Does catheter material affect functional performance of intravenous ports via the superior vena cava?

Introduction The catheter is the only intravascular portion of an implanted port and plays a crucial role in catheter related complications. Both polyurethane and silicone are biocompatible materials which are utilized for catheter manufacturing, but their correlation to complications remains controversial. The aim of this study was to try to analyze the relationship between catheter materials and complications. Materials and methods A total of 3144 patients who underwent intravenous port implantation between March 2012 and December 2018 at Chang Gung Memorial Hospital, Linkou, Taiwan were recruited. Of these, 1226 patients received silicone catheter port implantation and 1679 received polyurethane catheter ports. Case matching was done prior to analysis and catheter related complications and cumulative complication incidence for each group were compared. Results Intergroup differences were identified in entry vessel (p = 0.0441), operation year (p < 0.0001), operation method (p = 0.0095), functional period (p < 0.0001), patient follow up status (p < 0.0001), operating time for vessel cutdown (p < 0.0001) and wire assisted approach (p = 0.0008). Stratified by specific entry vessel, no statistical difference was found in complication rate or incidence between the silicone and polyurethane groups. We further compared the cumulative complication incidence of the silicone and polyurethane groups, and also found no statistical difference (p = 0.4451). Conclusion As long as external stress forces generated by surrounding structures and focused on potential weak points are avoided, both silicone and polyurethane materials provide sufficient structural stability to serve as reliable vascular access for patients.

Studies on Biofilm Formation by Psuedomonas Aeruginosa in Different Urinary Catheters

ABSTRACTUrinary Catheters are the leading cause of healthcare –associated Urinary Tract Infections (UTIs) making their use a necessary evil. Various models and approaches had been developed to help reduce the complications associated with the use of these catheters. This study aimed at investigating how two different types of urinary catheters (Silicone Catheter and Latex Coated Catheter) support biofilm formation of Pseudomonas aeruginosa isolates. The growth rate of the bacteria and the rate of formation of biofilm on each urinary catheter was determined by preparing biofilm assays, ranking them using crystal violet satins and measuring their absorbance using UV-VIS spectrophotometer. A difference in the level of biofilm in the catheters were observed. The differences in the level of biofilm observed in the catheters imply that different catheters may have different susceptibility for the formation of biofilms. The study recommends the assessment of biofilm formation in the quality evaluation of catheters. Also further studies should be done to investigate how different catheter material support biofilm formation and the mechanisms involved.

Surgical management of an extensive spinal epidural abscess: illustrative cases

BACKGROUNDExtensive spinal epidural abscesses (SEAs) occupying three or more spinal regions are rare. This study aimed to address the key dilemma of surgical treatment for holospinal epidural abscesses, i.e., to determine the required scope of surgery and minimize surgical trauma with adequate purulent drainage.OBSERVATIONSTwo patients with extensive SEAs were treated at the Neurosurgery Department of the Central Hospital of Ministry of Internal Affairs of Ukraine from 2018 to 2020. Both patients had a neurological deficit and general inflammatory response syndrome. Spinal magnetic resonance examinations were performed, showing that the first and second patients had extensive SEAs at T11/S1 and C2/L1, respectively. Both underwent minimally invasive abscess drainage via intra- and translaminar access at the most caudal point using an epidural silicone catheter in the cranial direction along the entire length of the abscess.LESSONSTo achieve the key goal of extensive SEA treatment, i.e., to prevent the development of a persistent neurological deficit, immediate effective spinal canal decompression should be performed. Access method and scope should meet the requirements of spinal canal decompression and purulent content aspiration to the greatest possible extent while inducing minimal trauma.

An exploration of men's experiences of learning intermittent self-catheterisation with a silicone catheter

Intermittent self-catheterisation (ISC) is the method of choice for men with lower urinary tract symptoms who need to drain retained urine from the bladder. It is preferred to using an indwelling urinary catheter as it has lower risks of complications and catheter-associated urinary tract infection. Learning ISC can be challenging for men initially but, with the support of knowledgeable nurses experienced in teaching ISC, the technique can be learned, accepted and normalised, improving symptom control and quality of life. This paper discusses the results of a survey exploring men's experiences of learning ISC with the Hydrosil Go™ (C.R. Bard Inc—now part of Becton, Dickinson and Company) silicone catheter and to highlight issues important to men when learning and living with ISC. The survey collected data from four countries: UK, France, Netherlands and Italy. It aims to help nurses who teach ISC and inform them to discuss what matters to men when learning and living with ISC.

Spontaneous Catheter Separation from the Implanted Venous Port and Its Migration to the Venous Heart: Clinical Case

Background. Currently, vascular access is one of the most important aspects in specific and accompanying treatment of cancer patients regardless of their age and sex. Partially implanted venous catheters previously described by Hickman were widely applied all over the world. The introduction of completely implanted venous port-systems revolutionized health care delivery and improved the quality of life in patients with oncological diseases. A fully implanted venous port consists of a silicone catheter which distal tip is connected to a port tank implanted subcutaneously. Such a design allows providing safe and multiple adequate vascular accesses regardless of the patient’s clinical state.Case Report. We present a clinical case of a 10-year-old patient diagnosed with medulloblastoma of the cerebellopontine angle and the left cerebellar hemisphere. The case described spontaneous detachment of an implanted venous port catheter and its migration to the venous heart in a patient who underwent chemotherapy by venous access provided through implantation of the venous port.Conclusion. Our clinical case demonstrated a rare and potentially extremely dangerous noninfectious complication associated with the use of venous port-systems. Implanted systems require washing 1–2 times per month with heparinized solutions or solutions containing taurolidine when they are not used. Periodic chest radiographs can reveal integrity alterations of the system. Any implanted system should be removed when it is not used, or it should be monitored on a regular basis.

Buccal mucosal urethroplasty, first experience in the Samara region

The incidence of urethral strictures in the structure of genitourinary diseases is about 6%. Treatment effectiveness, according to the literature, accounts for only 30%. The article describes the authors’ early experience of urethroplasty with free flaps of oral mucosa. Similar operations were performed for the first time in the Samara region. The stages of the surgery are described, images of surgical stages and pre- and post-operative urethrography results are presented. From the oral cavity a full-thickness mucosal flap 4×1.5 cm in size was taken. Wounds in the oral cavity were sutured, whereby uniform epithelialization without forming rough scars occurred. Through perineal access bulbar urethra with cicatricial changes was approached and mobilized. Buccal flaps were separated from underlying fatty tissue and sequentially fixed to the cavernous bodies with the separate sutures. Dorsal wall of the mobilized urethra was incised along the stricture. Bladder was drained through silicone catheter 14 Ch, above which the edges of incised urethra were sutured with the edges of transplanted mucosa. Surgical wound was sutured in layers tightly. In the late postoperative period, patients underwent urethrocopy and uroflowmetry. Good functional results were achieved.