This course is all about solving the medical emergency of...
Transcript of This course is all about solving the medical emergency of...
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This course is all about solving the medical emergency of difficult or failed urethral catheterisation, which in most cases happens in elderly men due to an enlarged prostate
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Part 1 1. Development and Rationale behind UCD® 2. Managing Difficult Catheterisation 3. Identify patients who need referral for specialist intervention
Part 2 Hands-on-UCD® Practice
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Part 1 1. Development and Rationale behind UCD® 2. Managing Difficult Catheterisation 3. Identify patients who need referral for specialist intervention
Part 2 Hands-on-UCD® Practice
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Traumatic urethral catheterisation turns a
simple procedure into an emergency
1. Development and Rationale behind UCD®
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Traumatic urethral catheterisation turns a
simple procedure into an emergency
1. Development and Rationale behind UCD®
• 4 Mio catheters inserted in UK/year
• 25% patients have urethral
catheterisation during Hospital stay
3 per 1000 retrospective data 7 per 1000 prospective data 7 in 100 high-risk patients
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Traumatic urethral catheterisation turns a
simple procedure into an emergency
1. Development and Rationale behind UCD®
• 4 Mio catheters inserted in UK/year
• 25% patients have urethral
catheterisation during Hospital stay
3 per 1000 retrospective data 1 7 per 1000 prospective data 2 7 in 100 high-risk patients 3
1. Kashefi C, Messer K, Barden R et al: Incidence and prevention of iatrogenic urethral injuries. J Urol 2008; 179: 2254. 2. Davis NF, Quinlan MR, Bhatt NR, Browne C et al: Incidence, Cost, Complications and Clinical Outcomes of Iatrogenic Urethral Catheterization Injuries: A Prospective Multi-Institutional Study. J Urol 2016; 196: 1473-1477 3 Mistry K, Roberts, N, Mundy et al. A new urethral catheterisation device (UCD ™) to manage difficult urethral catheterization. WJUR 2018; (in press)
Each case of
Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity with 80% of patients experiencing Clavien 2 or greater complications2
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Traumatic urethral catheterisation turns a
simple procedure into an emergency
1. Development and Rationale behind UCD®
Urethral Catheterisation Injury (UCI)
£215Mio / year problem in the UK
exclusive of any potential medico-legal costs £8000/UCI
3 per 1000 retrospective data 7 per 1000 prospective data 7 in 100 high-risk patients
“long-term burden to individuals who experience UCI is potentially life altering”
• Urinary infection • Sepsis1/3 of patients* • Fournier’s gangrene (mortality 7.5 - 40%) • Urethral stricture
* 5% required inotropic support in the Intensive Care Unit after a misplaced urethral catheter
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Guide wire catheterisation techniques
• guide wires well established in Medical Practice
• so far no ready-to-
use catheter with integrated guide wire available
• Healthcare
Professionals forced to improvise …
1. Development and Rationale behind UCD®
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Problems with ‘DIY’ - guide wire catheterisation techniques
• difficult to make hole
exactly at tip • damage balloon
inflation channel
• Needle stick injury risk!
1. Development and Rationale behind UCD®
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Problems with ‘DIY’ - guide wire catheterisation techniques
• difficult to make hole
exactly at tip • damage balloon
inflation channel
• Needle stick injury!
1. Development and Rationale behind UCD®
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Urethrotech’s NICE-approved UCD® integrates a non-traumatic guide wire into a 3-way urethral catheter design
‘Seldinger Technique’ principle
Problem Solution Urethral Catheterisation Device (UCD®)
Indication: difficult/failed, or anticipated difficult male urethral catheterisation
1. Development and Rationale behind UCD®
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Attached plug after guide wire removal
Foley balloon Valve 5-10cc
Guide wire luer-lock stopper for lubrication and safety
Problem Solution Urethral Catheterisation Device (UCD®)
Indication: difficult/failed, or anticipated difficult male urethral catheterisation
1. Development and Rationale behind UCD®
Large side holes good urine drainage
Guide wire exit at round
Nelaton tip
Integrated non-traumatic 90cm
hydrophilic Nitinol guide wire
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Problem Solution Urethral Catheterisation Device (UCD®)
Indication: difficult/failed, or anticipated difficult male urethral catheterisation
1. Development and Rationale behind UCD®
Difficult ≠ Trauma
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Part 1 1. Development and Rationale behind UCD® 2. Managing Difficult Catheterisation 3. Identify patients who need referral for specialist intervention
Part 2 Hands-on-UCD® Practice
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?‘LUTS’ – lower urinary tract symptoms
• TWOC-Clinic • BCG-Clinic
• Emergency
Department
• ITU/wards
• Community
• Hospice care
2. Managing Difficult Catheterisation
1. Take patient history
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‘LUTS’ – lower urinary tract symptoms
• Ageing population!
