intermittent catheterization
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2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 887-887
Author(s):  
John Harris ◽  
Mary Ackenbom ◽  
Alison Trinkoff ◽  
Steven Handler ◽  
John Engberg ◽  
...  

Abstract Reducing indwelling catheters and increasing clean intermittent catheterization is a key element of effective infection control and maintaining functional independence in nursing homes. Nursing care is often more difficult as obesity increases, leading to more nursing care or equipment to provide care. We hypothesized that nursing homes are more likely to use indwelling catheters for people with obesity because indwelling catheterization likely eases the nursing burden of toileting and personal hygiene care for residents with obesity. The study design was a retrospective cohort study of U.S. nursing home female residents in Minimum Data Set in 2013. Obesity and normal weight (the reference group) were categorized using National Institutes of Health criteria. Indwelling and intermittent bladder catheterization was defined during periodic assessment of residents. We modeled the outcomes using logistic regression using a robust variance estimator. Model covariates included obesity category, resident age, dementia status, comatose status, Stage 3 or 4 pressure ulcers, and the number of activities of daily living deficits. The study cohort included 1,068,388 female residents in 15,230 nursing homes. Obesity (BMI ≥ 30 kg/m2) prevalence was 31.9%. The prevalence of indwelling catheterization was 5.2% and of intermittent catheterization was 0.4%. The odds ratio of indwelling catheter use for obese residents varied from 1.05 to 1.74 (all with p-values <0.001), whereas the odds ratio. of intermittent catheter use varied from 0.84 to 0.46 (all with p-values <0.01) compared to residents of normal weight. Increasing obesity is independently associated with increased long-term indwelling bladder catheterization and decreased intermittent catheterization.


2021 ◽  
pp. 039156032110498
Author(s):  
Talal Ziadeh ◽  
Roy Chebel ◽  
Chris Labaki ◽  
Gebrael Saliba ◽  
Elie El Helou

Objective: To assess the efficacy and safety of different modalities of bladder instillation in patients with neurogenic bladder practicing intermittent catheterization. Methods: A systematic review of the literature were conducted using two databases: Medline via PubMed and Scopus. Articles evaluating bladder instillation in patients with neurogenic bladder, who are practicing intermittent catheterization, were collected and assessed for the efficacy and safety of the studied agent by two different reviewers. Results: Among the 1896 studies, eight involving 346 patients with neurogenic bladder, were included in this systematic review according to the PRISMA protocols. Gentamicin, Hyaluronic acid, and Lactobacillus rhamnosus was found to decrease the incidence of urinary tract infections, the former reduced multidrug-resistant organisms. Kanamycin-colistin, showed a drop in the mean incidence of bacteriuria in males only. Trisdine, the only studied antiseptic, significantly reduced bacteriuria. Neomycin, however, showed no efficacy in term of bacteriuria. Regarding safety, when evaluated, no major adverse events were reported with any of the studied modalities. Conclusion: Bladder instillations of either antibiotics, antiseptics, hyaluronic acid, or Lactobacillus rhamnosus GG are efficient and safe in patients having neurogenic bladder, with recurrent urinary tract infections and practicing clean intermittent catheterization, with gentamicin being the most recommended product among the different studied agents.


Author(s):  
Francesco Mariani ◽  
Emanuele Ausili ◽  
Margherita Zona ◽  
Giacomo Grotti ◽  
Antonietta Curatola ◽  
...  

