Urethral catheterization: do nurses have adequate exposure?

Background: Urethral catheterization is a vital basic skill which not learnt properly will lead to numerous complications. The aim of the study is to assess the knowledge and practice of urethral catheterization procedure among the nursing students. Methods: This study was conducted by a questionnaire to all the nurses in our hospital. It includes precautionary methods, knowledge of urethral catheterization procedure and the necessity for the demonstration of the procedure to the nurses.Results: A total of 120 nurses were included in the study. During training program, all were able to define and observed urethral catheterization. Overall, 19% did not perform the procedure as undergraduates and only14% passed >10 urethral catheterization. On assessing the steps, 61% described the steps involved in catheterization and 87% listed the possible complications of catheterization. Meanwhile, 93% revealed the need for practical demonstration of procedure during their training phase. Conclusions: With regards to urethral catheterization, poor practical experience was observed in nurses. An attempt should be formulated to enhance the supervised urethral catherization training programme conducted for nurses, in order to deliver preventable complications.

Case Report: Transient cortical blindness following coronary angiography

Temporary blindness, also known as transient cortical blindness, is an uncommon impediment of contrast agent usage during angiography procedures. The occurrence of blindness after a cardiac catheterization procedure is rare and its pathophysiology remains largely speculative. The most probable mechanism seems to be contrast agent-related disruption of the blood–brain barrier, possibly initiated by several predisposing factors. This case reports a 52-year-old man with transient vision loss that occurred following coronary angiography. Brain magnetic resonance imaging (MRI) showed no acute pathology and his vision spontaneously returned within approximately 15 hours post-procedure without any requirement of specific therapy. Suggesting that transient cortical blindness may have occurred following coronary angiography which subsequently self-resolved.

Interventional Cardiovascular Magnetic Resonance Imaging (iCMR) in an Adolescent with Pulmonary Hypertension

The interventional cardiac magnetic resonance imaging (iCMR) catheterization procedure is feasible and safe for children and adults with pulmonary hypertension and congenital heart defects (CHD). With iCMR, the calculation of pulmonary vascular resistance (PVR) in children with complex CHD with multilevel shunt lesions is accurate. In this paper, we describe the role of the MRI-guided right-sided cardiac catheterization procedure to accurately estimate PVR in the setting of multiple shunt lesions (ventricular septal defect and patent ductus arteriosus) and to address the clinical question of operability in an adolescent with trisomy 21 and severe pulmonary hypertension.

Abstract 15714: Intra-cardiac Pressure Estimation Using Subharmonic Aided Pressure Estimation (SHAPE) - A Clinical Evaluation

Introduction: Subharmonic aided pressure estimation (SHAPE) utilizes ambient pressure sensitivity of subharmonic signals from ultrasound contrast agents. The objective was to evaluate SHAPE with Definity (Lantheus Medical Imaging, Inc.) and Sonazoid (GE Healthcare) microbubbles for intra-cardiac pressure estimation. Hypothesis: Errors between SHAPE and pressures obtained during cardiac catheterization ≤ 5 mmHg. Methods: IRB approved this study. Consenting patients received an infusion of Definity (56 patients; 2 vials in 50 mL of saline; infusion rate: 4-10 mL/min) or Sonazoid (77 patients; rate (mL/hour) = 0.18 x weight in kg co-infused with saline at 120 mL/hour) during cardiac catheterization. Subharmonic data was acquired using a SonixTablet (PA 4/2 array; BK Ultrasound) synchronously with pressures from the left and right ventricles and the aorta (for left heart catheterizations only). Subharmonic data (in dB) was converted to pressure values (in mmHg) using calibration factors (mmHg/dB) based on data obtained from the aorta - utilizing pressures from the aorta either during the catheterization procedure or pressures obtained using a SphygmoCor (AtCor Medical Pty. Ltd.) device after the catheterization procedure. Clinically relevant pressures between the SHAPE technique and the pressure catheter were compared. Results: Correlation coefficient between the subharmonic and pressure data was -0.8 ± 0.1. With Definity, mean absolute errors ranged from 2.9 ± 1.5 to 5.0 ± 4.2 mmHg and from 4.4 ± 5.7 to 23.7 ± 28.3 mmHg for calibration factors utilizing aortic pressures from pressure catheter and SphygmoCor, respectively. For Sonazoid microbubbles, these errors ranged from 7.9 ± 12.0 to 10.1 ± 12.4 mmHg and from 7.2 ± 11.5 to 15.0 ± 23.2 mmHg, respectively. Two adverse events occurred during Definity infusion; these were resolved with return to baseline conditions. Conclusion: SHAPE may be useful for estimating intra-cardiac pressures noninvasively.

