A new urethral catheterisation device (UCD) to manage difficult urethral catheterisation

S Bugeja, K Mistry, I H W Yim, A Tamimi, N Roberts, A R Mundy, S Bugeja, K Mistry, I H W Yim, A Tamimi, N Roberts, A R Mundy

Abstract

The cost of urethral catheterisation injury (UCI) is significant, but the true incidence of patient care error is difficult to establish in the absence of specific hospital codes recording difficult urethral catheterisation (DUC) and UCI. For many years urologists are familiar passing a non-traumatic hydrophilic guidewire blindly into the bladder to aid urethral catheter insertion in difficult circumstances. However, so far, no purpose-built regulated medical device was available on the market and clinicians had to improvise. Urethrotech filled that gap and developed the Urethral Catheterisation Device (UCD®), which integrates a standard hydrophilic Nitinol guidewire into a 3-way 16F Silicone urethral catheter design to enable safe second-line urethral catheterisation when first-line catheterisation with a standard urethral catheter is unsuccessful. The safety and efficacy of UCD® catheterisation were evaluated in consecutive cohorts of men undergoing cardiac surgery and compared to the incidence of DUC and UCI with standard Foley catheterisation. A simple new Male Catheterisation Algorithm is proposed that can deliver a safe male urethral catheterisation treatment protocol for all clinical settings of healthcare services, which is easy to implement and integrate into standard catheterisation training programs to manage DUC and avoid UCI, empowering a frontline workforce to deliver better patient care.

Keywords: Difficult urethral catheterisation; Male catheterisation algorithm; Urethral catheterisation device; Urethral catheterisation injury; Urethrotech.

Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Urethrotech Urethral Catheterisation Device (UCD®)
Fig. 2
Fig. 2
New Male Catheterisation Algorithm to manage difficult urethral catheterisation
Fig. 3
Fig. 3
Urethral catheterisation adverse events. Group A: standard Foley catheterisation; group B: UCD® catheterisation

References

    1. Jain P, Parada JP, David A, Smith LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med. 1995;155(13):1425–1429. doi: 10.1001/archinte.1995.00430130115012.
    1. Bacsu C, Van Zyl S, Rourke KF. A prospective analysis of consultation for difficult urinary catheter insertion at tertiary care centres in Northern Alberta. Can Urol Assoc J. 2013;7(9–10):343–347. doi: 10.5489/cuaj.574.
    1. Thomas AZ, Giri SK, Meagher D, Creagh T. Avoidable iatrogenic complications of urethral catherisation and inadequate intern training in a tertiary-care teaching hospital. BJU Int. 2009;104(8):1109–1112. doi: 10.1111/j.1464-410X.2009.08494.x.
    1. Kashefi C, Messer K, Barden R, Sexton C, Parsons JK. Incidence and prevention of iatrogenic urethral injuries. J Urol. 2008;179(6):2254–2257. doi: 10.1016/j.juro.2008.01.108.
    1. Leuck AM, Wright D, Ellingson L, Kraemer L, Kuskowski MA, Johnson JR. Complications of Foley catheters—is infection the greatest risk? J Urol. 2012;187(5):1662–1666. doi: 10.1016/j.juro.2011.12.113.
    1. Davis NF, Quinlan MR, Bhatt NR, Browne C, MacCraith E, Manecksha R, Walsh MT, Thornhill JA, Mulvin D. Incidence, cost, complications and clinical outcomes of iatrogenic urethral catheterization injuries: a prospective multi-institutional study. J Urol. 2016;196(5):1473–1477. doi: 10.1016/j.juro.2016.05.114.
    1. Awad MA, Ostenberg EC, Chang H, Gaither TW, Alwaal A, Fox R, Breyer BN. Urethral catheters and medical malpractice: a legal database review from 1965 to 2015. Transl Androl Urol. 2016;5(5):762–773. doi: 10.21037/tau.2016.08.02.
    1. Feneley RCL, Hopley IB, Wells PNT. Urinary Catheters: history, current status, adverse events and research agenda. J Med Eng Technol. 2015;39(8):459–470. doi: 10.3109/03091902.2015.1085600.
    1. Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol. 1953;39(5):368–376. doi: 10.3109/00016925309136722.
    1. Blitz BF. A simple method using hydrophilic guide wires for the difficult urethral catheteriszation. Urology. 1995;46(1):99–100. doi: 10.1016/S0090-4295(99)80169-1.
    1. Villanueva C, Hemstreet G., III The approach to the difficult urethral catheterization among urology residents in the United States. Int BrJ Urol. 2010;36(6):710–717. doi: 10.1590/S1677-55382010000600009.
    1. Zammit PA, German K. The difficult urethral catheterization: use of a hydrophilic guidewire. BJU Int. 2004;93(6):883–884. doi: 10.1111/j.1464-410X.2003.04732.x.
    1. Levy B, Charkin A. A revised guide-wire techniques for urethral catheter insertion. Ann R Coll Surg Engl. 2006;88:224–232.
    1. Ghaffary C, Yohannes A, Villanueva C, Leslie SW. A practical approach to difficult urinary catheterizations. Curr Urol Rep. 2013;14(6):565–579. doi: 10.1007/s11934-013-0364-3.
    1. Wagner KR, Bird ET, Coffield KS. Urinary catheterization: a paradigm shift in difficult urinary catheterization. Curr Urol Rep. 2016;17(11):82. doi: 10.1007/s11934-016-0641-z.
    1. Villanueva C, Hemstreet GP., III Difficult male urethral catheterization: a review of different approaches. Int Braz J Urol. 2008;34(4):401–412. doi: 10.1590/S1677-55382008000400002.
    1. Chenoweth CE, Gould CV, Saint S. Diagnosis, management and prevention of catheter-associated urinary tract infections. Infect Dis Clin N Am. 2014;28(1):105–119. doi: 10.1016/j.idc.2013.09.002.
    1. Atala A, Steinbock GS. Self-retaining follower for urethral strictures. Urology. 1991;38(1):66. doi: 10.1016/0090-4295(91)80018-3.
    1. Freid RM, Smith AD. The Glidewire technique for overcoming urethral obstruction. J Urol. 1996;156(1):164–165. doi: 10.1016/S0022-5347(01)65975-5.
    1. Özkan B, et al. Difficult Urethral Catheterization in Cardiovascular Surgery Patients: do you have a Road Map? J Neph Urol Res. 2014;2:32–36. doi: 10.12970/2310-984X.2014.02.02.3.
    1. Bugeja S, Frost A, Ivaz S, Barker N, Dragova M, Mundy AR. Managing difficult urethral catheterization after urethroplasty using the new urethrotech™ urethral catheterisation device (UCD) World J Urol. 2016;34(Suppl 1):61.
    1. Dragova M, Bamfo A, Holmes K, Attard K, Bugeja S, Lock A, Frost A, Mundy AR (2018) Incidence of difficult re-catheterisation in nurse-led trial-without-catheter (TWOC) and catheter-change clinics: does re-catheterisation using a guide wire make a difference? (accepted for publication in summer edition 2018) ). Accessed 31 May 2018
    1. Dragova M, Lock A, Chiriaco G, Holmes K, Attard K, Bugeja S, Castiglione F, Bamfo A, Frost A, Mundy A (2018) Prevention of catheterisation trauma by adopting a new urethral catheterisation device (UCD®). EAUN2018 Video Session. . Accessed 31 May 2018
    1. NICE Medtech innovation briefing [MIB116] (2017) Urethrotech UCD for difficult of failed catheterisation. . Accessed 31 May 2018

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe