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A Simple Method of Retaining Catheters
THE JoTJJ-t"'.\TAL oF U1un,0GY
Vol. 75, No. 6, June 1956 Printed 1·n [: .S.A.
A SIMPLE lVIETHOD OF RE'L-\.1:'\I~G CATHETERS ,\ ESTIN COJVIARH
.·\ND
T. TORGEHSO:\'
From the Paraplegfo Servi<'e. Veterans Administration Hospital, Lonq Bea<:/1., Calif. and the Schoo[ o.f Medicine, Colleue of J1 edical E1•angcli.sls, Los cl nqeles, CaU.f.
,'\ nurnber of methods have been used to retaiu eatheters. 1 · 2 • :i This retainer is not new in principle. H owevc~r, in institutions where a large number of nepbrostomy, pyelostomy or ureterostomy catheters am in use, thi::; retai11er can be and inexpensively made a technician. It i::; u::;ed for ,Yhicitle-tip-like catheters which at the Paraplegic Center are prefeffed to the self-retaining catheters for nephrostomies, pyelostomies or ureterostomies. It can also be used for c,Uprapubic whistle-tip catheters. 1Ve have found it easier to use a mbher retainer ratber than plastic since it molds bett(,r to the particular contour of the body. Hec1a11gular shaped retai11ers have been used rather than round hut any shape can be nrnd.e.
Fm l
Integral parts of nonwelded "cathr,ter rr;(,aincr making" setup
Figure l ::;hmm the necessary parts used hy T. T. The ruler is used to approximate sizes. The itern1o are: 2, hard rubber (nsecl as a flat surface for boring holes); 8, steel "hole" punch; 1, cold patch; u, rougher; 6, proximal end of an "old" rubber catheter or rubber tubing; 7 and 8, plywood blocks; 9, plate with center hole; JO, hot patch; 11, finished retainer; 12, t,rn small C clarnp::; (size iuches); 73 and 14, heavy nylon thread used to place around No. {i when retainer is placed over catheter. Figure 2 demonstrates the method of placing the l'Old patch, catheter end, and bot patch together. Accepted for publication December 5, 1955. 1 Ba.rdam supra.pubic retainer and Brea.key-Burhans nephrostomy retainer. Urologiea.l Instrnments, C.R. Bard Inc., Summit, N'. J., 1952, pp. 33, 37. 1 Pal ken, Morton: A plastic holder for nephrostom:v tubes. J. Urol., 69: 465-466, HJ5:3 a Retention discs. l:rological and Allied Dia.gnostic lnstrnmcnts and High Frcqueney Equipment. American C,·stoscope 1Vfakern, Inc., New York, N. Y., 1952, p. 198. 1019
1020
A. ESTIN COMARR AND T. TORGERSON
-
/(.~_) ,-'
(
i
0
..2 )C 3"' Cold --Palclr
+-
~I/ /~
Y-------+Hot-Palch
-
/Yg_"
Ix /3/~
Fm. 2. Ureterostomy, pyelostomy, nephrostomy and suprapubic retainers. Method of placement of cold patch, catheter end and hot patch.
Fm. 3. Setup ready for lighting of hot patch. Here wooden plates are used
Figure 3 shows the apparatus, using detachable wooden plates, ready for lighting of the hot patch. Since it is somewhat cumbersome to handle the individual parts, the apparatus shown in figure 4, A was developed. This consists of the integral parts being welded to the C clamps. A groove has been cut into the metal base % inches wide. Five metal plates have been made available in the center of which have been drilled holes measuring % inch, ½ 6 inch, 7~ inch, :!-16 inch, and % inch respectively. These plates are adequate for the variety of sizes of catheters that will be used. To the desired size of metal plate are fixed the cold patch, catheter end and hot patch. The plate in turn is slipped through the groove depicted in figure 4, A.. The entire system is tightened and figure 4, B shows the final setup ready for lighting of the hot patch. After cooling, the retainer is sterilized and ready for use. Figure 5 demonstrates our method of using elastoplast and ties in order to hold the retainer in a fixed position. A split 4 by 4 inch gauze pad is placed between the skin and rubber retainer and also between the retainer and the elastoplast. The gauze may be changed daily or as required; and the catheter and retainer are
Fm. •-L A, metal plates welded to C clamps. Metal base, with% inch diameter groovt>, measures :! by 3 inches. Two "tightening" plates measure 1 by IJ~ inches. B, setup rea.dy lighting. Setup has welded metal plates.
I Frn. 5. Method of holding "catheter retainer" in position
1021
1022
A. ESTIN COMARR AND T. TORGERSON
Fm. 6. A, additional method of holding "catheter retainer" in position. B, catheter retainer acting as "girdle." "Zipper" makes application simple.
r
changed weekly. If infrequent dressings are performed, elastoplast strips can be placed across both sides of the retainer and onto the skin. This latter procedure depends on the skin's tolerance of elastoplast. At surgery, nephrostomy catheters are held in position with wire sutures to the skin until the time when the wound is healed and a good nephrostomy channel has been formed. Only then is the retainer used as described. For additional safety, some patients, especially with bilateral nephrostomies, prefer to use, in addition, a 6 inch elastic belt with holes to permit the exit of the catheters. This "girdle" reinforces the retainers and is also excellent as a support if postoperative muscle weakness is present (fig. 6). SUMMARY
A simple, inexpensive method of making nephrostomy, pyelostomy, ureterostomy or suprapubic retainers has been described. A very satisfactory method of keeping the "catheter retainer" in place is presented.