1. Take patient history 2. Managing Difficult Catheterisation
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2. Managing Difficult Catheterisation – Standard Approaches
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UCLH-New Male Catheterisation Algorithm
First pass Urethral Catheter
Successful Insertion Second line UCD®
Successful UCD® Insertion Specialist / Cystoscopy
Resistance/failure to pass into bladder
Guide wire turns and exits at meatus (>2x)
Resistance/buckling of UCD®-catheter
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2. Managing Difficult Catheterisation - with the UCD®
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Part 1 1. Development and Rationale behind UCD® 2. Managing Difficult Catheterisation - with the UCD® 3. Identify patients who need referral for specialist intervention
Part 2 Hands-on-UCD® Practice
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UCLH-New Male Catheterisation Algorithm
First pass Urethral Catheter
Successful Insertion Second line UCD®
Successful UCD® Insertion Specialist / Cystoscopy
Resistance/failure to pass into bladder
Guide wire turns and exits at meatus (>2x)
Resistance/buckling of UCD®-catheter
3. Identify patients who need referral for Specialist intervention
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UCLH-New Male Catheterisation Algorithm
First pass Urethral Catheter
Successful Insertion Second line UCD®
Successful UCD® Insertion Specialist / Cystoscopy
Resistance/failure to pass into bladder
Guide wire turns and exits at meatus (>2x)
Resistance/buckling of UCD®-catheter
3. Identify patients who need referral for Specialist intervention
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Urethral Stricture 3. Identify patients who need referral for specialist intervention
Normal vascular urethral wall
<60y idiopathic bulbar urethral stricture > 60y iatrogenic TURP/post-surgery/catheterisation stricture
stricture
Bladder Prostate Urethral sphincter
stricture
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Stricture Dilatation Management 3. Identify patients who need referral for specialist intervention
We can dilate safely Urethrotech UCD
blind over guide wire
Cook S-shape dilator
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Stricture Dilatation Management 3. Identify patients who need referral for specialist intervention
safely dilate over guide wire 1. Urethrotech UCD
Soft stricture
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Stricture Dilatation Management 3. Identify patients who need referral for specialist intervention
safely dilate over guide wire 2. Cook S-Dilator
Hard stricture
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UCLH-New Male Catheterisation Algorithm
First pass Urethral Catheter
Successful Insertion Second line UCD®
Successful UCD® Insertion Specialist / Cystoscopy
Resistance/failure to pass into bladder
Guide wire turns and exits at meatus (>2x)
Resistance/buckling of UCD®-catheter
3. Identify patients who need referral for Specialist intervention
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Guide Wire Turns .. 3. Identify patients who need referral for specialist intervention
Cystoscopically
insert
guide wire
into bladder
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UCLH – Service Innovation Male Catheterisation Supporting the delivery of high-quality, cost-effective Health Care
• Catheterisation Trolley
1st & 2nd line safe urethral catheterisation
• Mandatory staff hands-on training (AMUC) basic life support model
• Advanced Clinical Nurse Practitioner bed-site Flexible cystoscopy for failed UCD®
• Stream lined Urology referrals Urology follow-up
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UCLH-New Male Catheterisation Algorithm
First pass Urethral Catheter
Successful Insertion Second line UCD®
Successful UCD® Insertion Specialist / Cystoscopy
Resistance/failure to pass into bladder
Guide wire turns and exits at meatus (>2x)
Resistance/buckling of UCD®-catheter
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UCLH – Service Innovation Male Catheterisation Supporting the delivery of high-quality, cost-effective Health Care
UserPatientfeed-backQuestionnaire V2.10/17
www.urethrotech.com
forfurtherinformationcontact:
InstructionofUseVideowww.youtube.com/watch?v=gteSYEpdl18
www.nice.org.uk/guidance/published?type=mib
pleasescanandemailformto:
[PatientLabel] [HospitalAddress/ward]
Nursefeed-back: ...pleasetickallthatapply
Technicalskillrequirement… theUCD®iseasytouseandIamhappytousetheUCDindependently
IhadproblemstoinsertUCD®guidewire
IfeelIneedmorepractice
Icouldn’tuseUCD
Ididn'tlikeitandIwon'tusetheUCD®again
UCD®training… I'vedonehands-onAdvanvedMaleUrethralCatheterisation(AMUC)course
I'veseentheYouTubeAdvanvedMaleUrethralCatheterisation(AMUC)course
I'dsayIwanttouseUCD®.. once..
..beforefeelingconfident! 2-5times..
>5times..
