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Catheter-associated urinary tract infections are commonly reported health care-associated infections. It was demonstrated that the urinary catheter alleviation navigator protocol (UCANP) pilot resulted in a reduction of catheter utilization and catheter days. Quality improvement initiative that was implemented at a single urban, tertiary health care center, focusing on early discontinuation of indwelling urinary catheters (IUCs) and avoidance of reinsertion. The protocol was expanded hospital-wide from September 2020 to April 2022. We compared IUC utilization, IUC standardized utilization ratio (SUR), and catheter-associated urinary tract infection standardized infection ratio in the preintervention period (March 2020 to August 2020) to the postintervention period (May 2022 to October 2022). Preimplementation, 2 patients with IUC removal were placed on UCANP. Postimplementation, 835 (45%) patients with IUC removal participated in the protocol. The number of patients requiring IUC reinsertion did not differ among the 2 groups. IUC utilization was significantly decreased from 0.28 to 0.24 with a 14% reduction (P =.025). SUR decreased by 11% from 0.778 to 0.693 (P =.007) and standardized infection ratio by 84% from 0.311 to 0.049 (P =.009). Our protocol significantly reduced IUC utilization and SUR after hospital-wide implementation. UCANP is a safe and effective strategy that can potentially decrease unnecessary IUCs in patients with transient urinary retention. • UCANP significantly reduced IUC utilization after hospital-wide implementation. • CAUTI rate was decreased when combining UCANP with other interventions. • UCANP is a safe and effective approach to managing transient urinary retention. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the impact of family synchronized empowerment education on the sense of shame and quality of life in patients discharged with catheters following radical surgery for cervical cancer. The data of 92 patients who underwent radical cervical cancer surgery and were discharged with urinary catheters from October 2022 to October 2023 were retrospectively retrieved and assessed. Patients who had surgery from October 2022 to April 2023 comprised the control group, while those who had surgery from May 2023 to October 2023 formed the observation group, with 46 patients in each group. The control group received conventional health education, while the observation group received family synchronized empowerment education. The Social Influence Scale (SIS), Family Assessment Device (FAD), and Quality of Life Questionnaire-C30 (QLQ-C30) were used to assess patients’ sense of shame, family function and quality of life. Data on self-urination cases, urinary retention, catheter reset and urinary tract infection were collected during follow-up visits. The results showed that those from the observation group had statistically significant improvements in SIS score, FAD score, functional domain of QLQ-C30, symptom domain, six symptom scores, and overall health status score compared to the control group (p < 0.05). In addition, the observation group also had better outcomes in self-urination (p < 0.05), urine retention incidence, catheter reset rate, and urinary infection incidence (p < 0.05). Thus, family synchronized empowerment education may effectively reduce the sense of shame, enhance the quality of life for patients discharged with catheters and facilitate early catheter removal and resumption of self-urination. [ABSTRACT FROM AUTHOR]

Aim: To develop and test the psychometric properties of an expanded catheter self‐management scale for patients with in‐dwelling urinary catheters. Design: A cross‐sectional validation study. Despite the utility of the original 13‐item catheter self‐management scale, this instrument did not include bowel management, general hygiene and drainage bag care, which are fundamental skills in urinary catheter self‐management to prevent common problems resulting in unnecessary hospital presentations. The expanded catheter self‐management scale was developed with 10 additional items to comprehensively assess all five essential aspects of urinary catheter self‐management. Methods: A total of 101 adult community‐dwelling patients living with indwelling urinary catheters were recruited from Western Sydney, Australia. Using exploratory factor analysis with Varimax rotation, the number of factors to be extracted from the expanded 23‐item expanded catheter self‐management scale was determined using a scree plot. The reliability of the overall scale and subscales was measured using Cronbach's alpha. Convergent validity was assessed using Spearman's correlations between clinical characteristics, overall scale and subscales. Results: The 23‐item expanded catheter self‐management scale yielded a 5‐factor solution, labelled as: (i) self‐monitoring of catheter function, (ii) proactive, help‐seeking behaviour function, (iii) bowel self‐care function, (iv) hygiene‐related catheter site function and (v) drainage bag care function. Cronbach's alpha of the expanded catheter self‐management scale indicating all 23 items contributed to the overall alpha value. Convergent validity results showed a negative correlation between the overall expanded catheter self‐management scale and catheter‐related problems. Conclusion: The 5‐factor structure provided a comprehensive assessment of key aspects of urinary catheter self‐management essential to reduce the likelihood of catheter‐related hospital presentations. Implications: The expanded catheter self‐management scale can be used to assess and monitor effective patient‐centred interventions for optimal self‐management to prevent catheter‐related problems and improve the quality of life of patients. Impact: Many patients start their journey of living with a urinary catheter unexpectedly and are not supported with quality information to care for their catheter.The findings of this study show the correlation between catheter self‐management skills and catheter‐related problems.The expanded catheter self‐management scale (E‐CSM) assists with analysing the self‐management skills of patients living with a catheter and developing tailored interventions to prevent problems and improve their quality of life. In addition, this screening tool can be included in policies, guidelines, and care plans as a standard for improving catheter management and developing educational resources for patients. Reporting Method: STROBE checklist was used to report all aspects of this study comprehensively and accurately. Patient or Public Contribution: Patients living with indwelling urinary catheter and their carers have participated in surveys, interviews and co‐designing interventions. This paper reports the psychometric analysis of the expanded catheter self‐management scale (E‐CSM) used in the patient survey as part of the main study 'Improving Quality of Life of Patients Living with Indwelling Urinary Catheters: IQ‐IDC Study' (Alex et al. in Collegian, 29:405–413, 2021). We greatly value our consumers' contributions and continue to communicate the progress of the study to them. Their contributions will be acknowledged in all publications and presentations. In addition, all participants will be provided the option of receiving the interventions and publications generated from this study. [ABSTRACT FROM AUTHOR]

