Prevalence and Appropriateness of Indwelling Urinary Catheters in Japanese Hospital Wards: A Multicenter Point Prevalence Study

Background: Indwelling urinary catheters are commonly used in hospitalized patients, which can lead to the development of urinary catheter complications, including catheter-associated urinary tract infection (CAUTI). Limited reports on the appropriateness of urinary catheter use exist in Japan. This study investigated the prevalence and appropriateness of indwelling urinary catheters, and the incidence of CAUTI in non-intensive care unit (non-ICU) wards in Japanese hospitals. Methods: This prospective observational study was conducted in 7 non-ICU wards from 6 hospitals in Japan from October 2017 to June 2018. At each hospital the study teams evaluated urinary catheter prevalence through in-person bedside evaluation for at least 5 days of each week for 3 months. Catheter associated urinary tract infection (CAUTI) incidence and appropriateness of catheter use was collected via chart review.Results: We assessed 710 catheter-days over 5528 patient-days. The mean prevalence of indwelling urinary catheter use in participating wards was 13% (range: 5% to 19%), while the mean incidence of CAUTI was 9.86 per 1000 catheter-days (range: 0 to 33.90). Approximately 66% of the urinary catheter days assessed had an appropriate indication for use (range: 17% to 81%). A physician's order for catheter placement was present in only 10% of catheterized patients.Conclusion: This national prospective study provides epidemiological information about the appropriate use of urinary catheters in Japanese non-ICU wards. A multimodal intervention may help improve the appropriate use of urinary catheters.

Umbilically and Peripherally Inserted Thin Central Venous Catheters Have Similar Risks of Complications in Very Low Birth Weight Infants

In order to compare the complications associated with thin (1-2F) umbilical vein catheters (tUVC) and peripherally inserted central catheters (PICC) in very low birth weight (VLBW) infants, the frequencies and causes of the non-elective removal of first tUVCs and PICCs were evaluated in 195 VLBW infants born in one hospital. Data were collected from patient records. Risk factors for catheter complications were analysed using logistic regression analysis. Altogether, 92 (47%) infants had tUVCs, and 103 (53%) PICCs. In total, 78 (40%) infants underwent the non-elective removal of their first catheters, most commonly due to suspected infection (n=42) or catheter dislocation (n=30). Infants with complications had lower birth weights and gestational ages than those without. The frequencies and causes of the non-elective catheter removal were similar in the tUVC and PICC groups. True catheter infection was diagnosed in 31 infants. The number of infections/1,000 catheter days was higher in the tUVC than in the PICC group. In a multivariable analysis, gestational age was found to be associated with catheter infection, but catheter type was not. Conclusion: The odds of catheter complications seem to decrease with increasing gestational age, but no clear association with thin catheter type was found.

The Patency Rate of the Primary and Exchanged Femoral Haemodialysis Catheters

Background: This prospective cohort study aims to evaluate the primary and exchanged femoral catheter patency rates, as well as mortality rates and determine the probable risk factors affecting femoral catheter survival. Methods: All 79 tunneled femoral catheters created in our hospital from 2017 to 2020 were included in this study. Patients having no other means for dialysis access other than the femoral catheter was recruited in this study. Data collected included patient age, sex, comorbidities (diabetes and hypertension), transplant history, dialysis duration, catheter complications, femoral access history, and primary and exchanged femoral patency rates. Patients were followed for 4–36 months. Results: The median catheter primary patency was 7 months (95% confidence interval [CI]: 5.77, 8.22) and the primary patency rates at 2, 4 and 6 months were 79%, 68% and 48%, respectively. The median exchanged catheter survival was 8 months (95% CI: 0.83, 15.17) and the exchanged patency rates at 1, 3 and 8 months were 72%, 64% and 32%, respectively. Of the patients (n = 62), 8% (5 patients) died because they had no other option for dialysis access. Conclusion: Tunneled femoral catheters have a low patency rate and should be the last option for haemodialysis patients when other probable accesses are not available.

