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Journal of Hospital Medicine May 2017Urinary tract infections (UTIs) in nursing homes are common, costly, and morbid. (Review)
Review
BACKGROUND
Urinary tract infections (UTIs) in nursing homes are common, costly, and morbid.
PURPOSE
Systematic literature review of strategies to reduce UTIs in nursing home residents.
DATA SOURCES
Ovid MEDLINE, Cochrane Library, CINAHL, Web of Science and Embase through June 22, 2015.
STUDY SELECTION
Interventional studies with a comparison group reporting at least 1 outcome for: catheter-associated UTI (CAUTI), UTIs not identified as catheter-associated, bacteriuria, or urinary catheter use.
DATA EXTRACTION
Two authors abstracted study design, participant and intervention details, outcomes, and quality measures.
DATA SYNTHESIS
Of 5794 records retrieved, 20 records describing 19 interventions were included: 8 randomized controlled trials, 10 pre-post nonrandomized interventions, and 1 nonrandomized intervention with concurrent controls. Quality (range, 8-25; median, 15) and outcome definitions varied greatly. Thirteen studies employed strategies to reduce catheter use or improve catheter care; 9 studies employed general infection prevention strategies (eg, improving hand hygiene, surveillance, contact precautions, reducing antibiotics). The 19 studies reported 12 UTI outcomes, 9 CAUTI outcomes, 4 bacteriuria outcomes, and 5 catheter use outcomes. Five studies showed CAUTI reduction (1 significantly); 9 studies showed UTI reduction (none significantly); 2 studies showed bacteriuria reduction (none significantly). Four studies showed reduced catheter use (1 significantly).
LIMITATIONS
Studies were often underpowered to assess statistical significance; none were pooled given variety of interventions and outcomes.
CONCLUSIONS
Several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or CAUTI in nursing home residents. Journal of Hospital Medicine 2017;12:356-368.
Topics: Anti-Bacterial Agents; Catheter-Related Infections; Catheters, Indwelling; Homes for the Aged; Humans; Infection Control; Nursing Homes; Randomized Controlled Trials as Topic; Urinary Catheterization; Urinary Tract Infections
PubMed: 28459908
DOI: 10.12788/jhm.2724 -
The Journal of International Medical... Oct 2022Despite the considerable efforts made to increase the prevalence of autogenous fistula in patients on hemodialysis, tunneled cuffed catheters are still an important... (Review)
Review
Despite the considerable efforts made to increase the prevalence of autogenous fistula in patients on hemodialysis, tunneled cuffed catheters are still an important access modality and used in a high percentage of the hemodialysis population. However, because of the conundrum posed by tunneled cuffed catheters, patients can develop a multitude of complications, including thrombosis, infections, formation of a fibrin sheath, and central vein stenosis, resulting in increased morbidity and mortality as well as placing a heavy burden on the healthcare system. However, with an increasing number of studies now focusing on how to manage these catheter-related complications, there has been less translational research on the pathology of these complications. This review of the most recent literature provides an update on the pathological aspects of catheter-related complications, highlighting what we need to know and what is yet to be discovered. The future research strategies and innovations needed to prevent these complications are also addressed.
Topics: Humans; Catheters, Indwelling; Catheterization, Central Venous; Renal Dialysis; Central Venous Catheters; Fibrin; Catheter-Related Infections
PubMed: 36268763
DOI: 10.1177/03000605221127890 -
Journal of Anesthesia Apr 2020Central venous catheterization is a basic skill applicable in various medical fields. However, because it may occasionally cause lethal complications, we developed this... (Review)
Review
Central venous catheterization is a basic skill applicable in various medical fields. However, because it may occasionally cause lethal complications, we developed this practical guide that will help a novice operator successfully perform central venous catheterization using ultrasound guidance. The focus of this practical guide is patient safety. It details the fundamental knowledge and techniques that are indispensable for performing ultrasound-guided internal jugular vein catheterization (other choices of indwelling catheters, subclavian, axillary, and femoral venous catheter, or peripherally inserted central venous catheter are also described in alternatives).
Topics: Catheterization, Central Venous; Catheterization, Peripheral; Catheters, Indwelling; Humans; Jugular Veins
PubMed: 31786676
DOI: 10.1007/s00540-019-02702-9 -
Lancet (London, England) Jul 2021Hickman-type tunnelled catheters (Hickman), peripherally inserted central catheters (PICCs), and totally implanted ports (PORTs) are used to deliver systemic anticancer... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Hickman-type tunnelled catheters (Hickman), peripherally inserted central catheters (PICCs), and totally implanted ports (PORTs) are used to deliver systemic anticancer treatment (SACT) via a central vein. We aimed to compare complication rates and costs of the three devices to establish acceptability, clinical effectiveness, and cost-effectiveness of the devices for patients receiving SACT.
