Antibiotic bonded nephrostomy catheters for percutaneous nephrostomies

Infectious Complications Associated with Percutaneous Nephrostomy Catheters: Do we know Enough?

The percutaneous nephrostomy catheter (PCNC) has evolved since its inception. Over more than half a century, it has gone from a temporary maneuver to a permanent fixture in a large proportion of patients who have incurable illnesses with obstructed renal drainage systems. Unfortunately, the research looking specifically at infectious complications associated with PCNCs suffers from oversimplification as studies predominantly assess sepsis alone. There are no standardized definitions or criteria to define the various infectious complications described in this paper. Although the PCNC has a relative paucity of infectious complications, which represents an excellent marker for patient care, the low rate of infection dictates a large sample size for sufficiently-powered research studies to be able to find a significant impact of interventional measures. In this review article, we discuss various aspects of pathogenesis and treatment of the different subtypes of PCNC-associated infections.

Novel strategies to prevent catheter-associated infections in oncology patients

Aggressive cytotoxic treatment of cancer contributes to the growing number of life-threatening infections. Vascular catheters create predominant risks for staphylococcal, enterococcal and candida blood stream infections. Although the contaminating microorganisms may be few in number, the altered host immune response in the presence of such implants as well as disease-associated immunosuppression implies that even small bacterial counts have to be regarded as highly virulent species. Diagnosis of catheter-related infection (CRI) remains difficult before withdrawal of the suspected catheter. Positive culture of catheter surface, lumen and hub and positive peripheral blood probes (paired quantitative blood culture) are predictive for catheter related bacteremia (CRB). Diligent catheter care and effective antimicrobial catheters may reduce prolonged hospital stay, increased morbidity or mortality and serious economical consequences. The most promising approach features the incorporation of antimicrobial drugs into the polymer matrices that entrap but do not bind the drugs, allowing for extended release. For the efficacious prevention of colonization in the microenvironment of the implantable device the concentration of the antimicrobial substances must exceed usual antibiotic concentrations by a thousand-fold. This is the desired effect--high concentration near the device surface and very low systemic concentration. Incorporation of antimicrobials in the bulk material that constitutes a device can be effective as shown in several in vitro and in vivo studies. In the future, modification of both short-term and long-term catheters by biofilm-active antimicrobials creating slow delivery systems may provide an effective method to protect patients from nosocomial infection in oncology.

Polymer materials for the prevention of catheter-related infections

Catheter-related infections are major problems in medicine because of severe consequences for the patient, prolongation of hospitalization, and increasing therapy costs. Beside progress in hygienic measures, development of catheters with antiinfective properties seems to be a promising approach to the prevention of such infections. Two approaches for infection-resistant catheter materials have been developed: materials with antiadhesive properties and materials with antimicrobial properties. Antiadhesive polymers shall prevent the adhesion of microorganisms to the medical device. However, up to now there has been no material which would lead to a complete inhibition of adherence ("zero adherence"). Materials with antimicrobial properties contain antimicrobial substances which are incorporated into the biomaterial or bound to the polymer surface. These devices seem to be effective in the prevention of "early onset infections". In this paper, an overview of the development and efficiency of antiadhesive or antimicrobial polymers is given.

Emergency percutaneous nephrostomy: results and complications

PURPOSE

Percutaneous nephrostomy is a well-established standardized procedure in the management of patients with various urologic problems. The goal of this study was to evaluate the effectiveness and safety of percutaneous nephrostomy in an emergency setting.

PATIENTS AND METHODS

Emergency percutaneous nephrostomy was performed in 160 patients with ages ranging from 2 to 89 years (mean, 52 years). Access to the kidney was planned and achieved with C-arm fluoroscopic guidance.

RESULTS

The initial technical success rate was 98%. Overall complication rate was 34%; 6% were major and 28% were minor. Major procedure-related complications, including sepsis, occurred in 6% of patients. Hematuria requiring transfusion was noted in 2.4% of patients. Minor complications included catheter displacement or malposition (4.8%), pelvic perforation (4.3%), paralytic ileus (2.4%), pneumonia/atelectasis (1.8%), and pleural effusion (1.2%). High-risk patients included those with diabetes, hypertension, and obesity. No deaths or significant morbidity resulted from any complication.

CONCLUSIONS

Emergency percutaneous nephrostomy under fluoroscopic guidance is a simple, safe, and effective procedure and should be offered in all suitably equipped radiology departments.

Over-the-wire placement of large bore thoracostomy tubes

A simple method is described for placement of large caliber thoracostomy tubes utilizing an over-the-wire (Seldinger) technique. The method employs an angioplasty balloon catheter on which a renal fascial dilator and sheath are mounted. Through the sheath a large caliber thoracostomy tube is placed into the pleural space.