Abstract Introduction Spinal dysraphism (SD) is a general term used to refer to developmental abnormalities of the spine that involves many clinical conditions including myelomeningocele (MMC). In these patients, neurogenic bladder (NB) is a common and predisposing factor for renal damage; the most frequently used approach to manage this situation is based on clean intermittent catheterization (CIC) and anticholinergic drugs. Urinary tract infections (UTIs) are a significant concern for these patients, and antibiotic prophylaxis is frequently used even if it is still a debated topic of literature. The purpose of this paper is to investigate the role and the real effectiveness of antibiotic prophylaxis in the reduction of incidence of UTIs in patients with spina bifida performing CIC. Methods We collected data of all patients performing CIC, who did their last follow-up visit in the period between January 2019 and January 2021, followed at the children multidisciplinary Spina Bifida Center of A. Gemelli Hospital in Rome. Data collected included age at referral, gender, type of SD lesion, serum creatinine and cystatin C levels, the use of anticholinergic medications, antibiotic prophylaxis and type of prophylaxis (oral/endovesical), age of starting prophylaxis with its duration/adherence, number of CIC/day and its duration, episodes of UTIs in the 2 years prior to the last follow-up, and presence and grade of vesical-ureteric reflux (VUR) on cystourethrogram. Results A total of 121 patients with SD performing CIC was included in the study; 66 (54%) presented ≥ 1 episode of UTIs in the last two years and 55 (46%) none. During the study period, 85 (70%) patients received antibiotic prophylaxis (ABP group) and 36 (30%) did not (NABP group): no statistically significative difference in terms of UTI development was observed between the two groups (p = 0.17). We also evaluated compliance to the therapy; 71 patients (59%) took antibiotic prophylaxis constantly (CABP group) and 50 (41%) did not do antibiotic prophylaxis constantly or did not do antibiotic prophylaxis at all (NCABP group): we observed a statistically significative difference in terms of UTIs with a 2.2 times higher risk of development at least one episode of UTIs in NCABP group. Conclusion In conclusion, antibiotic prophylaxis performed constantly, without interruption, is associated with a lower risk of developing urinary tract infections and consequently to develop renal failure in adulthood.


Author(s):  
Daniel Roberson ◽  
Diane K. Newman ◽  
Justin B. Ziemba ◽  
Alan Wein ◽  
Hanna Stambakio ◽  
...  

2021 ◽  
Author(s):  
Karthik Gopalakrishnan ◽  
Nick F Nielsen ◽  
Andrea L Ramirez ◽  
Jeppe Soerensen ◽  
Matthias Walter ◽  
...  

Background: Intermittent catheterization (IC), considered the gold standard for bladder management for individuals with spinal cord injury (SCI) with sufficient dexterity, is usually performed using hydrophilic (HPC) or non-hydrophilic (non-HPC) catheters. Currently, there is no evidence on the temporal burden associated with IC with either catheter. Objective: To compare both catheters regarding their time requirement for IC and participant satisfaction. Design, setting and participants: Twenty individuals with chronic (>1-year) SCI at any spinal segment were randomized to undergo two cross-over assessments within 10 days (i.e., either starting with HPC or non-HPC). We measured time taken to perform IC using a 13 step pre-determined IC protocol (e.g., enter bathroom, wash hands, transfer to toilet, etc.). Furthermore, we assessed user satisfaction of both catheters using a Likert scale (i.e., strongly agree=5, strongly disagree=1). Outcome measures and statistical analysis: Time (i.e., for each step and in total) to perform IC and participant satisfaction were compared between catheters using non-parametric statistics, i.e., Wilcoxon rank sign tests. Results are presented as median with interquartile range. Results and limitations: Participants using HPCs spent less time to prepare a catheter [15 s (10-20) vs. 41 (20-69), p=0.002] and overall to perform IC [283 s (242-352) vs. 373 (249-441), p=0.01] compared to non-HPCs. Moreover, participants rated the preparation of HPCs to be easier [5 (4-5) vs. 4 (2-4), p=0.047] compared to non-HPCs. The key limitation of this pilot study was the sample size. Conclusions: Preparation and usage of HPCs for IC is easier and faster compared to non-HPCs. IC can be a significant temporal burden for SCI individuals. Patient summary: We compared coated and uncoated catheters on time needed for intermittent catheterization and user satisfaction in individuals with spinal cord injury. Participants can manually empty their bladder quicker and easier with coated compared to uncoated catheters.


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