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A comparative study to assess the effect of amikacin sulfate bladder wash on catheter-associated urinary tract infection in neurosurgical patients  [cached]
Zacharias Sumi,Dwarakanath Srinivas,Agarwal Meena,Sharma Bhavani
Indian Journal of Critical Care Medicine , 2009,
Abstract: Background: The indwelling urinary catheter is an essential part of modern medical care. Unfortunately, when poorly managed, the indwelling catheter may present a hazard to the very patients it is designed to protect. Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection in hospitals and nursing homes. Aims and Objectives: The primary objective was to study the effect of amikacin sulfate bladder wash on CAUTI in neurosurgical patients. The other objectives were to study the various organisms causing CAUTI and their antibiotic sensitivity and resistance pattern. Materials and Methods: This was a prospective randomized controlled study performed on 60 patients who met the inclusion criteria at the neurosurgical intensive care of the All India Institute of Medical Sciences between June and December 2006. The patients were randomized into two groups - one was the trial group which received amikacin bladder wash, while the other was the control group that did not receive any bladder wash. Results: Forty percent of the subjects in the control group developed CAUTI, while none of the subjects in study group developed CAUTI. (Fisher′s exact test, P value < 0.001) Pseudomonas aeruginosa (51%) was the commonest pathogen. Conclusions: Amikacin sulfate bladder wash was effective in preventing CAUTI. It can thus decrease the antibiotic usage thereby preventing the emergence of antibiotic resistance.
Encrusted and incarcerated urinary bladder catheter: what are the options?
CCK Ho, Y Khandasamy, P Singam, E Hong Goh, ZM Zainuddin
Libyan Journal of Medicine , 2010,
Abstract: Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated urinary bladder catheter include extracorporeal shock wave lithotripsy and lithoclast. We describe here another technique of dealing with a stuck and encrustated catheter, via direct crushing of the encrustations with a rigid cystoscope inserted through a suprapubic cystostomy tract.
Could Bladder Inflation Prior to Cesarean Section Prevent Urinary Tract Injury in High Risk Group? A Randomized Controlled Trial  [PDF]
Abd El-Naser Abd El-Gaber Ali, Mohammad A. M. Ahmed, Mustafa M. Khodry, Ahmed M. Abbas
Open Journal of Obstetrics and Gynecology (OJOG) , 2019, DOI: 10.4236/ojog.2019.92021
Abstract: Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes development of urinary tract fistulae. Objective: To find out the efficacy of urinary bladder inflation immediately prior to cesarean section (CS) procedure in minimizing incidence of accidently urinary tract injury in high risk patients. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Qena, Egypt. Duration: From August 2017 to November 2018. Study Design: A prospective randomized controlled trial. Methods: Seventy six pregnant women recruited from attendants of outpatient antenatal care unit of obstetrics and gynecology department who planned for cesarean delivery and carried one or more risk factors for urinary tract injury. Patients randomly were classified into 2 groups (group I included 38 cases, underwent bladder inflation using triple way Foley’s catheter immediately before CS and group II included 38 cases, and underwent bladder deflation with 2 ways Foley’s catheter immediately before CS. Results: The overall incidence of urinary tract injury was significantly higher in group II (7 cases = 18.4%) than in group I (2 cases = 5.2%) with
Spiculated Bladder Calculi: The Culprit for Repeated Catheter Failure  [PDF]
C. Wek,T. P. Fox,G. H. Muir
Case Reports in Urology , 2013, DOI: 10.1155/2013/346891
Abstract: We report on the case of a frustrated 90-year-old gentleman who was seen in the Accident and Emergency department for the third time in four days with failure of his long-term urethral catheter. He reported that the catheter simply “fell out” with the balloon deflated. On each occasion previously, the catheter had been reinserted in A&E and the patient discharged home. These repeated visits to A&E were understandably a source of much frustration for the patient and his family. On the third presentation, plain abdominal radiography demonstrated a large spiculated bladder calculus. 1. Background Bladder stones account for approximately 5% of urinary calculi and are usually associated with benign prostate enlargement, spinal cord injury, or long-term indwelling catheters [1]. We report on an unusual complication of a bladder stone which caused repeated catheter failure and recurrent urinary retention. 2. Case Presentation A 90-year-old gentleman attended Accident and Emergency department three times in one week with acute retention; each time his long-term catheter had “fallen out.” He had sustained a type 3 odontoid peg fracture five months prior to his attendance, managed conservatively but requiring a long-term indwelling catheter. He was initially referred to A&E by his rehabilitation centre after his indwelling catheter fell out and he went into retention. He was discharged from the A&E after a catheter change. The following day he returned to the A&E with retention and catheter dislodgement, again being discharged after a catheter change. Two days later, the patient was brought back to A&E by an ambulance with acute abdominal pain. His catheter had dislodged at the rehabilitation centre and a district nurse was called to resite the catheter. After resiting the catheter, the nurse reported that she heard a balloon burst and so did not attempt to site another. A catheter was inserted by the urology registrar which drained 800?mLs of clear urine. This instantly failed. An abdominal X-ray was requested by the urology registrar. 