BackgroundExternal urinary collection devices (EUCDs) may serve as an alternative to indwelling urinary catheters (IUCs) and decrease the rate of catheter associated urinary tract infections (CAUTIs). PureWick® is a novel female EUCD; however, no study has definitively proven benefit regarding reduction of CAUTIs.AimWe sought to compare the CAUTI rate and IUC days before and after availability of the PureWick® EUCD at a single institution. We provide a descriptive analysis of female medical patients receiving an EUCD.MethodsA retrospective review of adult female patients admitted to a single institution on a medical service who received an IUC and/or an EUCD was performed. Patients who received an IUC in the 3 months before EUCD availability (PRE) were compared to patients who received an IUC and/or EUCD in the 12 months after (POST).ResultsOut of 848 female patients, 292 received an EUCD in the POST cohort and overall, 656 received an IUC (259 (100%) PRE vs. 397 (67.4%) POST). Compared to the PRE cohort, the POST cohort had a higher number of IUC days (median, 3 vs 2 days, p = 0.001) and a higher rate of CAUTI (infections per 1000 catheter days, 9.3 vs 2.3, p = 0.001). The rate of UTI associated with EUCD use was 9.8 infections per 1000 device days.DiscussionWhile EUCDs might appear to be a promising alternative to IUCs for female patients, this single center pre-/post-analysis found that both the number of IUC days and the CAUTI rate increased after introduction of a female EUCD.

ABSTRACT The aims of this study were to search for the presence of bacterial and fungal growth in urine samples from cats with urethral obstruction, to identify the causative infectious agents, and to compare select clinical-laboratory parameters with urine culture results after urethral catheterization. Twenty-eight male cats were enrolled in this prospective study. Urethral catheterization was performed aseptically, and the catheter was maintained for 24-48 hours with a sterile closed collection system. No antibiotics were used during this period. The first urine sample was obtained at the time of presentation, and the second, 24-48 hours after catheter removal, both by cystocentesis. Two cats (7.1%) presented a positive bacterial urine culture on the first sample. The frequency of positive urine cultures in the second sample was 52.4% (11/21 cats). One third of bacterial pathogens were Gram-positive, one third were Gram-negative, and one third were mixed isolates. Fungal cultures were all negative. There was significant association of positive urine culture results with pyuria (P=0.0128). A high frequency of positive urine cultures after urinary catheter removal was observed, despite respecting the standards of care for urethral catheters. Still, these results should be interpreted with caution, since intermittent bladder flushing was performed disconnecting the collecting system, which may have represented a critical point for bacterial contamination. It is emphasized that urine cultures should be considered as follow up in cats with urethral obstruction, after urethral catheter removal.

Background: Indwelling urinary catheters (IDUCs) are associated with complications and early removal is therefore essential. Currently, it is unknown what the effect of a specific removal time is and what the consequences of this removal time are. Research question: To present an overview of the available evidence to determine the effects of three postoperative IDUC removal times (after a certain number of hours, at a specific time of day and flexible removal time) on the development of complications in hospital. Methods: PubMed, Medline, Embase, Emcare and Cochrane Central Register of Controlled Trials were searched till 6 June, 2021. Studies were included that described the effect of the removal time in relation to re‐catheterisation, urinary tract infections (UTIs), ambulation time, time of first voiding and hospital stay. The quality of the studies was assessed with the Newcastle‐Ottawa Scale and the Cochrane Effective Practice and Organisation of Care. A narrative descriptive analysis was performed. PRISMA guidelines were followed in reporting this review. Results: Twenty studies were included from which 18 compared removal after a number of hours, 1 reported on a specific removal time and 1 reported on both topics. The results were contradicting regarding the hypothesis that later removal increases the incidence of UTIs. Earlier removal does not lead to a higher re‐catheterisation rate while immediate removal is beneficial for reducing the time to first ambulation and shortening the hospital stay. Studies reporting on specific removal times did not find differences in outcomes. No study addressed flexible removal time. Conclusions: There is inconclusive evidence that earlier removal results in less UTIs, despite the incidence of UTIs increasing if the IDUC is removed ≥24 h. Immediate or after 1–2 day(s) removal does not lead to higher re‐catheterisation rates while immediate removal results in earlier ambulation and shorter length of hospital stay. Implications of key findings: Nurses should focus on early IDUC removal while being aware of urinary retention. [ABSTRACT FROM AUTHOR]

Persons with spinal cord injury are at risk for developing debris in the neuropathic bladder. Ultrasound scan of the urinary bladder helps to (1) detect debris, (2) differentiate debris from other bladder lesions, (3) alert the spinal cord physician to review bladder management, and (4) monitor the effect of various treatment regime to clear the debris. We present 4 cases to illustrate the sonographic appearances of debris in the neuropathic bladder and how treatment plans tailored to the needs of the individual patient helped to clear the debris.