IthinktheUCD®is… brilliant&veryhelpfuldevice
maybehelpfulinsomecircumstances
don'tthinkitishelpfulformypractice
I'drecommendtheUCD® ..highly
toacolleague.. ..maybe
..won't
Pleasecommentandallowustolearn
fromyourexperience:
Patientfeed-back: ...pleasetickallthatapply
UCD®devicefeed-back itwasaverygoodexperienceandnotpainful
Icouldnotcomment..onewayortheother
itwasjustasbadanexperienceaswithpreviousstandardcatheters
Recommendationtoanotherpatient IwouldhighlyrecommendtheUCD®..tootherpatients
Maybe,butnotsurewhetherIwouldrecommendtheUCD®…
IwouldnotrecommendtheUCD®tootherpatients
Pleasecommentandallowustolearn
fromyourexperience:
Incidence of difficult re-catheterisation in Nurse-led Trial Without
Catheter (TWOC) and catheter change clinics: Does the re-
catheterisation using a guide wire make a difference? Dragova M1, Bamfo A1,Kevin Holmes2, Kirk Attard2, Bugeja S2, Lock A1, Frost A1, Mundy A1
1 University College London Hospitals NHS Foundation Trust. Urology, London, UK
2 Mater Dei Hospitals, Urology, Msida, Malta
Introduction The use of guide wires is well established in surgical practice, but relatively new in Nurse-led services. The aim of this study was to
investigate the incidence of difficult re-catheterisation and whether guide wire based urethral catheterisation technique reduces the
incidence of disrupted patient care pathways.
Materials and Methods • Retrospective Audit (September 2016-August 2017) • Prospective Audit (September 2017-Decmeber 2017) • Two Health Care Services (HCS)
HCS – A: Mater Dei Hospital, Malta
HCS – B: UCLH, London, UK • TWOC Service delivered by Clinical Nurse Specialist’s in both HCS
HCS – A : ‘DIY-guide wire - catheterisation’ enabled
HCS – B: not guide wire enabled until UCD implementation Sept 2017
•
UCD Advantages - catheter with integrated guide wire
· Integrated non-traumatic hydrophilic Nitinol guide wire into
standard 3-way silicone Foley catheter
· Facilitates safe second-line urethral catheterisation after failed
catheterisation attempt and prevents urethral trauma · Ready-to-use Single medical device when needed, 5-year
shelf life · Avoids needle-stick injury risk associated with 'DIY'-guide-wire-
catheterisation · Easy-to-use without assistance, requires minimal training,
empowers Nurse-led services · Avoids Patient Care delays and Urologist referral for more
invasive second-line catheterisation under vision, or SPC
insertion
Conclusions • Difficult re-catheterisation is a frequent occurrence and has a significant risk of urethral trauma.
• Traumatic catheterisation can be avoided by passing a catheter over a guide-wire, thus reducing patient care delays.
• Prevents unnecessary hospital referrals for more invasive specialist interventions.
• The Urethrotech UCD™ offers a purpose built 2nd line catheterisation solution which is easy and safe to use with high user and patient
satisfaction.
Results I – Retrospective Audit (Sept 2016- August 2017)
Results II – Prospective Audit (September – December 2017) HCS-B was attended by 194 men for TWOC. All 19% (36/194) who failed
the TWOC were now managed successfully by the CNS, and 3 UCD were
used as a second-line catheter on three occasions. No urology referrals
had to be made and no bleeding occurred as a result of catheterisation.
HCS – A
DIY- guide wire
catheter system
HCS – B
Before UCD
implementation
HCS – B
After UCD
implementation
Retrospecitve
Sept2016-Aug2017
Retrospecitve
Sept2016-Aug2017
Prospecitve
Sept2017-Dec2017
Patients attending
for TWOC
n=540 n=1002 n=194
Successful TWOC n=371 n=776 n=158
Failed
TWOC
n=169
31%
n=226
23%
n=36
19%
Successful
re-catheterisation
with standard
catheter
n=163 (of 169)
96%
n=169 (of 226)
75%
N=33 (of 36)
91%
Difficult
re-catheterisation
with standard
catheter
n=6
4%
n=57
25%
n=3 (à UCD for
re-catheterisation)
8%
Complications of
difficult re-
catheterisation
Bleeding
0%
Urologist Called
0%
Bleeding
40%
Urologist Called
18%
Bleeding
0%
Urologist Called
0%
Incidence of difficult re-catheterisation in Nurse-led Trial Without
Catheter (TWOC) and catheter change clinics: Does the re-
catheterisation using a guide wire make a difference? Dragova M1, Bamfo A1,Kevin Holmes2, Kirk Attard2, Bugeja S2, Lock A1, Frost A1, Mundy A1
1 University College London Hospitals NHS Foundation Trust. Urology, London, UK
2 Mater Dei Hospitals, Urology, Msida, Malta
Introduction The use of guide wires is well established in surgical practice, but relatively new in Nurse-led services. The aim of this study was to
investigate the incidence of difficult re-catheterisation and whether guide wire based urethral catheterisation technique reduces the
incidence of disrupted patient care pathways.
