Innovation, Guides, and News

• Medicare 200 Catheter Policy Changes
• Mens’ Guide to Foley Catheters
• Speedicath Compact for Women
• Catheters for Scuba Diving
• Surinate Catheters for Men approved by FDA
• New Medline Catheter Trays help Prevent CAUTI

CAUTI, Injuries, and Infection

• Avoiding Injuries with Catheters
• CAUTI on the Rise in Hospitals
• Reducing Infection with Indwelling Catheters
• A Simple Way to Stop CAUTI in Hospitals

Product Catalogs
This year, we posted catalogs of both Mentor-Coloplast products as well as Rochester’s Urinary catheter products.

• Mentor Coloplast Catheter Product Catalog
• Rochester Medical Catheter Product Catalog

The study involved 105 patients with acute spinal cord injury who were randomized to have a hydrophilic-coated Speedicath and 114 randomized patients to receive a non-hydrophilic Conveen catheter (also produced by Coloplast). These patients spanned 11 hospitals in the United States and 4 hospitals in Canada, aged 18 and older with spinal cord injuries in the past three months and required intermittent catheterization.

UTIs occurred in 40% of the patients with hydrophilic-coated Speedicath catheters in the 6 months of the study; 65% occurance among the group with uncoated catheters.

The study, while specific to Coloplast, shows the advantages of hydrophilic-coated catheters over the uncoated catheters. A 15% difference is exceptional considering the suffering, extra care care and hospital resources required to treat catheter-associated Urinary Tract Infections.

This study is from the October 2010 issue of Renal and Urology News.

With an aging group of Baby Boomers and Medicare acceptance of 200 catheters per month are likely the biggest reasons for the expansion. (Catheters are now indicated by Medicare for single use only, an effort to curb the costly instances of Catheter-Associated Urinary Tract Infections).

Brands like Coloplast and their subsidiary Mentor-Coloplast have surged forward with a powerful presence in the Urology market, with products like the MentorSelf-Cath and others providing over 50% of the supply of Urinary Catheters to patients in the United States. Not far behind are Hollister, Bard, Astra Tech, Rochester and Rusch.

The prevalence of urology in our everyday lives has extended out of the health care setting and into our living rooms, with companies advertising urinary catheters (namely, the Medicare catheter policy change).

Many long-term catheter users are also still re-using their catheters by boiling them or cleaning them, a practice that has been encouraged by Medicare and various other entities for many years. It is only two years ago that Medicare changed their policy, so the potential for these companies only grows.

Who would’ve thought such a simple device would become so prevalent in business and in the daily lives of millions of people?

The new technology is known as Vytex NRL – a type of natural latex rubber that adds Aluminum Hydroxide Al(OH)3 to liquid latex which binds with proteins and makes them easy to remove. This purifies the latex, producing a finished material with the best qualities of latex with a 20-fold lower allergy-causing protein count.

Latex is everywhere in medical products, including urinary catheters and wound care. Many catheter users choose most costly catheters made with synthetic materials to circumvent their latex allergies.

Modified NRL could produce the soft latex catheters often preferred among catheter that do not cause the allergic reactions that many suffer when using latex; allergies caused by the proteins that the modified versions do not have.

Vytex NRL is already being used in products available to consumers – in condoms – a product commonly built with latex. The new Vytex qualities still retain the same strength, sensitivity, comfort, and 20-fold lower protein count than typical latex condoms.

When will this technology extend to other medical products? Soon, would be my guess. The demand is there for an improved latex and a lower cost of health care supplies. I suspect we’ll see modified latex in bandages, tapes, catheters, tubing, and more sprouting up over the next several years.

New studies by Jennifer Meddings and University of Michigan colleagues have been studying hospital reminder systems and their effectiveness in preventing CAUTI and reducing the time and number of catheters required by patients. So far, the reminder systems they’re using to remind hospital staff that patients need their catheter removed have dropped CAUTI by 52%.

This number is huge, considering the number of patients who require cathing after surgery or while immobilized in hospital beds.

According to this Press release, there are four required steps to remove a urinary catheter in a hospital. 1) A physician identifes it’s there. 2) They identify it as unnecessary. 3) The physician requests with written order to remove it. 4) A nurse removes the catheter.

A reminder system can be constructed to skip these steps a number of ways, including stickers on charts, computer-generated reminders on patient’s information form, or placing a “stop order” to identify a date to discontinue further cathing of a patient.