Purpose of Review: There is a dearth of robust, peer-reviewed literature detailing the epidemiology, natural history, and sequelae associated with fungal infections of urologic implants, prostheses, and permanent devices. We curated and analyzed the available literature on this topic in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses system (PRISMA) criteria. The purpose of this systematic review is to consolidate the available research and highlight areas that require greater exploration. Recent Findings: As hypothesized, the literature investigating fungal infections of urologic implants and prostheses is scant. There were, however, several studies detailing the mycobiome, clinical outcomes, and risk factors associated with fungal infections of indwelling urinary catheters. Of the 20 studies that met inclusion criteria, only 4 focused on prosthetic devices, 3 for inflatable penile prosthetics and 1 for the adjustable transobturator male system. There were 15 studies pertaining to chronic indwelling urinary catheters and 1 study about chronic nephrostomy tubes. Furthermore, there were no studies investigating fungal infections of common urologic implants such as slings, sacral neuromodulators, or artificial urinary sphincters. Summary: This detailed systematic review found that the vast majority of studies focus on fungal infections associated with indwelling urinary catheters. There are virtually no retrospective or prospective studies investigating fungal infections of the various urologic implants and prostheses routinely used. Moreover, nearly half the studies included in this review were published over 20 years ago. There is a pressing need for more foundational literature on this topic that may ultimately yield sound prophylactic and management strategies. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of no indwelling urinary catheter and vaginal gauze packing after cervical cold knife conization(CKC) on patients with cervical intraepithelial neoplasia grade Ⅱ-Ⅲ(CIN Ⅱ-Ⅲ). Methods A total of 134 patients with CINⅡ-Ⅲ and who underwent CKC in this hospital from January to November 2021 were divided into the observation group and the control group, with 67 cases in each group. After CKC was performed, patients in the observation group were not packed with vaginal gauze, and indwelling urinary catheters were fit in place. By contrast, patients in the control group were packed with vaginal gauze, and indwelling urinary catheters were fit in place. The postoperative complications, duration of hospital stay and hospitalization expenses of the two groups were compared. Results The incidence of postoperative fever and infection, related postoperative discomfort, hospitalization length and expenses in the observation group were better than those in the control group, with statistically significant differences(P<0. 05). There was no significant difference in the incidence of postoperative vaginal bleeding between the two groups(P>0. 05). Conclusion Urinary catheter indwelling and vaginal gauze packing may not be performed routinely in patients with CIN Ⅱ-Ⅲ after CKC. [ABSTRACT FROM AUTHOR]

To develop and test the psychometric properties of a self-administered scale to assess the knowledge, skills, attitudes and behaviour of nurses to support the self-management of patients living with indwelling urinary catheters. Nurses are pivotal in supporting patients with urinary catheter self-management to prevent potentially avoidable hospital presentations. However, no validated scale is available to assess nurses' attitudes and readiness for this task. A quasi-experimental design was used to collect survey data both at baseline and after the completion of the intervention. A total of 128 participants were recruited from the Western Sydney region (New South Wales, Australia), who were working in community healthcare settings. Research Electronic Data Capture (REDCap™) database was used to manage the survey data collected for data analysis purposes. This study has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN126210 0 0683831) Using a three-stage process of concept identification, item construction and pilot testing to develop the Catheter Assessment, Management and Performance (CAMP) scale, followed by factorial and discriminant validity and reliability testing. This 23-item CAMP scale is theoretically informed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model, recognised for its effectiveness in understanding and influencing behaviour change. The scale was distributed to nurses working in three community health care settings to assess their knowledge, attitude and behaviour regarding catheter management and performance. Four factors were identified using scree plot, accounting for 63.36 % of total explained variance, which reflected the four dimensions of the COM-B model. Cronbach's alpha of the overall CAMP scale (0.93) and subscales (0.92, 0.87, 0.85 and 0.86) indicate good internal consistencies. The CAMP scale was able to detect changes in nurses' self-reported behaviour change following educational intervention (85.53 versus 95.98, p < 0.001). The CAMP scale is valid and reliable scale, capable of assessing nurses' capability, opportunity and motivation to support patients, through delivery of catheter self-management education that can potentially prevent catheter-related complications and avoid hospital presentations. Future research could explore using CAMP scale among non-specialist nurses and in various clinical settings to enhance its effectiveness and generalisability. [ABSTRACT FROM AUTHOR]

• Nurse driven protocols can help reduce urinary catheter utilization. • Statistical process control charts show improvements in measures over time. • No signals of improvement were found on the urinary catheter utilization Statistical process control chart. • Assessing process and balancing measures gives a comprehensive view of a QI project. • Nurse driven protocols should be used with other strategies for catheter-associated urinary tract infections prevention. Implementing a nurse-driven protocol (NDP) to remove indwelling urinary catheters is a strategy to reduce catheter-associated urinary tract infections (CAUTI). The purpose of this project was to implement a comprehensive NDP to reduce indwelling urinary catheter utilization and CAUTI rates at a large academic health system. Statistical process control charts, a quality improvement method, was used to identify special cause variation. A formal protocol was developed to provide guidance for nurses to remove indwelling urinary catheters when no longer indicated. Changes were also made within the electronic health record. Signals of improvement were not noted on the Statistical process control charts for urinary catheter utilization or CAUTI rates. The frequency with which the NDP was documented (process measure) was assessed, showing it is used approximately 600 times each month. Of those catheters removed by the NDP, an average of 6% were reinserted within 48 hours (balancing measure). Our findings differed from other literature as we did not see a reduction in urinary catheter utilization after implementing a NDP. However, our project adds to the literature as we also evaluated process and balancing measures. A NDP for urinary catheter removal provides nurses with the autonomy to remove catheters when no longer indicated; however, other interventions should be added to a comprehensive CAUTI-prevention program. [ABSTRACT FROM AUTHOR]

Background: Catheter-associated urinary tract infection (CAUTI) commonly occurs in intensive care units (ICU) and is associated with longer hospital stays and higher healthcare costs, morbidity, and mortality. Purpose: The purpose of this study was to examine the factors associated with CAUTI in ICU patients. Methods: This study was a secondary analysis of data from a study on the usage of indwelling catheters in adult internal and surgical ICU patients at a teaching hospital in southern Taiwan conducted between January 1 and December 31, 2017. Descriptive analysis, the independent t test, chi-square test, and logistic regression were used to examine the factors associated with CAUTI. Results: Of the 1,120 patients with an indwelling urinary catheter in the ICU, 330 revealed a positive urine culture result, indicating a 29.5% prevalence of CAUTI. The average duration of indwelling urinary catheter usage was 6.55 (SD = 4.89) days. The participants averaged 69.93 years old (SD = 15.19 years), and 627 (56.0%) were men and 493 (44.0%) were women. Being female, having diabetes, having a large indwelling urinary catheter, having a longer duration of indwelling urinary catheter usage, and being unable to remove the indwelling urinary catheter during the ICU stay were found to be associated with a significantly higher risk of CAUTI. Conclusion/Implications for Practice: Women and patients with diabetes are particularly vulnerable to CAUTI. Thus, urinary catheters should be used with caution. Using smaller-sized urinary catheters and reducing the duration of urinary catheter use are suggested. The results of this study may be used to guide clinical practice to help reduce the incidence of CAUTI and enhance overall healthcare service quality. [ABSTRACT FROM AUTHOR]

