This course is all about solving the medical emergency of ...urethrotech.com/downloads/eaun-2018/AMUC_EAUN2018.pdf · This course is all about solving the medical emergency of difficult

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

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



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




• 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




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

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 …


Problems with ‘DIY’ - guide wire catheterisation techniques

• difficult to make hole

exactly at tip • damage balloon

inflation channel

• Needle stick injury risk!


Problems with ‘DIY’ - guide wire catheterisation techniques

• difficult to make hole

exactly at tip • damage balloon

inflation channel

• Needle stick injury!


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


Attached plug after guide wire removal

Foley balloon Valve 5-10cc

Guide wire luer-lock stopper for lubrication and safety




Large side holes good urine drainage

Guide wire exit at round

Nelaton tip

Integrated non-traumatic 90cm

hydrophilic Nitinol guide wire




Difficult ≠ Trauma



?‘LUTS’ – lower urinary tract symptoms

• TWOC-Clinic • BCG-Clinic

• Emergency

Department

• ITU/wards

• Community

• Hospice care

2. Managing Difficult Catheterisation

1. Take patient history

‘LUTS’ – lower urinary tract symptoms

• Ageing population!

1. Take patient history 2. Managing Difficult Catheterisation

2. Managing Difficult Catheterisation – Standard Approaches

Go to www.urethrotech.com/meetings.html to view the video

http://www.urethrotech.com/meetings.html

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

2. Managing Difficult Catheterisation - with the UCD®



Part 1 1. Development and Rationale behind UCD® 2. Managing Difficult Catheterisation - with the UCD® 3. Identify patients who need referral for specialist intervention









3. Identify patients who need referral for Specialist intervention













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

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


safely dilate over guide wire 1. Urethrotech UCD

Soft stricture


safely dilate over guide wire 2. Cook S-Dilator

Hard stricture









Guide Wire Turns .. 3. Identify patients who need referral for specialist intervention

Cystoscopically

insert

guide wire

into bladder

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








UCLH – Service Innovation Male Catheterisation Supporting the delivery of high-quality, cost-effective Health Care

UserPatientfeed-backQuestionnaire V2.10/17

www.urethrotech.com

forfurtherinformationcontact:

[email protected]

InstructionofUseVideowww.youtube.com/watch?v=gteSYEpdl18

www.nice.org.uk/guidance/published?type=mib

pleasescanandemailformto:

[email protected]

[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

Quiz

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

Quiz

Fournier gangrene (necrotizing fasciitis) … due to misplaced catheter!

Urethral Catheterisation Injury (UCI) is a preventable patient care error!

Quiz

Cystoscopically

insert

guide wire

into bladder

Golden Rule - if in doubt …

Conclusion

• Traumatic urethral catheterisation turns a simple procedure into an emergency

info: www.urethrotech.com

Conclusion


• Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity and long-term complications


Conclusion



• UCI £215Mio / year problem in the UK


Conclusion




• The UCD® is easy to use and empowers nurses to manage difficult catheterisation independently and safely in any clinic environment


Conclusion




• 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


AMUC Training Certificate please email Lecture available at

[email protected] www.urethrotech.com

mailto:[email protected]



Please collect

Hands-on Practical Part

Vouchers at Urethrotech booth

Documents

This course is all about solving the medical emergency of ...urethrotech.com/downloads/eaun-2018/AMUC_EAUN2018.pdf · This course is all about solving the medical emergency of difficult