These systems can also be designed to help empower nurses to provide catheter care to patients without requesting an order from a busy physician.

This strategy is extremely inexpensive to implement and has seen an astounding success rate. Stopping half of hospitalized CAUTI can result in not only less patient suffering, but save hundreds of caregiver hours and millions of health care dollars.

http://www.wocn.org/pdfs/WOCN_Library/Fact_Sheets/cauti_fact_sheet.pdf

This review of CAUTIs and urinary catheters presents factual, sourced information about the incidence, causes, diagnosis, contributing factors, treatment, and prevention of CAUTI.

Notable points:

1) Catheter infections are one of the most frequent infections today, with 8% prevalence in the homecare setting and 3-7% in the acute care setting.
2) CAUTI is the second most common cause of bloodstream infection, and 3% of patients with a catheter will develop bacteremia (a life-threatening infection). Urosepsis can also develop, which also has a high mortality rate.
3) CAUTI is diagnosed by finding bacteriuria along with an elevated white blood cell count. Some other signs are pain in the bladder or urethra, fever/chills, odorous urine, catheter obstructions, weakness, mental changes in old adults.
4) Some factors increasing the risk of CAUTI include: catheters left in place for more than 6 days, incorrect positioning of tubing, pregnancy, malnourishment, diabetes, azotemia, ureteral stent.
5) Treating CAUTI includes diagnosis and drugs and hospitalization in very serious infections.
6) Prevention starts with removal of the catheter as soon as possible. The longer a catheter is in place, the greater the risk of infection.

Here are some points to prevent CAUTI:

1) Always use sterile equipment
2) Use the smallest sized lumen possible when cashing.
3) Keep the system closed to prevent bacteria development.
4) While not proven, keeping perineal regions clean is recommended.
5) Also not proven but recommended, increased fluid intake may provide benefit.
6) Short-term silver alloy catheters can reduce incidence of CAUTI.
7) Silicone and Hydrogel catheters are recommended for cathing longer than 2 weeks.

Some more interesting points are what is NOT proven to prevent or treat CAUTI:

1) Antibiotics in the drainage bag.
2) Antibiotics and cleansers applied to the meatus.
3) Cranberry Juice (helpful in preventing recurring UTI in non-cathed people but not for preventing CAUTI.)

Nature calls no matter where you’re at, and scuba diving presents some unique challenges. Scuba divers on extra long exploration dives in drysuits at some point need will need to urinate – surfacing on a deep dive to remove equipment and unzip the drysuit just to urinate is not practical or ideal.

And, of course, urinating in a drysuit is never a pleasant experience. So there are two realistic options that do not involve surfacing: 1) Wear a diaper or pad (such as Depends) to soak up urine and dispose when you surface or 2) Wear an external catheter that drains the urine from the suit through an output valve.

Since drysuits are made to prevent water from entering, a way to release urine underwater is needed to vent urine from inside the suit to the outside. Thankfully for male divers, valves designed for drysuits (known as a P-Valve) allow urine to release through a vent and an external catheter system.

A P-Valve connects to the drysuit on the thigh and allows for fluids to transfer out without allowing water in. It attaches directly to an external catheter system that allows the urine to drain through the tubing and out of the P-Valve.

What kind of catheters should be used for Scuba Diving?

A male external “Condom” catheter is the standard catheter worn by male divers. There are multiple options and brands in condom catheters, but typically the favorite among divers seems to be Rochester’s WideBand Catheters. Rochester WideBand series are popular scuba diving catheters because they offer more adhesive area and protection for the wearer than most other external caths.

Also popular is Rocheter Pop-On catheters, which are much shorter in length but still have a securing adhesive band.

There are also female versions of the condom catheter made for diving.

Considerations when using a Catheter during Scuba Diving

• Just as you should with all scuba equipment, keep P-valves and tubing clean. Flush the P-Valve tubing out with vinegar and water after each dive.
• Re-using catheters can cause bacteria buildup, putting you at risk for Urinary Tract Infections. Catheters are relatively cheap, so use a new one instead of attempting to re-use an old catheter.
• Minimize or eliminate kinking and bending of the tube when donning a drysuit. Kinking or bending can cause urine backflow in some instances or build pressure which can cause leaks.
• Consider an adhesive remover to keep away the “tacky” feeling common with using medical adhesives.
• Get proper sizing for the catheter. Catheters are usually measured in millimeters. If you’re unsure which catheter would provide the best fit, suppliers such as Rochester may provide samples, or try purchasing catheters individually in several different sizes to see which ones fit the best.
• If putting on a Wideband or lengthy adhesive bonded external catheter, be sure to pull back or remove any hair prior to wearing!