Despite the many advancements in infection prevention, catheter-associated urinary tract infections (CAUTI) continue to be problematic for many hospitals. The large urban teaching hospital featured in this article developed a team that consisted of a registered nurse quality Lean coach, bedside nurses from each inpatient nursing unit, physicians, an infection prevention specialist nurse, an education specialist nurse, and members of the quality department to study this matter. The team focused on understanding current practice related to the use and duration of indwelling urinary catheters. It was discovered that while some indwelling urinary catheters were justified, others could have been avoided altogether or removed earlier. Multifaceted measures were instituted at this hospital to decrease indwelling urinary catheter days and reduce CAUTI rates. The team's journey to successfully decreasing indwelling urinary catheter days by 19.79% and CAUTI rates by 38% is highlighted. [ABSTRACT FROM AUTHOR]

This case report details the clinical management and implications of infection with pan-drug-resistant Providencia rettgeri in a 50-year-old male admitted and diagnosed with acute peritonitis due to hollow viscus perforation, highlighting an emerging challenge in healthcare settings. Following emergency laparotomy and intensive care admission, the patient was catheterized to assist urine drainage and subsequent urine bacterial culture which yielded pan-drug-resistant P. rettgeri , signifying a notable instance of nosocomial infection by a multi-drug-resistant organism. Despite the organism's resistance to broad-spectrum antibiotics, clinical improvement was observed with levofloxacin treatment, underlining the potential discrepancy between in vitro resistance patterns and in vivo response, particularly in urinary tract infections (UTIs) where urine drug concentrations are pivotal. This case underscores the necessity for heightened surveillance, stringent infection control measures, and judicious antibiotic use in managing infections caused by pan-drug-resistant pathogens like P. rettgeri , challenging the traditional paradigms of antimicrobial resistance and therapy in hospital settings., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Neelambike Sumana et al.)

Objectives: Since patients with stroke frequently develop bladder dysfunction, a careful approach is required to reduce unnecessary indwelling urinary catheter (IUC) for preventing catheter‐associated urinary tract infection (CAUTI). This study aimed to assess the effectiveness and safety of a program to promote appropriate IUC use in stroke care. Methods: We conducted a prospective interrupted time series study in three tertiary care hospitals in Japan. Adult patients with acute stroke were eligible. The study consisted of three phases: baseline, education and implementation. Our program included an assessment of IUC indications, educational meetings among healthcare professionals, reminders for removal of inappropriate IUC and a urinary retention protocol. The primary outcome was the proportion of inappropriate IUC use to assess effectiveness. The device utilization ratio and incidence of CAUTI were examined to assess effectiveness, and incidences of urinary retention and all symptomatic urinary tract infection (UTI) were examined to assess safety. Results: Among 976 patients who met the inclusion criteria, 738 were analysed. Inappropriate IUC use decreased from 50.1% in the baseline phase to 22.5% in the implementation phase (absolute risk reduction in interrupted time series analysis 42.4% [95% confidence interval, 19.2%–65.6%]). The device utilization ratio decreased from 0.302 to 0.194 (p < 0.001), whereas CAUTI did not change significantly (from 8.81 to 8.28 per 1000 catheter‐days; incidence rate ratio 0.95 [0.44–1.94]). All symptomatic UTI decreased from 9.5% to 4.9% (p = 0.015), with no increase in urinary retention. Conclusions: Our program improved the appropriateness of IUC use in stroke care while ensuring safety. [ABSTRACT FROM AUTHOR]

Nurses play a critical role in supporting patients in self-managing their indwelling urinary catheters and preventing avoidable hospital presentations. This study aimed to explore the effectiveness of a co-designed educational approach developed to enhance nurses' ability to provide optimal care for patients with catheters. The primary aim of this study was to enhance nurses' knowledge and skills in urinary catheterisation, care, and management. The secondary aim was to transform their current catheter management practices to improve patient outcomes. Nurses (n = 127) from one New South Wales, Australia region participated in the study. These nurses provided healthcare across various community settings. Ethics approval was received from the Local Health District (HREC/2019/ETH12575) and the study was registered in ANZCTR (ACTRN12621000683831). A mixed-methods approach was used, collecting data at baseline and after the intervention. Quantitative data were analysed using descriptive statistics, tests for normality, and bivariate analysis with the Wilcoxon Signed Ranks test to identify differences between variables. Qualitative data were analysed using a directed content analysis approach to categorise occurrences of specific phenomena. The composite mean knowledge score increased from 65.03 to 84.30 following the intervention (p < 0.001). In addition, the magnitude of knowledge score improvement in seven out of eight questions following the intervention were: Financial support: 1.1 %; Bladder spasm/urine leakage: 3.3 %; Blockage: 3.5 %; Catheter-Associated Urinary Tract Infection (CAUTI): 4.4 %; Self-management: 6.1 %; Sexuality: 7.9 %; and Urinary catheterisation: 11.3 %. Qualitative findings confirmed that the eLearning module was effective in transforming participants' clinical practice, towards improving patient outcomes. The co-designed eLearning module effectively addressed the learning needs of nurses, enhancing their knowledge and skills in urinary catheter management. Incorporating a theoretical model and contextual approach in the intervention delivery increased relevance, personalisation, and engagement, facilitating the behaviour change required to transform current practices. • Nurses play a vital role in supporting patients with IDC self-management and to prevent avoidable hospital presentations. • However, there are still significant knowledge and practice gaps among nurses in IDC insertion and management. • Engaging consumers was important to create authentic learning experiences that were responsive to knowledge gaps. • eLearning through Qstream offered an accessible, relevant, practical and engaging 'learning on the go'. [ABSTRACT FROM AUTHOR]