METHODS
We did an open-label, multicentre, randomised controlled trial (Cancer and Venous Access [CAVA]) of three central venous access devices: PICCs versus Hickman (non-inferiority; 10% margin); PORTs versus Hickman (superiority; 15% margin); and PORTs versus PICCs (superiority; 15% margin). Adults (aged ≥18 years) receiving SACT (≥12 weeks) for solid or haematological malignancy from 18 oncology units in the UK were included. Four randomisation options were available: Hickman versus PICCs versus PORTs (2:2:1), PICCs versus Hickman (1:1), PORTs versus Hickman (1:1), and PORTs versus PICCs (1:1). Randomisation was done using a minimisation algorithm stratifying by centre, body-mass index, type of cancer, device history, and treatment mode. The primary outcome was complication rate (composite of infection, venous thrombosis, pulmonary embolus, inability to aspirate blood, mechanical failure, and other) assessed until device removal, withdrawal from study, or 1-year follow-up. This study is registered with ISRCTN, ISRCTN44504648.
FINDINGS
Between Nov 8, 2013, and Feb 28, 2018, of 2714 individuals screened for eligibility, 1061 were enrolled and randomly assigned, contributing to the relevant comparison or comparisons (PICC vs Hickman n=424, 212 [50%] on PICC and 212 [50%] on Hickman; PORT vs Hickman n=556, 253 [46%] on PORT and 303 [54%] on Hickman; and PORT vs PICC n=346, 147 [42%] on PORT and 199 [58%] on PICC). Similar complication rates were observed for PICCs (110 [52%] of 212) and Hickman (103 [49%] of 212). Although the observed difference was less than 10%, non-inferiority of PICCs was not confirmed (odds ratio [OR] 1·15 [95% CI 0·78-1·71]) potentially due to inadequate power. PORTs were superior to Hickman with a complication rate of 29% (73 of 253) versus 43% (131 of 303; OR 0·54 [95% CI 0·37-0·77]). PORTs were superior to PICCs with a complication rate of 32% (47 of 147) versus 47% (93 of 199; OR 0·52 [0·33-0·83]).
INTERPRETATION
For most patients receiving SACT, PORTs are more effective and safer than both Hickman and PICCs. Our findings suggest that most patients receiving SACT for solid tumours should receive a PORT within the UK National Health Service.
FUNDING
UK National Institute for Health Research Health Technology Assessment Programme.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Catheter-Related Infections; Catheterization, Peripheral; Catheters, Indwelling; Central Venous Catheters; Cost-Benefit Analysis; Female; Humans; Male; Middle Aged; Neoplasms; Vascular Access Devices; Young Adult
PubMed: 34297997
DOI: 10.1016/S0140-6736(21)00766-2 -
Peritoneal Dialysis International :... 2019
Topics: Adult; Catheter-Related Infections; Catheterization; Catheters, Indwelling; Equipment Design; Equipment Failure; Humans; Peritoneal Dialysis
PubMed: 31028108
DOI: 10.3747/pdi.2018.00232 -
Ugeskrift For Laeger May 2021Catheter-related bladder discomfort is frequent in the post-perative setting, due to an indwelling urinary catheter. It clearly causes discomfort for the patient with... (Review)
Review
Catheter-related bladder discomfort is frequent in the post-perative setting, due to an indwelling urinary catheter. It clearly causes discomfort for the patient with the potential consequences of prolonging the post-operative course. Effective treatment to prevent the condition is missing, and lots of different strategies have been investigated. In this review, we aim to address the current options for treatment with the purpose to encourage focus on the topic and suggest strategies to prevent the condition in order to facilitate a better patient course.
Topics: Catheters, Indwelling; Humans; Urinary Bladder; Urinary Catheterization; Urinary Catheters
PubMed: 33998453
DOI: No ID Found -
BMC Infectious Diseases Aug 2023Patients with neurogenic lower urinary tract dysfunction (NLUTD) often rely on some type of catheterization for bladder emptying. Intermittent catheterization (IC) is...
BACKGROUND
Patients with neurogenic lower urinary tract dysfunction (NLUTD) often rely on some type of catheterization for bladder emptying. Intermittent catheterization (IC) is considered the gold standard and is preferred over continuous catheterization, since it is considered to cause fewer urinary tract infections (UTIs) than indwelling catheterization. The main objective of our study was to describe UTI prevalence (at visit) and incidence (within the last 12 months) and urine culture characteristics between patients using an indwelling catheter versus (vs) those performing IC.
METHODS
In this cross-sectional study, we prospectively evaluated from 02/2020 to 01/2021 patients with NLUTD undergoing urine cultures for prophylactic reasons or due to UTI symptoms. At visit, all patients underwent a standardized interview on current UTI symptoms as well as UTI history and antibiotic consumption within the past year. Patients using an indwelling catheter (n = 206) or IC (n = 299) were included in the analysis. The main outcome was between-group differences regarding UTI characteristics.