3. Investigations A plain abdominal X-ray revealed a 3.3?cm spiculated bladder calculus (Figures 1 and 2). Figure 1: Plain abdominal radiograph clearly showing spiculated bladder calculi. Figure 2: Magnified film showing spiculated bladder calculi. 4. Differential Diagnosis The causes of urinary retention can be systematically divided into acute and chronic. Causes of acute urinary retention include urinary tract infections, general anaesthesia and surgery, various medications to treat urinary incontinence such as antimuscarinics,
Intraperitoneal Urinary Bladder Perforation Observed in a Patient with an Indwelling Urethral Catheter  [PDF]
Soichiro Ogawa,Tomonori Date,Osamu Muraki
Case Reports in Urology , 2013, DOI: 10.1155/2013/765704
Abstract: This report describes a rare case of an 86-year-old man with an indwelling urethral catheter who developed severe abdominal pain and was diagnosed with intraperitoneal urinary bladder perforation. A home-visiting nurse suspected catheter obstruction and performed a catheter exchange. However, bladder irrigation could not subsequently be performed. Computed tomography of the abdomen and pelvis after transurethral perfusion of contrast medium demonstrated extravasation of the contrast material into the peritoneal cavity. Furthermore, the Foley catheter balloon was positioned in the peritoneal cavity through the bladder. The patient was diagnosed with peritonitis due to spontaneous intraperitoneal perforation of the urinary bladder, and exploratory laparotomy was performed. During exploration, a perforated tear at the top of the bladder was discovered where the Foley catheter had penetrated the bladder. The Foley catheter balloon was floating freely in the peritoneal cavity. There was no evidence of pathologic lesions, such as cancer or inflammatory mass at the site of the injured peritoneum. Successful closure of the damaged peritoneum and bladder was performed. Since the proportion of elderly individuals continues to increase in the general Japanese population, the incidence of the chronic Foley catheterization is expected to increase. Therefore, clinicians should be aware of this potential complication. 1. Introduction Bladder perforation associated with indwelling urethral catheter is rare and can be life threatening [1], and long-term use of the urethral catheter can weaken the bladder wall. This report describes a rare case of an 86-year-old man with an indwelling urethral catheter who developed severe abdominal pain and was diagnosed with intraperitoneal urinary bladder perforation. 2. Case Report An 86-year-old man was admitted to our hospital with sudden onset of abdominal pain that had persisted for a few hours. He had a past history of two abdominal surgeries at 21 years and 4 years earlier for appendectomy and reduction of bowel torsion, respectively. He also had a history of cerebral infarction that occurred more than 20 years prior, two brain surgeries for subdural hematoma removal, and neurogenic bladder that had been managed for more than 4 months with a chronic indwelling urethral catheter. His urethral catheter was exchanged for a new one by a home-visiting nurse. After two days, he felt acutely ill with vomiting and a decrease in urine volume. A home-visiting nurse suspected catheter obstruction and exchanged the urethral catheter for a
The Professional Medical Journal , 2010,
Abstract: Introduction: Bladder discomfort is a common side effect after surgical procedures that involve either extensive bladder dissection or prolonged postoperative catheter drainage. Various treatments have been tried with varying degrees of success for managing this adverse effect. In this study we compared the efficacy of ketamine and tolterodine in prevention of catheter induced bladder discomfort.Patients and Methods: Three hundred patients who were scheduled for open prostatectomy or transurethral resection of prostate (TURP)were randomized into three groups. The first group received placebo, the second one received tolterodine before operation, and the third group received ketamine250ìg/kg IV, just before the anesthesia induction. Bladder discomfort was assessed by anesthesiologist who was unaware of the type of medication. The assessment was done on arrival in the post anesthesia care unit (PACU) and then at 0, 1, 2 and 6 hours after patient’s consciousness. Severity of discomfort was recorded as none, mild, moderate, or severe. The absence or presence of adverse effects were recorded. The data were analyzed using SPSS and Pearson chi-squared and ANOVA tests were applied for further statistical evaluations. Results: Both the incidence rate of bladder discomfort and its severity in the control group was significantly higher compared with ketamine and tolterodine groups (P< 0.001). Comparing the ketamine and tolterodine groups, tolterodine had lead to lesser degree of bladder discomfort at 0, 1, 2 hours, while ketamine was more effective at 6 hours. Conclusions: Pretreatment with either ketamine or tolterodine is effective in decreasing the incidence and severity of catheter related bladder discomfort in patients under going open prostatectomy or TURP.