New, contextualized modern solutions must be found to solve the dilemma of catheter-associated urinary infection (CAUTI) in long-term care settings. In this paper, we describe the etiology, risk factors, and complications of CAUTI, explore different preventive strategies proposed in literature from the past to the present, and offer new insights on therapeutic opportunities. A care bundle to prevent CAUTI mainly consists of multiple interventions to improve clinical indications, identifying a timeline for catheter removal, or whether any alternatives may be offered in elderly and frail patients suffering from chronic urinary retention and/or untreatable urinary incontinence. Among the various approaches used to prevent CAUTI, specific urinary catheter coatings according to their antifouling and/or biocidal properties have been widely investigated. Nonetheless, an ideal catheter offering holistic antimicrobial effectiveness is still far from being available. After pioneering research in favor of bladder irrigations or endovesical instillations was initially published more than 50 years ago, only recently has it been made clear that evidence supporting their use to treat symptomatic CAUTI and prevent complications is needed. [ABSTRACT FROM AUTHOR]

A case of septic pulmonary thromboembolism arising from thrombophlebitis of the prostatic venous plexus associated with long-term urinary catheterisation in a 51-year-old man is reported. Despite a previous autopsy having been conducted in the country where he had been resident overseas, a re-examination showed histological evidence of mild patchy chronic prostatitis with a florid, focally purulent, thrombophlebitis of the periprostatic venous plexus with abscess formation and evidence of bacterial overgrowth. Corresponding microscopy of the lungs showed septic microthromboemboli within small pulmonary arteries with variable degrees of necrotising acute inflammation and thrombosis. Death was not due to 'acute pulmonary oedema' as had been originally certified but to septic thromboembolism. This case demonstrates the need to carefully evaluate the prostatic venous plexus at autopsy, and also the type of problems that may arise at the time of the re-examination of repatriated remains., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction In 2019, a level one trauma center in St. Louis, Missouri launched a campaign to reduce the use of indwelling urinary catheters (IUC) in the trauma population. Our study assesses whether the campaign achieved the intended effect of reducing catheter-associated urinary tract infection (CAUTI) and whether this came at the cost of increased acute kidney injury (AKI). Methods We examined a cohort of patients from before and after the IUC reduction campaign. We compared days with IUC, UTI, CAUTI, and AKI, both recorded in the registry and based on a direct review of laboratory results. Significance testing is performed with the Student's t-test for continuous variables and Fisher's exact test for categorical variables. For multivariate analysis, multivariate linear regression is used for continuous outcomes, and multivariate logistic regression is used for binary categorical outcomes.  Results On average, the post-campaign cohort was older and more severely injured. There was a modest decrease in IUC usage following the campaign, which was significant when adjusted for common trauma covariates, B=-0.93; p=0.04. There were 10 (0.4%) cases of CAUTI in the pre-intervention group versus 0 post-intervention (p=0.002). Pyuria was significantly lower post-intervention: 118 (40.3%) versus 84 (29.3%), p=0.007. This remained significant on multivariate analysis: odds ratio (OR): 0.52, p=0.008. There were no significant differences in creatinine (Cr) absolute values or temporal trends over the course of admission between the cohorts. There was no increased AKI measured by kidney disease improving global outcomes (KDIGO) criteria. Conclusion The IUC reduction protocol was associated with a significant decrease in CAUTI without a significant increase in AKI., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Roche et al.)

Background: Colovesical fistulas are uncommon but associated with significant morbidity and reduced quality of life. In cases with diverticular etiology, surgical management involves single-stage colonic resection with anastomosis and simple or no bladder repair. No single approach to postoperative bladder management has been widely accepted. Although historically a Foley catheter remained in place for about 2 weeks, elevated risk of the attendant complications has motivated exploring shorter durations. This study examined the feasibility and safety of removing the Foley catheter on postoperative day two. Methods: Patients with colovesical fistula due to diverticular disease undergoing colectomy with simple or no bladder repair were enrolled in this single-arm prospective trial conducted at a large community health system. The primary outcome was removal of the Foley catheter on postoperative day two after negative cystogram without re-insertion prior to hospital discharge. Secondary outcomes were complications after Foley catheter removal and hospital length of stay. Ninety-five percent confidence intervals were calculated for the outcomes. Results: Twenty-four patients were enrolled. About half (54%) of procedures were open, with 33% requiring simple bladder repair. Ninety-six percent (95% confidence interval, 79–99%) of patients had their Foley catheter removed on postoperative day two after a negative cystogram. There were no complications. Mean (range) hospital length of stay was 4.3 (2–6) days. Discussion: Foley catheter removal after negative cystogram on postoperative day two appears to be feasible and safe in the setting of diverticulitis-related colovesical fistula repair. Further research on a larger number of patients should confirm these findings. [ABSTRACT FROM AUTHOR]

Nurse educators are challenged to promote student success in all learning environments. Historically, students had increased anxiety associated with poor outcomes for indwelling urinary catheter skill validation. Faculty were looking for alternative ways to reduce stress, improve learning, and achieve successful student skill validations. The purpose of this process change project was to implement and evaluate an innovative teaching strategy of a psychomotor skill. Specifically, the integration of smartphone technology, self-evaluation, and peer feedback on indwelling urinary catheter skill validation was implemented and student perceptions of this strategy were evaluated. Throughout two, four-hour skills lab sessions, 81 students in the second semester of a baccalaureate program in nursing participated in peer pairs where they used smartphones to video and refine their indwelling urinary catheter skills through self-reflection and peer feedback. Students reported the utilization of technology and peer feedback positively enhanced learning and "decreased anxiety". However, students agreed integrating technology into a psychomotor skill validation was not without challenges. However, the benefits outweighed the challenges providing implications for nursing education to use smartphones to evaluate a psychomotor skill as a strategy to integrate technology, self-reflection, and peer feedback into a clinical skills lab environment. • Smartphone technology and skill validation • Decreasing anxiety during skill validation • Innovative skill validation approaches to promote student success • Promoting psychological safety during skills validation • Virtual skills validation and positive student feedback [ABSTRACT FROM AUTHOR]