RESULTS
Patients using an indwelling catheter were older (indwelling catheter vs IC: median 66 (Q1-Q3: 55-77) vs 55 (42-67) years of age) and showed a higher Charlson comorbidity index (indwelling catheter vs IC: median 4 (Q1-Q3: 2-6) vs 2 (1-4) (both p < 0·001). A total of 40 patients from both groups were diagnosed with a UTI at visit (indwelling catheters vs IC: 8% (16/206) vs 8% (24/299); p = 0·782), and the number of UTIs within the past 12 months was not significantly different between groups. Overall, Escherichia coli (21%), Enterococcus faecalis (17%), and Klebsiella spp. (12%) were the most frequently detected bacteria.
CONCLUSIONS
In this cohort of patients with NLUTD, we did not find relevant differences in UTI frequency between groups. These results suggest that UTI-related concerns should not be given undue emphasis when counseling patients for catheter-related bladder emptying methods.
Topics: Humans; Catheters, Indwelling; Urinary Bladder; Urinary Catheterization; Cross-Sectional Studies; Urinary Tract Infections; Escherichia coli
PubMed: 37533010
DOI: 10.1186/s12879-023-08475-7 -
Annals of the American Thoracic Society Jun 2020
Topics: Catheters, Indwelling; Cost-Benefit Analysis; Drainage; Humans; Pleura; Pleural Effusion, Malignant
PubMed: 32469650
DOI: 10.1513/AnnalsATS.202003-230ED -
Journal of Patient Safety Jun 2020Indwelling urinary catheters (IUCs) are commonly used devices in acute care that may lead to catheter-associated urinary tract infections or noninfectious complications....
OBJECTIVES
Indwelling urinary catheters (IUCs) are commonly used devices in acute care that may lead to catheter-associated urinary tract infections or noninfectious complications. Responsibilities for IUC are usually shared between nurses and physicians, and a common mental model among the two professional groups is thus essential for a successful reduction in catheter use. The aim of this study was to determine variation in the perceptions of current practices and culture regarding IUC use between these two groups.
METHODS
Nurses and physicians (N = 1579) from seven Swiss hospitals completed a written survey on safe IUC use in their institution. The survey assessed participant's perceptions of current practices and culture in their institution, and their perceived responsibilities related to IUC care. t tests and logistic regression were used to examine differences in responses between physicians and nurses.
RESULTS
Nurses and physicians each have their own tasks but also share responsibilities for catheter placement, care, and removal. Overall, nurses were more positive than physicians about current practices and culture regarding IUC use within their institution (mean scale scores = 5.4 for nurses versus 5.1 for physicians, P < 0.001). Perceptions of the two professional groups diverged most strongly on practices to avoid unnecessary placement of IUCs, the presence of shared values and attitudes in support of restrictive catheter use, and the other group's leadership commitment.
CONCLUSIONS
Indwelling urinary catheter management is a strong interprofessional domain and a shared responsibility. It is crucial that measures to raise awareness and to communicate new standards target both nurses and physicians and are discussed in interprofessional formats.
Topics: Adult; Catheters, Indwelling; Cross-Sectional Studies; Female; Humans; Male; Nurses; Perception; Physicians; Surveys and Questionnaires; Urinary Catheterization; Urinary Catheters
PubMed: 29847464
DOI: 10.1097/PTS.0000000000000502 -
Technology and Health Care : Official... 2022Catheter jamming is an emerging and possibly underrated complication.
BACKGROUND
Catheter jamming is an emerging and possibly underrated complication.
OBJECTIVE
To find the criteria for determining if the catheter cannot be removed through the mechanical analysis of fracture tension and fracture strain (εf) of Peripheral Inserted Central Catheters (PICC).
METHOD
We removed 30 pieces of PICC catheters from patients and recorded the indwelling time. Those with an indwelling time shorter than 12 weeks belonged to the short-term group. Those with an indwelling time longer than 12 weeks belonged to the long-term group. The first half of the same catheter is section A, and the second half is section B. The fraction tension and fracture strain of the catheter were measured, and statistical analysis was conducted.
RESULTS
The fracture tension of catheter in sections A and B were 5.8917 ± 1.0095 and 6.0670 ± 0.8066 Newtons respectively (p= 0.393) and the fracture strain of catheter in sections A and B were 6.0611 ± 1.0810 and 6.2543 ± 0.7187 Newtons respectively (p= 0.343). The fracture tension of catheter in short-term and long-term group were 6.0696 ± 0.9414 and 5.9192 ± 0.8972 Newtons respectively (p= 0.535) and the fracture strain of catheter in short-term and long-term group were 6.0067 ± 0.7227 and 6.2584 ± 1.0212 respectively (p= 0.301).
CONCLUSION
It is objective and consistent to take the catheter fracture tension as the standard. This standard would be able to accurately define the concept of catheter failure and reduce the risk of catheter fracture and the misdiagnosis of catheter failure. The catheter fracture tension and fracture strain was not affected by the catheter indwelling time. It is recommended to set the tensile force as 5 Newtons and carry it out at a speed of 100 mm/min for the catheter drawing of the PICC single-lumen silicone catheter (4.0F) from Budd Company.
Topics: Catheterization, Central Venous; Catheters, Indwelling; Humans
PubMed: 34957968
DOI: 10.3233/THC-213361