The Actual Epidemiological Effectiveness of Assessing and Improving the System for Ensuring the Epidemiological Safety of Medical Care for Catheterized Patients

The basis of optimized conventional system of surveillance and control for catheter-related bloodstream infections (CRBI) was priority in detection and risk assessment an infectious complication of puncture catheterization that substantially justified with inclusion of two main components as an addition to the existing system: monitoring of puncture catheterization, which allows to obtain and analyze data on risk factors for infections associated with the catheterization procedure and subsequent manipulations of the device, standardize approaches to working with a venous catheter and improve the diagnosis of CRBI; assessment of ensuring the epidemiological safety of medical care for catheterized patients. Epidemiological efficiency risk-based surveillance, primarily determined to reduce the incidence of CRBI by 1.8 times compared to initially defined real incidence: 12.5‰ (95% CI — CI 11,8–13 2) vs 22.8‰ (95% CI 21,1–24,5) catheterized patients, p=0.0001.

Construção de manual educativo sobre cateterismo vesical intermitente limpo: relato de experiência

Trata-se de um relato de experiência com o objetivo de descrever a construção de manual educativo com informações e orientações sobre cateterismo vesical intermitente limpo. O estudo foi realizado entre os meses de junho e agosto de 2018, no setor de traumatologia e neurocirurgia do Hospital Universitário da Universidade Federal do Maranhão, São Luís, Maranhão, Brasil. O manual discorre sobre a técnica do procedimento cateterismo vesical intermitente limpo, com orientações e figuras ilustrativas voltadas aos pacientes com disfunção neurogênica do trato urinário inferior como sequela de trauma raquimedular. Identificou-se a importância da elaboração deste manual, como um material de apoio para o fornecimento de instruções e ensinamentos para a realização do cateterismo vesical intermitente limpo, visando a prevenção e redução de infecções urinárias e insuficiência renal, e ainda reinserção do paciente lesado medular ao convívio social proporcionando melhoria em sua qualidade de vida.Descritores: Cateterismo Uretral Intermitente, Educação em Saúde, Enfermagem. Construction of educational manual on clear intermitent bladder cathederism: experience reportAbstract: This is an experience report with the objective of to describe the construction of an educational manual with information and guidance on clean intermittent bladder catheterization. The study was carried out between June and August 2018, in the trauma and neurosurgery sector of the University Hospital of the Federal University of Maranhão, São Luís, Maranhão, Brazil. The manual discusses the technique of the clean intermittent bladder catheterization procedure, with guidelines and illustrative figures aimed at patients with neurogenic lower urinary tract dysfunction as a sequel of spinal cord trauma. The importance of preparing this manual was identified, as a support material for the provision of instructions and teachings for the performance of clean intermittent bladder catheterization, aiming at the prevention and reduction of urinary infections and renal failure, as well as there insertion of the injured spinal cord patient to social interaction providing improvement in their quality of life.Descriptors: Intermittent Urethral Catheterization, Health Education, Nursing. Construcción del manual educativo sobre catederismo vesical de intervalo claro: informe de experienciaResumen: Este es un informe de experiencia con el objetivo de describir la construcción de un manual educativo con información y orientación sobre la cateterización vesical intermitente limpia. El estudio se realizó entre junio y agosto de 2018, en el sector de traumatología y neurocirugía del Hospital Universitario de la Universidad Federal de Maranhão, São Luís, Maranhão, Brasil. El manual discute la técnica del procedimiento de cateterización vesical intermitente limpia, con pautas y figuras ilustrativas dirigidas a pacientes con disfunción neurogénica del tracto urinario inferior como secuela del trauma de la médula espinal. Se identificó la importancia de preparar este manual, como material de apoyo para la provisión de instrucciones y enseñanzas para la realización de una cateterización vesical intermitente limpia, con el objetivo de prevenir y reducir las infecciones urinarias y la insuficiencia renal, así como la reinserción del paciente con lesión de la médula espinal a la interacción social que mejora su calidad de vida.Descriptores: Cateterismo Uretral Intermitente, Educación en Salud, Enfermería.