For good prices on scuba diving catheters, visit STLMedical.com.

For more information on diving with catheters, see these posts on Scubaboard.com:
http://www.scubaboard.com/forums/exposure-suits/212834-pee-valve-catheter-success.html
http://www.scubaboard.com/forums/exposure-suits/210719-wideband-catheter-holy-crap.html

Regardless if an individual chooses to self-cath or is being cathed by a caretaker, good procedures should always be followed to prevent infection. And an individual needing a catheter should have a good understanding of the proper procedures for cathing – so, what can a patient do to protect themselves from improper nursing procedures and prevention of UTIs?
Educate Yourself

• Learn how Catheter-associated infections happen.
• Ask a lot of questions about the hospital’s procedures for catheterization. Understand how their process works, and ask what they do to prevent infections from happening.
• Find out the answers to how long it will be needed, why its necessary, and when it expected to be removed.
• If you don’t understand an answer, keep asking. Or perhaps you’re not asking the right questions – so talk with hospital staff who can lead you to the person who can answer your questions properly. Get family and friends involved if necessary to get the right answers.

Keeping it Clean

• Ensure any visitors, nurses, and doctors all clean their hands with soap and water. All caregivers should wash their hands before touching you, the catheter, or the tubing. Don’t touch, or let anyone else touch, the catheter and tubing without washing their hands first.
• Ensure any catheter inserted into the body is sterile and opened immediately before use.
• If you are told you have a high bacteria count on your skin, clean it with an anti-septic solution.
• Keep a stock of soaps, anti-septics, no-rinse cleansers, gels, lotions, etc. for your own personal use and for nursing care.

Getting Help

• Talk with the nurses or doctors immediately if bandages or equipment get wet or dirty.
• If there is any pain, redness, or soreness around the catheter, let the nurses and doctors know.

Medline’s new catheter tray helps to improve the process of cathing patients to help prevent the costly ($4.5 – 6.65 billion dollar) healthcare-associated UTIs from cathing, most of which is due to incorrect procedure in the cathing process.  CAUTIS stand for about 40% of all healthcare-associated infections.

So whats the big idea?  Medline’s new ERASE CAUTI system helps prevent these catheter infections by helping to streamline the process of correct cathing.  Here are some of the new additions:

Photo Illustrations of Tray Contents - Easy and clear instructions for nurses and health care professionals to know exactly how to use the tray.  This is helpful not only for the health care professional, but also explaining the catheter and the tray components to the patient.

Checklist of Procedures – The instructions with the system come with a checklist of procedures for the catheter tray.  Using a checklist dramatically reduces the number of procedural errors in health care; likewise, following correct procedures can dramatically reduce incidents of incorrect cathing and infections.

Patient Education Cards – Included with the tray are materials to educate the patient for the bedside care they are receiving.  The cards are an easy, useful way of providing this information to patients.

One-Layer Tray Design – The simple design of the tray allows the caretaker to follow an easy, straightforward process that leaves little room for variance (and error).  The sequence of events followed using the ERASE CAUTI system follows the instructions from start to finish.  This helps make patient care efficient and accurate.

Visit Medline’s Website for More.

In fact, urinary infections caused by catheterization after surgery increased in frequency by 3.6 percent last month.

CAUTIs isn’t the only lacking element of health care infections; bloodstream infections increased by 8 percent, and overall infections increased 1.6 percent.

The silver lining of the report shows that pneumonia follwowing surgery has dropped by 12 percent, but these cases are far less prevelent than CAUTIs, one of the most common forms of infection.

The study also shows us that Catheter associated urinary tract  infections are most common among the low-income patients and the uninsured, disappointing officials in the Institute of Medicine who have worked to educate about medical errors and how to prevent them, including CAUTIs.

These infections increase hospitalization time, patient suffering, and costs which puts more strain on the already complex and strained healthcare system.    Minimizing infections has the opposite effect; better care, less expenses, and one more hospital bed for a new patient.  All CAUTIs can be mediated simply by providing mindful, careful consideration for any catheter insertion.  By good nursing with sterile environments, correct procedures, and changing the catheter at the correct, recommended interval infections can be prevented and possibly eliminated.