Introduction: Although Indwelling Urinary Catheter (IUC) have an important role in the care of hospitalised patients, nevertheless it is associated with numerous issues that must be addressed on a daily basis. Due to its invasive nature, it is a cause of discomfort and/or pain and also a potential threat to patients safety. The various adverse effects of IUC are associated with higher risk of infection, longer hospital stay and negative impact on daily activities of the patients. Patients perspective is the best source of information for IUC related adverse effects. Aim: To estimate the incidence of all adverse effects (complications) associated with the IUC use and to reproduce patients perception about how their well-being and safety is affected by it. Materials and Methods: In this observational study, hospitalised patients with an IUC were identified and followed-up for 30 days after its insertion. Information regarding both infectious and non-infectious IUC related adverse effects (complications) was collected through patients interviews. Follow-up assessments were performed 15 days and 30 days after the catheter insertion. During this assessment patient’s perspectives about the IUC and its adverse effects were collected. All variables were categorical and percentage and proportions were calculated manually. Results: Total 390 patients were evaluated and analysed. Study comprised of 73.85% males and 26.15% females. The mean age was of 56.7±6.5 years. The IUCs was inserted before surgical procedures in 305 patients (78.2%) with 284 patients (72.82%) having them removed within five days of insertion. A total of 259 patients (66.4%) reported at least one complication because of the IUC. The non-infectious complications were 54.1% and infectious were 12.3%. Both infectious and noninfectious complications were described more commonly by patients who still had their IUC. Most common complications were feeling of urgency/bladder spasms (25.9%) in catheter removal group and pain/ discomfort (52.7%) in catheter in situ group. Conclusion: As per the patients perspective the non-infectious complications are also bothersome in addition to the infectious one and management programme should include both the component essentially.

Introduction: Although Indwelling Urinary Catheter (IUC) have an important role in the care of hospitalised patients, nevertheless it is associated with numerous issues that must be addressed on a daily basis. Due to its invasive nature, it is a cause of discomfort and/or pain and also a potential threat to patients safety. The various adverse effects of IUC are associated with higher risk of infection, longer hospital stay and negative impact on daily activities of the patients. Patients perspective is the best source of information for IUC related adverse effects. Aim: To estimate the incidence of all adverse effects (complications) associated with the IUC use and to reproduce patients perception about how their well-being and safety is affected by it. Materials and Methods: In this observational study, hospitalised patients with an IUC were identified and followed-up for 30 days after its insertion. Information regarding both infectious and non-infectious IUC related adverse effects (complications) was collected through patients interviews. Follow-up assessments were performed 15 days and 30 days after the catheter insertion. During this assessment patient's perspectives about the IUC and its adverse effects were collected. All variables were categorical and percentage and proportions were calculated manually. Results: Total 390 patients were evaluated and analysed. Study comprised of 73.84% males and 26.15% females. The mean age was of 56.7±6.5 years. The IUCs was inserted before surgical procedures in 305 patients (78.2%) with 72.82% having them removed within five days of insertion. A total of 259 patients (66.4%) reported at least one complication because of the IUC. The non-infectious complications were 54.1% and infectious were 12.3%. Both infectious and noninfectious complications were described more commonly by patients who still had their IUC. Most common complications were feeling of urgency/bladder spasms (25.9%) in catheter removal group and pain/discomfort (52.7%) in catheter in situ group. Conclusion: As per the patients perspective the non-infectious complications are also bothersome in addition to the infectious one and management programme should include both the component essentially. [ABSTRACT FROM AUTHOR]

Background: Urinary catheters are considered as one of the complicating factors for urinary tract infections (UTIs). Many factors have an important impact in the development as well as limitation of the inflammation accompanying the infection in urinary tissues In this work, we aimed at evaluating the urine levels of IL23 in patients using indwelling urinary catheters Methods: A total of ninety four patients with long-term Foley catheter usage who have been admitted to three different teaching hospitals in Baghdad-Iraq, during the period extended from September to December2019. Urine samples were collected from them. Isolation and Identification of bacteria were done according to the standard procedures and considerations. Interleukin-23 detection in urine was made using ELISA. Data were entered, checked and analyzed using SPSS version 26 and STATISTICA version 12. Results: Most of the study sample found to have a positive culture for bacteria (66%); of which 22% found to have Klebsiella pneumoniae, 21% have Escherichia coll, 12% Proteus mirabilis and 11% have Providencia stuartii. The mean of urine IL-23 concentrations in positive culture was significantly higher than that of negative one (132.547 ± 66.3644 vs. 55.266 ± 33.3776) respectively. Besides, significant differences were found in the means of urine IL-23 concentrations among different bacterial UTIs forms with mean square differences between groups was 128090.827 and within groups was 3383.801(F: 9.464, df: 4, P: 0.000) Conclusion: Urine IL23 level is likely to be affected by UTI in patients using indwelling urinary catheters. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To describe the prevalence, indications, and complications of indwelling urinary catheters use in Portuguese older inpatients. Findings: UriCath is the first Portuguese multicentric study including a high number of public hospitals, addressing the use of indwelling urinary catheter in older inpatients. Indwelling urinary catheter use among older inpatients is prevalent and often inappropriate. Message: The results of UriCath will highlight the importance of rethinking the use of indwelling urinary catheter and the need to improve geriatric skills. Purpose: Approximately 25% of older inpatients have an indwelling urinary catheter (IUC), 45–54% unnecessarily. This study aims to describe the prevalence, indications, and complications of IUC use in Portuguese older inpatients. Methods: Multicentric, cross-sectional, observational study conducted in Portuguese internal medicine wards (UriCath). Results: Of a total of 3135 inpatients from 39 hospitals, we included 628 patients with 65 years old or more using an IUC, mean age 82.0 ± 7.5. Prevalence of IUC use was 20.0%. The average Barthel Index was 44.0 ± 37.3 and Charlson comorbidity Index was 7.0 ± 2.8. The main reasons for IUC use were: urinary output monitoring (47.5%), urinary retention (22.5%), and pressure ulcers (11.0%). The IUC removal was attempted in 9.1% and 24.7% developed a complication. Conclusion: IUC use among older inpatients is prevalent and often inappropriate. Clinical awareness and development guidelines for restricted use of IUC are essential to reduce morbimortality and healthcare costs. [ABSTRACT FROM AUTHOR]

