generally do so in the first 3 months.     

A new technique to remove a “stuck” totally implantable venous access catheter

Removal of a totally implantable venous access device (port) is usually a simple procedure; however, if a catheter has been in place for a very long period, it may adhere firmly to the vessel wall. We report a new technique to facilitate removal of a stuck catheter. A 16-year-old girl was admitted for removal of her port, which had been inserted for chemotherapy 11 years earlier. After her disease was controlled, the catheter could not be pulled out during surgery. To remove the catheter, we inserted a guidewire to straighten the catheter and then applied a “push-in” force to detach the adherence from the central vein. The catheter was then removed successfully. We believe that this is a new and simple method for removing a “stuck” catheter.     

Epidural catheter-induced paresthesia accompanied by changes in skin color and temperature in an obstetric patient

Placement of epidural catheters for labor analgesia is a common procedure that has become more popular in recent years. However, this procedure can often cause paresthesia, which is typically characterized as a transient and intense burning pain radiating to the hip or leg. In this case report, we describe a patient who had persistent paresthesia in her right foot caused by an indwelling epidural catheter, which was successfully relieved following a partial withdrawal of the epidural catheter. More interestingly, we also observed dramatic changes in skin color and temperature (cold and pale) on her right foot that was well correlated both in time and location with the epidural-induced paresthesia. This cold and pale skin on the right foot represents a localized sympathetic discharge associated with the epidural-induced paresthesia, a phenomenon that has not previously been described. Based on the location of the paresthesia and the pathway of the sympathetic nerve fibers, it is unlikely that this localized sympathetic discharge was due to a direct irritation of the preganglionic sympathetic fibers in the spinal nerve roots by the epidural catheter and thus, a spinal reflex was probably involved. This phenomenon provided us with additional clinical evidence of nerve root irritation, which prompted us to act quickly, and resulted in a favorable outcome.     

外周静脉留置针拔管指征的实验研究

目的 通过动物实验研究静脉条索状改变血管的病理变化转归及其发生的相关因素,探讨合适的静脉留置针拔管指征.方法 将24只大耳健康新西兰白兔的耳缘静脉（48条）随机分为三组,进行静脉留置针输液,分别留置72h、120 h和168 h,拔针前评估静脉有无条索状改变;对所有拔除静脉留置针7d后的静脉血管活体标本做病理切片观察.结果 随着静脉留置针留置时间的延长,其静脉条索状改变发生率增加,三组比较,差异有统计学意义（P＜0.01）.在对拔除静脉留置针7d后的静脉血管活体标本病理切片观察发现,触及条索状改变的静脉血管切片均有较大机化血栓且再通呈网状或环状贴在血管内部,造成血管腔变窄或半堵塞,使留置部位静脉血管功能受损甚至失去功能.结论 不应以静脉出现条索状改变作为静脉留置针拔除指征,而应以时间为参考条件基础上,注重局部表现的评估,在患者留置72 h后应每天在输液前、输液后和患者主诉不适时评估血管,在有静脉炎早期表现时,及时拔出静脉留置针,避免静脉发生条索状改变.     

大网膜部分切除在腹腔镜腹膜透析管置入术的应用价值

目的探讨大网膜部分切除术在慢性肾脏病5期患者腹膜透析管置入术中的应用价值。方法选择郑州大学第一附属医院腹腔镜外科于2017-01—2019-08间收治的268例慢性肾脏病5期患者,其中190例行常规腹腔镜下腹膜透析管植入术(常规腹腔镜组)、78例行腹腔镜下腹膜透析管置入并大网膜部分切除术(大网膜切除组)。对2组患者的临床资料进行比较分析。结果2组患者的年龄、性别、术前血红蛋白、术前肌酐值等一般资料差异无统计学意义(P>0.05)。268例手术均获成功,大网膜切除组手术时间长于常规腹腔镜组,手术费用多于常规腹腔镜组;常规腹腔镜组堵管10例,大网膜切除组无堵管病例。差异均有统计学意义(P<0.05)。结论腹腔镜下腹膜透析管置入并大网膜部分切除术,对预防术后大网膜包裹腹膜透析管效果良好,具有临床应用价值。     

Peritoneal dialysis catheter management and exit-site care: an Australian survey of current practices

Summary: In view of the apparently high prevalence of patient dropout from peritoneal dialysis due to peritoneal catheter related issues, a national survey was undertaken to examine current unit practices and to identify areas in which changes in procedure might lead to improved results. Problems related to the catheter itself accounted for 28% of the principal indications for removal of the peritoneal catheter. A number of practices were identified as potentially suboptimal, which, if changed, might lead to improved outcomes. In determining placement, the exit-site was marked while the patient was seated, and patient preference taken into account in less than two thirds of the units. Skin preparation, including shaving of the abdominal wall prior to catheter insertion, and administration of prophylactic antibiotics were not universally practised. Dedicated surgeons performing the procedure were available in less than half of the units. Techniques to expel air from the dacron cuffs at the time of placement were used in only one-third of the units. Laparoscopy was used in only a small percentage of units. Other practices identified as potential means of improving outcomes were use of a stylet to manoeuvre the catheter into place and a trocar to create the exit-site, facing the exit-site in a downward position, creating the exit-site the same diameter as the catheter, not using sutures at the exit-site, delaying the use of the catheter for dialysis, delaying showering early after implantation and not using strong oxidants such as povidone iodine. It is hoped that review of some current procedures in light of these results might reduce the high prevalence of loss of peritoneal catheters.     