Materials and Methods • Retrospective Audit (September 2016-August 2017) • Prospective Audit (September 2017-Decmeber 2017) • Two Health Care Services (HCS)
HCS – A: Mater Dei Hospital, Malta
HCS – B: UCLH, London, UK • TWOC Service delivered by Clinical Nurse Specialist’s in both HCS
HCS – A : ‘DIY-guide wire - catheterisation’ enabled
HCS – B: not guide wire enabled until UCD implementation Sept 2017
•
UCD Advantages - catheter with integrated guide wire
· Integrated non-traumatic hydrophilic Nitinol guide wire into
standard 3-way silicone Foley catheter
· Facilitates safe second-line urethral catheterisation after failed
catheterisation attempt and prevents urethral trauma · Ready-to-use Single medical device when needed, 5-year
shelf life · Avoids needle-stick injury risk associated with 'DIY'-guide-wire-
catheterisation · Easy-to-use without assistance, requires minimal training,
empowers Nurse-led services · Avoids Patient Care delays and Urologist referral for more
invasive second-line catheterisation under vision, or SPC
insertion
Conclusions • Difficult re-catheterisation is a frequent occurrence and has a significant risk of urethral trauma.
• Traumatic catheterisation can be avoided by passing a catheter over a guide-wire, thus reducing patient care delays.
• Prevents unnecessary hospital referrals for more invasive specialist interventions.
• The Urethrotech UCD™ offers a purpose built 2nd line catheterisation solution which is easy and safe to use with high user and patient
satisfaction.
Results I – Retrospective Audit (Sept 2016- August 2017)
Results II – Prospective Audit (September – December 2017) HCS-B was attended by 194 men for TWOC. All 19% (36/194) who failed
the TWOC were now managed successfully by the CNS, and 3 UCD were
used as a second-line catheter on three occasions. No urology referrals
had to be made and no bleeding occurred as a result of catheterisation.
HCS – A
DIY- guide wire
catheter system
HCS – B
Before UCD
implementation
HCS – B
After UCD
implementation
Retrospecitve
Sept2016-Aug2017
Retrospecitve
Sept2016-Aug2017
Prospecitve
Sept2017-Dec2017
Patients attending
for TWOC
n=540 n=1002 n=194
Successful TWOC n=371 n=776 n=158
Failed
TWOC
n=169
31%
n=226
23%
n=36
19%
Successful
re-catheterisation
with standard
catheter
n=163 (of 169)
96%
n=169 (of 226)
75%
N=33 (of 36)
91%
Difficult
re-catheterisation
with standard
catheter
n=6
4%
n=57
25%
n=3 (à UCD for
re-catheterisation)
8%
Complications of
difficult re-
catheterisation
Bleeding
0%
Urologist Called
0%
Bleeding
40%
Urologist Called
18%
Bleeding
0%
Urologist Called
0%
UCD®- TWOC-Clinic Service Innovation
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Quiz
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Quiz
Photomicrograph of Fournier gangrene (necrotizing fasciitis). Note the acute inflammatory cells in the necrotic tissue. Bacteria are located in the haziness of their cytoplasm. Courtesy of Billie Fife, MD, and Thomas A. Santora, MD
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Quiz
Fournier gangrene (necrotizing fasciitis) … due to misplaced catheter!
Urethral Catheterisation Injury (UCI) is a preventable patient care error!
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Quiz
Cystoscopically
insert
guide wire
into bladder
Golden Rule - if in doubt …
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Conclusion
• Traumatic urethral catheterisation turns a simple procedure into an emergency
info: www.urethrotech.com
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Conclusion
• Traumatic urethral catheterisation turns a simple procedure into an emergency
• Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity and long-term complications
info: www.urethrotech.com
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Conclusion
• Traumatic urethral catheterisation turns a simple procedure into an emergency
• Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity and long-term complications
• UCI £215Mio / year problem in the UK
info: www.urethrotech.com
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Conclusion
• Traumatic urethral catheterisation turns a simple procedure into an emergency
• Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity and long-term complications
• UCI £215Mio / year problem in the UK
• The UCD® is easy to use and empowers nurses to manage difficult catheterisation independently and safely in any clinic environment
info: www.urethrotech.com
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Conclusion
• Traumatic urethral catheterisation turns a simple procedure into an emergency
• Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity and long-term complications
• UCI £215Mio / year problem in the UK
• The UCD® is easy to use and empowers nurses to manage difficult catheterisation independently and safely in any clinic environment
• The UCD® catheterisation solution avoids unnecessary referral to hospital specialists and patient care is not delayed
info: www.urethrotech.com
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Please collect
Hands-on Practical Part
Vouchers at Urethrotech booth
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