A 3D Visualization Method for Bladder Filling Examination Based on EIT  [PDF]
Wei He,Peng Ran,Zheng Xu,Bing Li,Song-nong Li
Computational and Mathematical Methods in Medicine , 2012, DOI: 10.1155/2012/528096
Abstract: As the researches of electric impedance tomography (EIT) applications in medical examinations deepen, we attempt to produce the visualization of 3D images of human bladder. In this paper, a planar electrode array system will be introduced as the measuring platform and a series of feasible methods are proposed to evaluate the simulated volume of bladder to avoid overfilling. The combined regularization algorithm enhances the spatial resolution and presents distinguishable sketch of disturbances from the background, which provides us with reliable data from inverse problem to carry on to the three-dimensional reconstruction. By detecting the edge elements and tracking down the lost information, we extract quantitative morphological features of the object from the noises and background. Preliminary measurements were conducted and the results showed that the proposed algorithm overcomes the defects of holes, protrusions, and debris in reconstruction. In addition, the targets' location in space and roughly volume could be calculated according to the grid of finite element of the model, and this feature was never achievable for the previous 2D imaging. 1. Introduction Bladder filling causes the desire to urinate when the bladder contains a certain volume of urine. But for unconsciousness elders, some handicapped with spinal cord injury or patients with urological disease, this sense will not occur. Urinary incontinence or lack of bladder control is an embarrassing problem, in case that many patients need professional nursing. And the work of nursing may be greatly reduced if the urination is detected and alarmed in time. In clinical, the traditional method to solve this problem is draining urine out by a catheter inserted in the bladder. But the intubation is invasive and not suitable for most patients, because it may cause secondary infection of the urinary tract. A way for measure in real time is the ultrasound imaging. Researchers have developed ultrasound bladder volume measurement devices to evaluate bladder volume. However, these devices are inconvenient for continuous monitoring, moreover, the ultrasonic images are greatly influenced by the human intraperitoneal gas [1, 2]. Several investigators over the last 20 years have verified that the electrical properties of human tissues and body fluids are significantly different and have demonstrated that measurement of these properties has obvious clinical potential [3]. Electric impedance tomography distills biomedicine information without trauma and generates real-time image, which examination is not
Impact of a formative nursing program in the implantation and following-up of the care protocol to the vesical catheter carrier patient  [cached]
Sonsoles Paniagua Tejo,Florencia González Jiménez,Rosa Hernández Rojo,Concepción Matos Eguiluz
NURE Investigación , 2008,
Abstract: Objective: To determine upon completion of a formative training program the differing hospital procedures followed by nursing personnel on the application of urinary catheter safeguards.Methods: A two-phased descriptive cross-section study was carried out over a period of two consecutive years. By means of a questionnaire, diverse features of hospital protocol, revised and updated in 2004, were assessed. An adaptation percentage was selected as indicator and chi square test as comparative reference.Results: A total of 463 hospital in-patients were studied overall. Two hundred and ten (210) patients had entered hospital in one given day in 2004 of whom 14.2% had been fitted with a vesicle catheter. In November 2005, two hundred and fifty three (253) entered hospital of which 9% had also thus been fitted. In nine (9) out of the twelve (12) variables evaluated, the result was significantly better in 2004 although only in 2 cases were significant differences detected, to wit: the under bladder draining conduit and the time interval at which emptying should be appropriately carried out. Percentage of unsoiled valves for not having touched the ground as well as record deeding of the clinical history of catheter used and the patient’s perception of its technique improved in 2005 although no significant differences were perceived.Conclusions: Adequate training of nursing personnel accounts not only for appropriate training on catheter usage techniques but aids also to achieve better medical results and increase patient’s confidence.