Formation of a calcified "cast" in a long-term indwelling central venous catheter: a case report

Catheter-related central venous thrombosis is a complication seen with long-term indwelling central venous catheters. The uses of total parenteral nutrition, catheter location, and duration of catheter use have been shown to increase the risk of thrombus formation. However, organized calcification of such a thrombus is a rare occurrence and, to our knowledge, has never been reported in a patient unexposed to total parenteral nutrition. We report a patient with an extensive, organized, calcified “cast” surrounding a central venous catheter used solely for chemotherapy administration.     

肝血流出道阻断后腹腔镜肝切除术

目的:探讨下腔静脉气囊导管阻断肝静脉流出道在腹腔镜肝切除术中的可行性。方法:用特制的带中央分流管的气囊导管阻断肝静脉血流,观察血流动力学和下腔静脉、肝静脉血流改变,行左半肝切除。结果:受试动物均耐受了腹腔镜左半肝切除。实验过程中平均动脉压轻度下降,心输出量下降至基础值的70％,中心静脉压下降明显,气囊内液体排除后,血流动力学指标均立即恢复正常。气囊充盈后,肝静脉血流几乎消失,下腔静脉中有部分血流通过。结论:用带中央分流的气囊导管阻断肝静脉血流行腹腔镜肝切除术安全、可行。     

Valve System Does Not Reduce the Catheter-Related Bloodstream Infection

ABSTRACT?

Background: The Groshong catheter (GC) is considered to have a lower risk of central venous catheter-related bloodstream infection (CVC-RBSI) than conventional catheters because of its valve system (closed-end) for preventing blood reflux. However, few studies have compared the GC with conventional (open-end) catheters in terms of catheter-related complications. Purpose: To compare the incidence of catheter-related complications including CVC-RBSI between the GC and the Argyle catheter (AC). Methods: The GC and the AC were inserted in the same way from the internal jugular vein. Catheter-related complications were evaluated from the database retrospectively. Results: Two hundred seventy GCs were inserted in 123 patients, and 251 ACs were inserted in 135 patients. There were no significant differences in patient background factors between GC and AC use, except for the following two parameters. Use of GC was associated with a longer catheter insertion length and a younger patient age. Univariate analysis revealed that neither type of catheter reduced the incidence of CVC-RBSI. Kaplan-Meier analysis and log rank test revealed no significant difference between the GC and the AC in the period from insertion to development of complications. Conclusions: The GC has no superiority over the conventional AC for preventing CVC-RBSI.     

A DOUBLE LUMEN SUPRAPUBIC URODYNAMIC CATHETER

A 7.5 FG double lumen suprapubic urodynamic catheter has been developed to avoid the effects of urethral catheterization and provide reliable continuous pressure monitoring. The device is an adapted central venous catheter which is easily introduced through a peel-away sheath, after the insertion of a guide wire.     

A MODIFIED COMBINATION TECHNIQUE FOR PERFORMING DIAGNOSTIC PERITONEAL LAVAGE

Existing open diagnostic peritoneal lavage techniques (DPL) use small bore catheters. through a small lower midline incision or infra-umbilical incision. This study evaluated a modified DPL technique using a 10 mm umbilical incision. with open insertion of a 20 French peritoneal lavage catheter. The catheter has 27 radial side holes in the terminal distal 13 cm, and a female Leur lock connector, Warmed saline is infused via a cystoscopy infusion set. The time required to peform a new technique was studied in 10 patients. The median time to catheter insertion was 2.4 ±3.8 min, infusion time 0.75± 0.3 min, effusion time 0.3 ±1.7 min, and a median total time of 7.6 ± 4.2 min (median ± s.d.). There were no complications. This technique of DPL is cosmetically attractive, much quicker than existing techniques and we have found its initial use encouraging.     

Directional differences in urethral pressure recordings: Contributions from the stiffness and weight of the recording catheter

The difference between urethral pressures measured along the anterior wall and those measured along the posterior wall was found to increase markedly as the stiffness of the catheter was increased and to increase by a greater amount if the weight of the catheter was increased. A method of grading the stiffness of catheters is proposed and the use of stiff catheters in past reports of urethral measurements is discussed.     