How to Prevent Peritoneal Dialysis Catheter Tip Migration: A Japanese Perspective

The prevention of peritoneal dialysis (PD) catheter complications is essential to achieve a successful outcome. In recent years, nephrologists have performed more PD catheter insertion surgeries in Japan. The prevention of catheter complications is crucial for nephrologists who do not have all-around surgical skills. PD catheter tip migration is a common complication and a significant cause of catheter malfunction. Several preventive techniques have been reported for the PD catheter tip migration. This perspective described the following: (1) surgical technique in laparotomy, (2) laparoscopic surgery, (3) peritoneal wall anchor technique, and (4) catheter type selection. We hope that more effective methods of preventing catheter complications will be developed to ensure the success of PD treatment.

Infection related catheter complications in patients undergoing prone positioning for acute respiratory distress syndrome: an exposed/unexposed study

Background Prone positioning (PP) is a standard of care for patients with moderate–severe acute respiratory distress syndrome (ARDS). While adverse events associated with PP are well-documented in the literature, research examining the effect of PP on the risk of infectious complications of intravascular catheters is lacking. Method All consecutive ARDS patients treated with PP were recruited retrospectively over a two-year period and formed the exposed group. Intensive care unit (ICU) patients during the same period without ARDS for whom PP was not conducted but who had an equivalent disease severity were matched 1:1 to the exposed group based on age, sex, centre, length of ICU stay and SAPS II (unexposed group). Infection-related catheter complications were defined by a composite criterion, including catheter tip colonization or intravascular catheter-related infection. Results A total of 101 exposed patients were included in the study. Most had direct ARDS (pneumonia). The median [Q1–Q3] PP session number was 2 [1–4]. These patients were matched with 101 unexposed patients. The mortality rates of the exposed and unexposed groups were 31 and 30%, respectively. The incidence of the composite criterion was 14.2/1000 in the exposed group compared with 8.2/1000 days in the control group (p = 0.09). Multivariate analysis identified PP as a factor related to catheter colonization or infection (p = 0.04). Conclusion Our data suggest that PP is associated with a higher risk of CVC infectious complications.

Do antimicrobial and antithrombogenic peripherally inserted central catheter (PICC) materials prevent catheter complications? An analysis of 42,562 hospitalized medical patients

Objective: To examine the effectiveness of antimicrobial and antithrombogenic materials incorporated into peripherally inserted central catheters (PICCs) to prevent bloodstream infection, thrombosis, and catheter occlusion. Methods: Prospective cohort study involving 52 hospitals participating in the Michigan Hospital Medicine Safety Consortium. Sample included adult hospitalized medical patients who received a PICC between January 2013 and October 2019. Coated and impregnated catheters were identified by name, brand, and device marketing or regulatory materials. Multivariable Cox proportional hazards models with robust sandwich standard error estimates accounting for the clustered nature of data were used to identify factors associated with PICC complications in coated versus noncoated devices across general care, intensive care unit (ICU), and oncology patients. Results were expressed as hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). Results: Of 42,562 patients with a PICC, 39,806 (93.5%) were plain polyurethane, 2,263 (5.3%) incorporated antimicrobial materials, and 921 (2.2%) incorporated antithrombogenic materials. Most were inserted in general ward settings (n = 28,111, 66.0%), with 12, 078 (28.4%) and 1,407 (3.3%) placed in ICU and oncological settings, respectively. Within the entire cohort, 540 (1.3%) developed thrombosis, 745 (1.8%) developed bloodstream infection, and 4,090 (9.6%) developed catheter occlusion. Adjusting for known risk factors, antimicrobial PICCs were not associated with infection reduction (HR, 1.16; 95% CI, 0.82–1.64), and antithrombogenic PICCs were not associated with reduction in thrombosis and occlusion (HR, 1.15; 95% CI, 0.92–1.44). Results were consistent across populations and care settings. Conclusions: Antimicrobial and antithrombogenic PICCs were not associated with a reduction in major catheter complications. Guidance aimed at informing use of these devices, balancing benefits against cost, appear necessary.