This course is all about solving the medical emergency of ... · with an enlarged prostate). The...

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 / Identifying patients at risk 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 Bugeja S, 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 has been 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!


Legislation Health and Safety Regulations 2013 No. 645


Use and disposal of medical sharps 5. (1) An employer must ensure that—

(a) the use of medical sharps at work is avoided so far as is reasonably practicable (b) when medical sharps are used at work, safer sharps are used so far as is reasonably practicable (c) needles that are medical sharps are not capped after use at work unless—

(i) that act is required to control a risk identified by an assessment undertaken pursuant to regulation 3 of the Management of

Health and Safety at Work Regulations 1999(1); and

(ii) the risk of injury to employees is effectively controlled by the use of a suitable appliance, tool or other equipment (d) in relation to the safe disposal of medical sharps that are not designed for re-use— (i) written instructions for employees, and (ii)clearly marked and secure containers are located close to areas where medical sharps are used at work.

(2) An employer must review at suitable intervals the policies and procedures in place to meet the requirements of

paragraph (1) so as to ensure that those policies and procedures remain up to date and effective.

http://www.legislation.gov.uk/uksi/2013/645/regulation/5/made



Information and training 6.—(1) An employer must provide each employee of that employer who is exposed to a risk of injury at work from medical sharps with information on the matters specified in Schedule 1. (2) In complying with paragraph (1) the employer must cooperate with worker representatives in that employer’s undertaking in developing and promoting the information specified in Schedule 1. (3) In paragraph (2), “worker representatives” means any— (a) safety representatives within the meaning of the Safety Representatives and Safety Committees Regulations 1977(1); or (b) representatives of employee safety within the meaning of the Health and Safety (Consultation with Employees) Regulations 1996(2).

(4) An employer must provide each employee of that employer who is exposed to a risk of injury at work from medical

sharps with training on the matters specified in Schedule 2 to the extent that those matters are relevant to the type of work carried

out by that employee




Arrangements in the event of injury 7.—(1) Where an employer is notified of any incident at work in which an employee has suffered an injury from a medical sharp, the employer must— (a) record the incident;

(b) investigate the circumstances and cause of the incident; and

(c) take any necessary action to prevent a recurrence (2) Additionally, where an employer is notified of any incident at work in which an employee has suffered an injury caused by a medical sharp that exposed, or may have exposed, the employee to a biological agent, the employer must— (a) take immediate steps to ensure that the employee receives medical advice; (b) ensure that any treatment advised by a registered medical practitioner, including post-exposure prophylaxis, is made available to the employee; and (c) consider providing the employee with counselling.

(3) In this regulation— (a) “biological agent” means a micro-organism, cell culture or human endoparasite, whether or not genetically modified, which may cause infection, allergy, toxicity or otherwise create a hazard to human health; and (b) “post-exposure prophylaxis” means a course of treatment of medicine administered to a person after exposure, or suspected exposure, to a biological agent in order to prevent infection or development of disease caused by that biological agent.



Notification of injuries 8.—(1) Person “A”, who is an employee or other person working under the supervision and direction of a healthcare employer or a

healthcare contractor, must—

(a) as soon as practicable, notify A’s employer, or any other employee of that employer with specific responsibility for the health

and safety of persons at work, of any incident at work in which A has suffered an injury from a medical sharp; and

(b) provide when requested by that employer sufficient information as to the circumstances of the incident to enable the employer to comply with regulation 7. (2) In the case of an employee or other person working under the supervision and direction of a healthcare contractor, this regulation only applies to incidents which take place— (a) on a healthcare employer’s premises; or (b) under the authority of a healthcare employer


Policies/Guidelines: Management of difficult catheterisation


“Use an appropriate lubricant from a sterile single use container to minimise urethral trauma and infection”

... but there are NO National Guidelines and NO Hospital Policies in NHS/other Healthcare Providers on managing difficult catheterisation !

Journal of Hospital Infection (2007) 65S, S1–S64 https://www.ncbi.nlm.nih.gov/pubmed/27665577



BUT so far! - No National Guidelines / No Policies .. on managing difficult catheterisation !

since April 2018

New DATIX Code ‘Difficult Urethral Catheterisation’ for Hospital Trust Incidence Reporting



https://www.nice.org.uk/Search?q=+urethral+catheterisation+trauma

since August 2017 = 1st published

Problem Solution !

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 / Identifying patients at risk

Take patient history

‘LUTS’ – lower urinary tract symptoms

Ageing population!

Take patient history / IPSS questionnaire 2. Managing Difficult Catheterisation / Identifying patients at risk

2. Managing Difficult Catheterisation – Product/Policy development

Policies/Guidelines:

https://www.nice.org.uk/Search?q=+urethral+catheterisation+trauma

“The technology described (Urethrotech UCD) is designed to be used for difficult or failed catheterisations in men.

The innovative aspect is that it is the only currently available system which integrates a guidewire into a standard Foley catheter.

The intended place in therapy would be instead of cystoscopy and supra-pubic catheterisation methods after standard catheterisation has failed, or when it is difficult (such as in men with an enlarged prostate).

The device could potentially be used in any healthcare setting by appropriately trained staff.

Clinical study evidence (157 patients in a UK setting) show that the Urethrotech UCD can be a useful urethral catheterisation method in men, and reported no adverse events.

The cost of the Urethrotech UCD is £198.98 per unit (exclusive of VAT).

The resource impact may be less than standard care, if the Urethrotech UCD avoids the need for more complex and costly cystoscopy and suprapubic catheterisations as second-line procedures.”

Summary: “The UCD would be used as an optional intermediated step before cystoscopy and suprapubic catheterisation”

UCLH-New Male Catheterisation Algorithm 1

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

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


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

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

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

3. Identify patients who need referral for specialist intervention

If Guide Wire Turns > x2 ..

Cystoscopically

insert

guide wire

under vision

into bladder

Cystoscopic guide wire insertion

? Established false passage

? Bleeding false passage

? Urethral stricture












3. Identify patients who need referral for Specialist intervention



Urethral Stricture

<60y bulbar urethral stricture > 60y post-surgery/TURP/catheter stricture

stricture

Bladder Prostate Urethral sphincter

stricture


Stricture Dilatation Management

safely dilate over guide wire !

Soft stricture – Urethrotech UCD Hard stricture – Cook S-Shape dilator

White urethral Stricture.. .. torn open (stretched) after stricture dilatation

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) Advanced Male Urethral Catheterisation

• Advanced Clinical Nurse Practitioner bed-site Flexible cystoscopy for failed UCD®

• Stream lined Urology referrals Urology follow-up

UCLH – Service Innovation Male Catheterisation Implementation trough Audit

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

AUDIT

QUESTIONNAIRE

UCLH-New Male Catheterisation Algorithm - established in TWOC Clinic !







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 register

www.AMUC.Academy

Certificate of Attendance

has completed the Hands-on-Training of the

Advanced Male Urethral Catheterisation Course (AMUC)

On

18 March 2018

Daniela Andrich MD MSc FRCS AMUC Course Organiser Consultant Reconstructive Urologist

Date post:	04-Aug-2020
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This course is all about solving the medical emergency of ... · with an enlarged prostate). The...

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