A Central Venous (W-B-W) Catheter for Multipurpose Vascular Access in Children

A central venous (W-B-W) catheter has been developed for vascular access in children of all ages and sizes. The catheter design and implantation technique permit nonsurgical bedside adjustment of catheter position and ease of removal. Multiple possible uses include intravenous fluid administration, blood sampling, central venous pressure monitoring, and plasma exchange therapy in addition to hemodialysis. Twenty-seven W-B-W catheters were placed in 24 patients in a 12-month period. The catheter provided adequate blood flow for hemodialysis. Seven catheters were removed nonelectively in five patients. One episode of catheter-associated sepsis occurred after renal transplantation in a patient on immunosuppressive therapy. It is concluded that the W-B-W catheter is a relatively safe, multipurpose, pain-free acute vascular access for children, which may also suffice for chronic hemodialysis.     

IMPROVED PERCUTANEOUS INSERTION OF LONG-TERM CENTRAL VENOUS CATHETERS IN CHILDREN: THE ‘SHRUG’ MANOEUVRE

Background : Surgical central venous access in children usually requires open exposure of the internal jugular vein or one of its tributaries. The percutaneous route has the potential advantages of a reduced rate of wound infection, superior cosmesis and reduced operating time. We report our modifications to the percutaneous approach that facilitate the application of this technique to children over the age of 12 months. Methods : The dilator and peel-away sheath of the introducer set should be inserted into the subclavian vein under fluoroscopic control. Elevation of the ipsilateral shoulder assists passage of the peel-away sheath and subsequently the catheter from the subclavian vein into the superior vena cava. Results : This technique has been used successfully to establish surgical central venous access in the majority of children at the Women’s and Children’s Hospital, Adelaide, South Australia, over a 3-year period. Conclusions : With the modifications described this technique may be safely applied to the paediatric age group.     

Sodium citrate 4% locking solution for central venous dialysis catheters--an effective, more cost-efficient alternative to heparin.

BACKGROUND: Thrombosis of the central venous haemodialysis catheter compromises dialysis adequacy and catheter survival. Heparin containing catheter-locking solution has been associated with bleeding, interferes with INR (prothrombin time/international normalized ratio) measurements and is costly. Sodium citrate has been used successfully as a catheter-locking solution, but long-term experience with its use as the exclusive locking solution has not been published. METHODS: Our haemodialysis unit converted to locking all central venous haemodialysis catheters with sodium citrate 4% instead of heparin 10 000 U/ml. A retrospective analysis compared the outcomes of the year prior and after the conversion. Flow-related catheter exchange rate, prevalence of INR assay interference, tissue plasminogen activator (rt-PA) utilization rate, rate of bacteraemias and annual cost of locking agent were examined. RESULTS: During the study period, 30 925 and 37 139 catheter days were identified during the heparin and citrate years, respectively. The rate of flow-related catheter exchange was not different during the two periods (1.81 vs 1.88 per 1000 catheter days, P = 0.89). Falsely elevated INR values were eliminated with citrate and the rate of rt-PA treatments was similar during the two periods (4.1 vs 3.23 per 1000 catheter days respectively, P = 0.07). The number of bacteraemias was similar during the two periods (0.77 vs 0.94 per 1000 catheter days respectively, P = 0.36) There was an 85% reduction in the costs associated with catheter-locking therapy during the citrate period. CONCLUSIONS: The pharmaco-economic benefits of sodium citrate 4% are well supported by this analysis. Furthermore, citrate offers several clinical advantages over concentrated heparin: citrate lock avoids heparin-associated bleeding complications, improves reliability of INR assays and provides an effective alternative for patients with suspected or confirmed heparin-induced thrombocytopenia.     

The Efficacy of Prophylactic Antibiotics Administration prior to Insertion of Tunneled Catheter in Hemodialysis Patients

Aim and background: Central venous catheter (CVC)-related blood stream infection is a major cause of morbidity and mortality in patients with end-stage renal diseases. However, CVCs are quite frequently required for vascular access in hemodialysis (HD) patients. Tunneled catheters (TCs) are widely used when a catheter is needed for a long period. However, long-term catheter survival is limited by TC-related infections. The purpose of this prospective study was to assess clinical outcomes of prophylactic antibiotics administration prior to insertion of TCs in HD patients. Material and methods: Sixty uremic patients who required TC insertion due to vascular access failure were included in our study between April 2009 and April 2010. Patients were randomized into two groups: group I and group II. Group I received 1 g of cefazolin sodium intravenously 1 h prior to catheter insertion. Group II received equal amount of saline intravenously 1 h prior to catheter insertion. The primary end points of the study were catheter loss, hospitalization, or mortality due to catheter-related infections (CRIs). The secondary end points included exit-site infection (not requiring hospitalization), tunnel infections (not requiring catheter removal), and bacteremia. Results: During the follow-up period, one patient in group I and three patients in group II reached primary end point (p < 0.05). Catheter loss due to infection was higher in group II than in group I as 6 versus 3, respectively (p < 0.05). Catheter exit-site infections, which does not require hospitalization, have been considered as secondary end points and have been detected in four patients for 7 times in group I and in six patients for 10 times in group II (p < 0.05). Tunnel infection, which does not require removal of the catheter, has been detected in two patients for 3 times in group I and in five patients for 6 times in group II (p < 0.05). Conclusion: The prophylactic antibiotic use prior to TC insertion significantly reduced CRIs, bacteremia, and catheter loss.