Catheter-associated urinary tract infections in Clinical Center of Banja Luka  [PDF]
Verhaz Antonija,?krbi? Ranko,Raki?-Musi? Mirjana,Sabo Ana
Medicinski Pregled , 2003, DOI: 10.2298/mpns0310460v
Abstract: Introduction Catheter-associated urinary tract infections are the most common nosocomial infections of the urinary tract, and among the most common nosocomial infections in general. The major problems of these infections include antibiotic resistance and enormous direct and indirect cost of treatment. Material and methods A retrospective study on major causes of infections and antibiotic resistance was conducted at four clinics of the Clinical Center of Banja Luka. An anonymous questionnaire was distributed to nursing staff dealing with urinary catheters in order to get an overview of their clinical performance. Results The results showed that in 89% of cases (out of 198 patients with developed catheter-associated urinary tract infection) infections were caused by gram-negative bacteria, in 7% by gram-positive bacteria and in 4% by Candida. The most common bacteria were: Escherichia coli (33.6%), Pseudomonas aeruginosa (14.1%), Proteus mirabilis (13.3%), and Enterobacter (10.5%). Majority of bacteria presented with extremely high resistance (72-100%) to ampicillin, gentamycin and cotrimoxazole, and in some cases a significant resistance to ciprofloxacine, nalidixic acid, ceftriaxone and ceftazidime. The questionnaire showed that nursing staff did not follow guidelines for medical care of patients with urinary catheters. Conclusion It can be concluded that poor hygienic and epidemiological conditions, as well as irrational use of antibiotics contribute to uncontrolled development of urinary tract infections in catheterized patients.
Lock-Out Valve to Decrease Catheter-Associated Urinary Tract Infections  [PDF]
Amir Shbeeb,Jennifer L. Young,Scott A. Hart,Juliet C. Hart,Joel Gelman
Advances in Urology , 2014, DOI: 10.1155/2014/765756
Abstract: Patients with long-term indwelling urinary catheters are at an increased risk for urinary tract infection due to bacteriuria. Catheter-associated urinary tract infections (CAUTIs) are a significant source of morbidity and mortality in long-term care facilities as well as in ambulatory patients requiring long-term catheterization. There is increased interest in the financial impact of CAUTI as Medicare no longer provides reimbursement for nosocomial CAUTIs. Ascending bacteria may in part enter the closed drainage system when the patient switches between leg and night collection bags. In an attempt to reduce this ascent, a double valve lock-out system was devised that maintains a closed system during bag exchange. The concept is introduced and CAUTIs are reviewed. 1. Introduction The urinary catheter is a device that serves as a tube to mechanically drain the bladder for a variety of pathological conditions or surgical procedures. Methods of collection for urinary catheterization include intermittent catheterization, condom or Texas catheters, adherent urine collection bags, and indwelling urethral or suprapubic catheters. Each type of urinary catheters has its own indications and associated risks and benefits. Indwelling urinary catheters have the highest risk of nosocomial infection due to the fact that they remain in the bladder for a long period of time and allow microbial colonization and invasion [1]. In general, catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection in the United States, accounting for nearly a third of all hospital infections [2, 3]. In fiscal year 2006, there were 11,780 Medicare cases of CAUTI with an average Medicare payment for admission in which CAUTI was present of $40,347 [4]. However, as of 2008, Medicare will no longer be reimbursing for CAUTI [5]. Reduction of CAUTI would decrease morbidity, mortality, length of hospital stay, and overall healthcare cost [6]. There is a daily infection rate of 5% in patients with long-term (>30 days) indwelling catheters [1]. One study showed that, after 8 weeks, 113 out of 115 patients with urinary catheters were infected [1]. Of note, the remaining 2 patients that were not infected were on antibiotics at that time. Urinary tract infection occurs when bacteria bypass normal host defenses [7] and gain access to the bladder while avoiding the urothelium’s bactericidal peptides, cytokines, defensins, and adhesion molecules of the urothelium [8]. Bacteria gain access to the urinary tract via two routes: from within the catheter or from the outside of the
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