This clinical pilot study assessed time of the procedure, perceived procedural pain, and gel consumption when using a novel gel instillation clamp to facilitate the urethral instillation of gel during change of indwelling urinary catheters. [ABSTRACT FROM AUTHOR]

Copyright of Der Nephrologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the effect of 4C continuous nursing in maintenance of indwelling urinary catheter in patients with hypospadias surgery. Methods Totally 30 pediatric patients undergoing hypospadias surgery between January and June, 2018 were included as the control group, another 30 pediatric patients undergoing hypospadias surgery between July and December, 2018 were included as the observation group. The control group received routine management for maintenance of indwelling urinary catheter, while the observation group received 4C continuous nursing interventions. The level of parents' knowledge regarding catheter was evaluated. The incidence rate of catheter-related complications was compared between two groups. Results Patients in the observation group were more knowledgeable about purpose of catheter placement, precautions, catheter-related complications and other issues compared with those in the control group (P < 0.05). The incidence rate of catheter-related complications such as catheter blockage, catheter dislocation, urethiral fistula was lower in the observation group than that in the control group (P < 0.05). Conclusion The 4C continuous nursing is effective to improve the level of parents' knowledge regarding catheter, and reduce the risk of postoperative catheter-related complications. [ABSTRACT FROM AUTHOR]

Urethral characterization can be difficult for patients and providers alike. This article describes an evidence-based protocol for difficult urethral catheter insertions in male patients. [ABSTRACT FROM AUTHOR]

Objective: To report on a simple technique of inserting any difficult urinary catheter using a hydrophilic guidewire and an angiocatheter. Materials and methods: A total of 764 requests were made to the urology team for assistance with a difficult urinary catheter placement. For all patients, either a regular or bent-tip catheter was attempted first. If the initial placement attempt failed, our technique using an angiocatheter, a hydrophilic guidewire, and a urinary catheter of choice was then employed. Results: We were able to successfully insert 526 regular or bent-tip indwelling urinary catheters on first attempt (68.8%). Two hundred and four (26.7%) placements required the use of our described technique. No complication was encountered from the bedside maneuver. Conclusions: Our method is safe, easily learned, and performed. The technique saves time, effort, and resources, as it averts the necessity of rare use of expensive equipment, bedside flexible cystoscopy, and cystotomy. [ABSTRACT FROM AUTHOR]

Every day, people around the world rely on intermittent and indwelling urinary catheters to manage bladder dysfunction, but the potential or actual harm caused by these devices is well-recognised. Current catheter designs can cause urinary tract infection and septicaemia, bladder and urethral trauma and indwelling devices frequently become blocked. Furthermore, the devices can severely disrupt users' lives, limiting their daily activities and can be costly to manage for healthcare providers. Despite this, little significant design innovation has taken place in the last 80 years. In this article current catheter designs and their limitations are reviewed, common catheter-associated problems are outlined and areas of design ripe for improvement proposed. The potential to relieve the individual and economic burden of catheter use is high. [ABSTRACT FROM AUTHOR]

Copyright of Der Nephrologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Indwelling urinary catheters (IUC) are reported as the most common indwelling device in hospitals and residential/care home settings. Aim: The aim of this study was to assess the prevalence and appropriateness of IUCs in people living at home and receiving a community nursing service. Methods: An IUC self-report questionnaire was sent to 66 community nurses in one community care area. A second questionnaire was completed by the researcher on each patient (n = 80) identified by the community nurses. Data were analysed using descriptive statistics and the chi-square test was used to test associations between patient demographics, catheter changes and nurses documentation. Results: The self-report questionnaire was completed by 46 of the 52 areas (88% response rate). The overall prevalence of IUCs was 1.9% with a higher prevalence among men (70%) and in the over-85-years age group (31%). The mean age was 76 years (age range = 34–98 years) and duration of use was approximately four years. Routine IUC changes were carried out by community nurses (52%), in the acute hospital (25%) or by general practitioners (20%) and the type of catheter influenced person/location of catheter changes (P = 0.001). Discussion: This study adds to the understanding of IUCs in patients at home and is the first to investigate if the IUC is appropriate in this setting. It prompted a review of current guidance and development of standard documentation for IUC management locally to ensure that the IUC in use is appropriate. It also suggests that there is a need for internationally accepted, appropriate indications for long-term IUC use to facilitate consistency and allow comparison across studies in future. [ABSTRACT FROM AUTHOR]