Urethral Catheterization: A Review of the Indications, Techniques, and Complications of Male Urethral Catheterization for General Medical Practice

The physiologic process of micturition plays an essential role in the ability of the human body to regulate homeostasis. When the urinary system encounters an obstruction such as a foreign body within the bladder or other prostatic diseases like benign prostatic hyperplasia (BPH), alternative measures to drain the bladder is required, this birthed the use of urethral catheters & the catheterization procedure. Urethral catheterization dates to the early days of medicine and while it is mostly a routine procedure in this era, the total understanding of its indications, proper techniques, and associated complications remains an essential tool in the arsenal of a practicing physician.

Killip-Kimball Classification Validation, Outcomes and Demographics in an Octogenarian Cohort with Acute Coronary Syndrome in a Developing Country: A Third-Level Multicenter 11-Year Experience

Introduction: The Killip-Kimball Classification (KC) is used to group patients with acute coronary syndrome (ACS) based on their clinical profile. It has proven to be useful while predicting both short- and long-term mortality. Contemporary data in the elderly population is limited. We sought to analyze trends in outcomes of patients 80 years or older admitted for ACS, by Killip Class. In addition, we assess the validity of the KC in this population. Methodology: A retrospective analysis of patients who underwent a catheterization procedure for ACS was performed. ACS was defined as per AHA guidelines, and included STEMI, non-STEMI and Unstable Angina. We determined factors influencing the KC in which patients present to the emergency room. Likewise, we compared in-hospital mortality, length of stay, and other outcomes dividing the patients by KC. Results: A total of 133 patients were analyzed. Included were: 86, 9, 23 and 15 patients in KC-I through IV respectively with a mean age of 83. The main comorbidities were hypertension (73%), and diabetes (43%). In-hospital mortality was 12%, which was different between KC groups (p< 0.01). In addition, we found higher KC groups to be associated with acute kidney injury during the hospitalization (p< 0.01). Conclusion: Despite a strong reduction in mortality for elderly patients with ACS in recent decades, patients presenting with ACS and higher Killip class have a high mortality rate, as described in younger cohorts. The Killip-Kimball classification remains a reliable prognostic tool, with applicability in octogenarian patients.

Cardiac Catheterization and Coronary Intervention

Cardiac catheterization and coronary angiography are both key components to routine cardiology practice. This new edition of Cardiac Catheterization and Coronary Intervention has been fully updated since the first edition, with new sections on primary percutaneous coronary intervention, trends in vascular access, bioabsorbable stents, optical coherence tomography, and more. Filled with over 150 clinical images and schematic illustrations, the handbook is an accessible ‘how-to’ guide, designed to demystify complex cardiac catheterization investigations. Expanded to reflect developments in practice, this new edition also introduces a new chapter on the multidisciplinary team and their roles and responsibilities from pre- to post-procedural care and relevant training requirements. It contains detailed instructions on how to perform a comprehensive left and right heart catheterization procedure, choosing the correct catheter for coronary and graft angiography, and how to perform a diagnostic coronary angiogram and interpret the subsequent findings.