Assessment of serum symmetric dimethylarginine and creatinine concentrations in cats with urethral obstruction

Objectives The aims of this study were to evaluate serum symmetric dimethylarginine (SDMA) and creatinine concentrations in cats with urethral obstruction pre- and post-decompression of the obstruction, and to determine if pre-decompression values were predictive of post-decompression renal function, as measured by SDMA and creatinine. Methods This was a prospective observational study. Twenty-five client-owned cats with urethral obstruction were hospitalized for decompression of the obstruction. Serum SDMA and creatinine were prospectively assessed at presentation, 24 h post-decompression and 5–20 days post-decompression. Urinalysis and culture were assessed at presentation and at the final follow-up. Exclusion criteria included positive urine culture, reobstruction or failure to obtain required samples. Results Mean SDMA concentration dropped by 41.8% from an initial pre-decompression concentration of 17.6 µg/dl to 10.3 µg/dl 24 h post-decompression ( P <0.001). The mean creatinine value dropped by 38.4% from an initial pre-decompression concentration of 2.5 mg/dl to 1.5 mg/dl 24 h post-decompression ( P <0.001). There was no association between SDMA concentration at initial presentation and SDMA concentration 5–20 days after urethral catheterization (Spearman’s ρ = 0.205, P = 0.314). Creatinine concentration upon initial presentation was associated with the 5–20 day values after urethral catheterization (Spearman’s ρ = 0.583, P <0.002). Twenty percent of cases were excluded due to bacterial growth on initial urine culture. SDMA and creatinine concentrations were significantly higher in these cases (median 59 µg/dl and 10.9 mg/dl, respectively) compared with those with negative cultures (median 14 µg/dl and 1.6 mg/dl [ P <0.002 and P <0.001], respectively). Conclusions and relevance Both SDMA and creatinine decreased significantly after urethral catheterization, suggesting that renal function post-decompression cannot be predicted by the pre-decompression concentrations of these values.

Development of a Leaking Urachal Fistula in A BPH Patient with Recurrent Acute Urinary Retention: A Case Report

FE is a 65yr old retired civil servant who developed lower urinary tract symptoms associated with recurrent acute urinary retentions relieved each time by urethral catheterization. In one episode he started leaking urine from the umbilicus. A fistulogram outlined an irregular fistulous cavity in the lower anterior abdominal wall. Patient had excision of the fistulous tract and communication with bladder sealed. He had uneventful post operative recovery and is being worked up for open simple prostatectomy for his large prostate.

1059 Confidence and Knowledge of Urethral Catheterization and Complications Amongst Junior Doctors: The Immediate Impact of Peer-Led Clinical Mentorship

Aim Approximately 20% of inpatients have urinary catheters. Deficiencies in knowledge and errors in catheterization techniques can cause short and long-term complications. This study aims to evaluate the short-term benefit of peer-led sessions on the knowledge and confidence of junior doctors in performing urethral catheterizations. Method 81 Foundation Year doctors participated in a one-hour basic catheterization workshop. Data was collected via a validated questionnaire covering three domains (confidence, procedural knowledge, and knowledge about complications) administered before and after the workshop. Confidence was measured using a 5-point Likert scale; knowledge was assessed through 10 questions about the procedure and three further questions about complications. Data are expressed as mean±standard deviation and were analyzed using SPSS v23. Result The majority (96.4%) had performed less than five catheterizations. 21% felt adequately trained to catheterize, 70% believed they would benefit from semi-formal training, and 97.5% found the information covered in the session to be very useful. The average pre-session confidence in performing easy and difficult catheterizations were 3.03±1.05 and 2.01±1, respectively, and increased to 3.7±1 and 3±1.1, respectively, following the session (p &lt; 0.005). Out of a total of 10 points, pre-workshop knowledge assessment scores were 3.9±1.6 and increased to 8.85±1.4 (p &lt; 0.005). Likewise, from a total of three points, the average pre-session knowledge of complications score was 1.75±0.7, which increased to 2.65±0.6 after the session (p &lt; 0.005). Conclusions Peer-led mentorship is an important and efficient educational tool. Short sessions have shown to improve the confidence and knowledge of junior doctors in urethral catheterization.

Urethral catheterization: do nurses have adequate exposure?

Background: Urethral catheterization is a vital basic skill which not learnt properly will lead to numerous complications. The aim of the study is to assess the knowledge and practice of urethral catheterization procedure among the nursing students. Methods: This study was conducted by a questionnaire to all the nurses in our hospital. It includes precautionary methods, knowledge of urethral catheterization procedure and the necessity for the demonstration of the procedure to the nurses.Results: A total of 120 nurses were included in the study. During training program, all were able to define and observed urethral catheterization. Overall, 19% did not perform the procedure as undergraduates and only14% passed >10 urethral catheterization. On assessing the steps, 61% described the steps involved in catheterization and 87% listed the possible complications of catheterization. Meanwhile, 93% revealed the need for practical demonstration of procedure during their training phase. Conclusions: With regards to urethral catheterization, poor practical experience was observed in nurses. An attempt should be formulated to enhance the supervised urethral catherization training programme conducted for nurses, in order to deliver preventable complications.

The impact of guidelines on sterility precautions during indwelling urethral catheterization at two acute-care hospitals in Sweden - a descriptive survey

Background To support a uniform and evidence-based practice for indwelling urinary catheterization in adults The European association of Urology Nurses (EAUN) published guidelines for this procedure in 2012. The Swedish national guidelines are based on the sterility precautions advocated by EAUN. Some hospitals have local guidelines with other requirements concerning sterility and leave to staff to decide how to perform the catheterization. The aim of this descriptive survey was to investigate the nurses´ self-reported sterility precautions during indwelling urethral catheterization at two acute-care hospitals, where the local guidelines differ in their sterility requirements. The study also aimed to analyze factors affecting conformity with sterility precautions in the EAUN-guidelines. Methods A structured questionnaire with questions concerning the participant, working conditions and performance of indwelling urethral catheterization was left to 931 nurses in two acute care hospitals. Chi-square test, Fisher’s exact test and Mann-Whitney U-test were used for descriptive statistics. Logistic regression was used to analyze variables associated with practicing the sterility precautions in the EAUN-guidelines. Results Answers were obtained from 852 persons (91.5%). Most of the participants called their insertion technique “non-sterile”. Regardless of designation of the technique the participants said that the indwelling urinary catheter (IUC) should be kept sterile during procedure. Despite that not everyone used sterile equipment to maintain sterility of the catheter. The nurses´ conformity with all the sterility precautions in the EAUN-guidelines were associated with working at departments for surgery and cardiology (OR 2.35, 95% CI 1.69–3.27), use of sterile set for catheterization (OR 2.06, 95% CI 1.42–2.97), use of sterile drapes for dressing on insertion area (OR 1.91, 95% CI 1.24–2.96) and using the term “sterile technique” for indwelling urethral catheterization (OR 1.64, 95% CI 1.11–2.43). Conclusions Only 55–74% of the nurses practiced one or more precautions that secured sterility of the IUC thus demonstrating a gap between the EAUN-guidelines and the actual performance. Adherence to the guidelines was associated with factors that facilitated an aseptic performance such as using a sterile set and sterile drapes. Healthcare-settings should ensure education and skill training including measures to ensure that the IUC is kept sterile during insertion.