Background: The indwelling urinary catheter (IUC) is a widely utilized device in modern hospital environments, yet they are not always used appropriately in hospital settings and can result in prolonged use and improper management, increasing risk of infections and length of stay. Hence, professional must have knowledge related to the management of urinary catheterization. Aim of the study: to evaluate the impact of protocol of care of patients undergoing urinary catheterization on nurses, knowledge. Materials and Method: A quasi- experimental research design was used to conduct this study. The study was carried out at Intensive Care Unit, Urology Department and Department of Internal Medicine at Al-Azhar University hospital in Damietta City to test the hypotheses that positive changes in nurses' knowledge after implementing the protocol of care for patients undergoing urinary catheterization. The research design was a quasi-experimental design. A convenient sample of 50 nurses was included. One tool was used for data collections, part (1) Structured Interview Questionnaire tool it includes demographic data part (2) Nurse's Knowledge Assessment tool, to assess nurse's Knowledge about urinary catheterization and urinary catheter care Results: The study results demonstrated that there were statistically significant improvements in the total score of nurses' knowledge regarding care of patients undergoing urinary catheterization throughout the protocol intervention. Conclusion & Recommendations: The study recommended that providing ongoing in-service education for nurses to update their knowledge related to care of patients undergoing urinary catheterization and catheter – associated problems. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the effect of clamping the indwelling urinary catheter before its removal on bladder reconditioning in patients with cervical cancer after radical hysterectomy. Background It is suggested that indwelling urinary catheters should be clamped intermittently to fill the bladder and restore bladder function before removal. However, indwelling urinary catheter clamping showed no effect on bladder reconditioning according to some clinical studies. Design Randomised controlled study. Methods A total of 210 patients with cervical cancer after type C radical hysterectomy were randomised on 1:2 into two groups. In the clamping group, indwelling urinary catheters were clamped intermittently for 48 hours before removal based on a bladder-training sheet, while in the control group, the indwelling urinary catheters were removed without clamping. The primary outcome of the study was the rate of recatheterisation. The secondary outcomes included residual urine volume 24 hours after removal, incidence of urinary tract infection and duration of recatheterisation. Results Seventy patients were assigned to the clamping group and 128 to the control group with paralleled baseline characteristics. The days of the primary catheterisation (13·20 ± 0·79 vs. 13·38 ± 1·04) and the incidence of urinary tract infection (22·9% vs. 20·3%) had no significant differences between the two groups. Ten patients in the clamping group and 19 in the control group underwent recatheterisation, the incidence of which showed no significant difference (14·3% vs. 14·8%). The days of recatheterisation were not statistically different between the two groups (11·40 ± 6·75 vs. 9·42 ± 5·23). However, the residual urine volume 24 hours after removal was higher in the clamping group than that in the control group. Conclusions Bladder recondition through indwelling urinary catheter clamping may not restore bladder function in patients after radical hysterectomy. Relevance to clinical practice As indwelling urinary catheter clamping may increase the residual urine volume after indwelling urinary catheter removal and lead to an increased nursing workload, it should not be recommended in patients with cervical cancer postoperatively. [ABSTRACT FROM AUTHOR]

Aim: The evidence-based project sought to improve knowledge and practice in the care and securement of indwelling urinary catheters. Methods: The project utilized a pre and post-implementation audit strategy, with the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. The best practice recommendations on the care and securement of indwelling urinary catheters were retrieved from the Joanna Briggs Institute Clinical Online Network of Evidence for Care and Therapeutics database. A proposed urinary catheter securement practice, which included the use of a specifically designed securement device, was developed and implemented based on these recommendations. The implemented practice was evaluated with an audit tool which comprised two criteria recommended by the Joanna Briggs Institute Practical Application of Clinical Evidence System on the topic: Appropriate Catheter Use and Management. Audit criteria outcomes included staff compliance to training for urinary catheter securement and care and effectiveness of the implemented practice utilized to secure urinary catheters. The project was conducted in a general surgical ward over a period of 14 months, from December 2013 to January 2015. A sample of 30 inpatients was recruited at each audit phase. The sample size was decided based on recommendations from the Joint Commission International guidelines. Results: A comparison between baseline and post-implementation audit findings indicated significant improvements in both audit criteria outcomes. For the first criterion, 100% compliance (P<0.001) was achieved with all ward nurses being trained in application and care of the proposed urinary catheter securement practice. Criterion 2, which measured the effectiveness of the implemented practice, showed a nine-fold improvement from 10 to 90% (P<0.001). A sustenance audit conducted 6 months post-implementation showed that compliance rates maintained at 100% for criterion 1 (P<0.001), with further improvement from 90 to 100% for criterion 2 (P<0.001). Conclusion: The proposed indwelling urinary catheter securement practice is an effective alternative to existing nursing practices. The use of a specifically designed securement device is found to complement and enhance the quality of urinary catheter securement. Nurses exhibited greater competency and knowledge in the application and care for urinary catheter securement. [ABSTRACT FROM AUTHOR]

We report a case of postoperative urinary leakage after bilateral laparoscopic totally extraperitoneal (TEP) herniorrhaphy. A man in his upper 80s with a healed cystostomy and appendectomy underwent bilateral TEP herniorrhaphy. Urinary leakage was noted by ultrasound examination 4 days after bilateral TEP. Cystography and computed tomography conclusively confirmed a 6-mm extraperitoneal fistula at the site of the previous cystostomy. The fistula involved the anterior bladder wall and was associated with an extended urinoma. The patient was treated by indwelling catheterization using a Foley catheter and repeated ultrasound-guided puncture and aspiration of the inguinal effusion at the bedside. The patient was completely healed 69 days after the operation with no mesh infection or bladder dysfunction. We believe that urinary leakage is possible after TEP herniorrhaphy in patients with a healed suprapubic cystostomy. Therefore, indwelling catheterization using a Foley catheter should be implemented before surgery, and the Foley catheter can be removed within 1 week after surgery if no postoperative urinary leakage is observed. A history of suprapubic cystotomy should not be regarded as a contraindication for TEP surgery. This is the first report of urinary leakage after bilateral TEP herniorrhaphy in a patient with a healed cystostomy and appendectomy.

Objectives: To 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 methods: This 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. Results: Of 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). Conclusions: Inability 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.