diane newman: welcome. I’m Diane Newman. I am an adult nurse practitioner, adjunct professor of urology and surgery, and senior fellow at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. In this presentation, I would like to introduce you to coding techniques for hydrophilic catheters for intermittent catheterization in those catheters that we use intermittently. It’s just a very fast timeline of our progress in catheter technology.
When you look at this, you’ll be amazed how what we use now with intermittent catheterization, what we teach our patients, has really changed. We’ve really gotten rid of the red rubber conduit. There’s a lot of concern now about latex, latex allergies, especially in healthcare settings, even among nurses, and you can imagine we really don’t want to use red rubber catheters anymore. That’s literally hundreds of years old now. That’s really outdated stuff.
We’ve now moved to more hydrophilic coated catheters, and we’ve found that the catheters are better for patients and actually better for their urethras, so that’s really important. It really enhances the experience of the person performing the catheterization. Materials have always been there, this slide just gives you an idea of the different types of materials that we’re seeing in catheters that are used intermittently. Rubber latex is the most flexible. Of course, latex allergies are involved.
PVC, has been around for a long time. Basically, it’s a very cheap catheter that tends to be stiffer. PEBA is a PVC-free plastic material that is durable and flexible. And then we have the silicone catheters, which we’ve found with intermittent catheterization that they can be really too flexible and not easy to get through. And then we have what we primarily use in the hydrophilic catheters that we use, PVP, which is actually the basis for most of the catheters that we use for hydrophilic.
But, you have to be aware that with those materials that we have, the hydrophilic layer adheres to the surface of the catheter. Where do our design changes go as technology advances in the field? In fact, the focus has been on polymer properties and latex has largely been replaced by silicone, polyethylene, PVC or organic PEBA. There are advantages to making these products: of course the cost can be reduced, and of course the question is always there whenever we see a design change, is there a concern about patients having an allergic reaction?
As I said, the hydrophilic polymer coating allows the catheter to pass through easily because it binds a lot of water. It forms a very smooth, hydrophilic hydration layer on the surface of the catheter. It reduces friction between the catheter and the tissue of the urethra, especially in very long male urethras. You need less force to thread the catheter and insert it into your urethra. In fact, data shows it’s getting stronger because it’s less traumatic during catheterization, more comfortable, and improves ease of use.
The thing is, there are different types of ways you can apply a coating to make a surface hydrophilic. This could be a problem for someone who may be less dexterous in terms of manipulating the packaging and all the material needed to cover the catheter. Hydrophilic catheters can be problematic. They can be painful because they dry out. The catheter may frictionally stick and over time, it starts to dry out, causing hematuria trauma, which can then lead to difficulty inserting the catheter. That problem is, then you have patients forcing the catheter through the urethra.
Also, it can cause strictures and of course catheter-related UTIs because the urethra is traumatized, it bleeds, and bacteria can get into the system. Now, there is some evidence for hydrophilic catheters in the literature. There have actually been quite a few publications. I do have a list of references at the end of this lecture, so you can look up the information yourself if you want.
Basically, the data released this year and the scoping review are recent, and in neurogenic and non-neurogenic patients with urinary retention, the results are better with hydrophilic coatings. What would be a better result? Satisfaction, preference, fewer adverse events, all the things I just mentioned are possible. UTIs, better quality of life, more cost-effective, less pain and discomfort. This slide is just to show you, all in all, they’re positive, dear. That’s HCIC, Hydrophilic Coated Intermittent Catheter. They really looked at many, many different publications.
They showed an impact on UTI, very positive in terms of reducing UTI. Again, here’s another one. You’ll see it all at the bottom, reducing pain and discomfort. We know this very well. In fact, the 2013 EAUN guidelines concluded that hydrophilic catheters reduce pain, and most patients prefer them for comfort. I think that’s something we have to remember. This is a great study, scoping review, because they looked at spinal cord injuries, they looked at spina bifida and mask EPH. They looked at a large number of patients, both men and women, and they showed that, yes, it is more comfortable for patients to use a hydrophilic agent.
There is no doubt that this technological advancement is indeed positive. We are aware of this. We do have some data. We do know patients who do, and we do know that hydrophilic catheters do add to the smoothest, wettest surface when you put that catheter through the urethra. Therefore, it is desirable for the catheter to have lower friction, lower force, and less microtrauma. Well, that’s really important.
As far as these catheters go, let’s talk a little bit about this. They do dry out. It’s a slippery stickiness that happens when they dry out. If we go back to Mandy Fader’s article in 2002, she asked this question. Her aim is to see if there are adhesions. When she says sticking, she means sticking to the sticky part of the hydrophilic coating during withdrawal. Of course, it depends on the timing. You put it in and when you take it out does it dry out and stick to the urethra? She wondered how well the catheter removal went.
She looked at 61 men with an average age of 54 and compared four different hydrophilic catheters in 2002. I must stress to you that technology has evolved since then. We are always seeing new designs and new coating types. She looked at how comfortable the men were with insertion and removal of the catheter, as well as bladder and penis comfort. She also looked at how smooth the removal was, and whether it was sticking. I think these results are somewhat surprising. We may find these results surprising, but stickiness occurred on removal on all four catheters she tested at the time.
That’s what the subjects, the patients, said. Oh well, if you like being turned over. The quarter sticks in like glue, duh. It was so sticky it was a pain to remove, it dries quickly and clings to the wall of the penis. Again, small study, 61 men. The point is that there is some sticking happening there. You’ll see that in the question below when she asks whether to stick with the removal, a little or a lot, and those are not trivial numbers.
These are the four different types of catheters she tested. Again, the technology may be old and has evolved since then, but it’s what the field started talking about. What you’re seeing from this is that the findings here suggest that there’s a difference. This is very important. Not all hydrophilic coated catheters are created equal. We don’t know exactly how much this happens, but we do have more data on what happens when catheters are removed.
In fact, in 2016, a validated questionnaire actually came out called the Intermittent Catheterization Difficulty Questionnaire. I’ve used this in research and they actually asked a question, look at question 11: I have a blockage when extubating. They were asked how often and how intensely this happened. You’ll see the evolution from 2002 to 2016 and see if we can document that in some of the research we’re doing.
In fact, in a study I did, which was supported by Wellspect, 200 patients who had catheterizations, mostly men, who had been in UC for a long time, 90 % It’s been a year and it’s mainly the spinal neurogenic population gentlemen we did ask about the questionnaire and we did publish the data. Now, that question, “I have a blockage when I remove the catheter,” yes, some people do. We’re starting to see more and more questions, as to whether there’s a problem with removing these catheters, as to potentially sticking to the urethra?
It’s important to understand that we’ve been using catheters for a long time, okay? Designs have really evolved, technology has really expanded, and we have better and better catheters to teach our patients. We have to realize that hydrophilicity has many advantages as long as they are applied to catheters that we use intermittently, but they dry out. We need to know more about what’s going on there, is the dryness causing some trauma to the urethra?
In the second part, what I want to guide you is, I want to talk to you about the latest technology that we have. It’s called Field Clean technology, and as opposed to being attached to a hydrophilic coating, the hydrophilic component is embedded into the surface of the catheter. I hope you can hear the second part.