Vol. 75, No. 6, June 1956 Printed 1·n [: .S.A.
A SIMPLE lVIETHOD OF RE'L-\.1:'\I~G CATHETERS ,\ ESTIN COJVIARH
.·\ND
T. TORGEHSO:\'
From the Paraplegfo Servi<'e. Veterans Administration Hospital, Lonq Bea<:/1., Calif. and the Schoo[ o.f Medicine, Colleue of J1 edical E1•angcli.sls, Los cl nqeles, CaU.f.
,'\ nurnber of methods have been used to retaiu eatheters. 1 · 2 • :i This retainer is not new in principle. H owevc~r, in institutions where a large number of nepbrostomy, pyelostomy or ureterostomy catheters am in use, thi::; retai11er can be and inexpensively made a technician. It i::; u::;ed for ,Yhicitle-tip-like catheters which at the Paraplegic Center are prefeffed to the self-retaining catheters for nephrostomies, pyelostomies or ureterostomies. It can also be used for c,Uprapubic whistle-tip catheters. 1Ve have found it easier to use a mbher retainer ratber than plastic since it molds bett(,r to the particular contour of the body. Hec1a11gular shaped retai11ers have been used rather than round hut any shape can be nrnd.e.
Fm l
Integral parts of nonwelded "cathr,ter rr;(,aincr making" setup
Figure l ::;hmm the necessary parts used hy T. T. The ruler is used to approximate sizes. The itern1o are: 2, hard rubber (nsecl as a flat surface for boring holes); 8, steel "hole" punch; 1, cold patch; u, rougher; 6, proximal end of an "old" rubber catheter or rubber tubing; 7 and 8, plywood blocks; 9, plate with center hole; JO, hot patch; 11, finished retainer; 12, t,rn small C clarnp::; (size iuches); 73 and 14, heavy nylon thread used to place around No. {i when retainer is placed over catheter. Figure 2 demonstrates the method of placing the l'Old patch, catheter end, and bot patch together. Accepted for publication December 5, 1955. 1 Ba.rdam supra.pubic retainer and Brea.key-Burhans nephrostomy retainer. Urologiea.l Instrnments, C.R. Bard Inc., Summit, N'. J., 1952, pp. 33, 37. 1 Pal ken, Morton: A plastic holder for nephrostom:v tubes. J. Urol., 69: 465-466, HJ5:3 a Retention discs. l:rological and Allied Dia.gnostic lnstrnmcnts and High Frcqueney Equipment. American C,·stoscope 1Vfakern, Inc., New York, N. Y., 1952, p. 198. 1019
1020
A. ESTIN COMARR AND T. TORGERSON
-
/(.~_) ,-'
(
i
0
..2 )C 3"' Cold --Palclr
+-
~I/ /~
Y-------+Hot-Palch
-
/Yg_"
Ix /3/~
Fm. 2. Ureterostomy, pyelostomy, nephrostomy and suprapubic retainers. Method of placement of cold patch, catheter end and hot patch.
Fm. 3. Setup ready for lighting of hot patch. Here wooden plates are used
Figure 3 shows the apparatus, using detachable wooden plates, ready for lighting of the hot patch. Since it is somewhat cumbersome to handle the individual parts, the apparatus shown in figure 4, A was developed. This consists of the integral parts being welded to the C clamps. A groove has been cut into the metal base % inches wide. Five metal plates have been made available in the center of which have been drilled holes measuring % inch, ½ 6 inch, 7~ inch, :!-16 inch, and % inch respectively. These plates are adequate for the variety of sizes of catheters that will be used. To the desired size of metal plate are fixed the cold patch, catheter end and hot patch. The plate in turn is slipped through the groove depicted in figure 4, A.. The entire system is tightened and figure 4, B shows the final setup ready for lighting of the hot patch. After cooling, the retainer is sterilized and ready for use. Figure 5 demonstrates our method of using elastoplast and ties in order to hold the retainer in a fixed position. A split 4 by 4 inch gauze pad is placed between the skin and rubber retainer and also between the retainer and the elastoplast. The gauze may be changed daily or as required; and the catheter and retainer are
Fm. •-L A, metal plates welded to C clamps. Metal base, with% inch diameter groovt>, measures :! by 3 inches. Two "tightening" plates measure 1 by IJ~ inches. B, setup rea.dy lighting. Setup has welded metal plates.
I Frn. 5. Method of holding "catheter retainer" in position
1021
1022
A. ESTIN COMARR AND T. TORGERSON
Fm. 6. A, additional method of holding "catheter retainer" in position. B, catheter retainer acting as "girdle." "Zipper" makes application simple.
r
changed weekly. If infrequent dressings are performed, elastoplast strips can be placed across both sides of the retainer and onto the skin. This latter procedure depends on the skin's tolerance of elastoplast. At surgery, nephrostomy catheters are held in position with wire sutures to the skin until the time when the wound is healed and a good nephrostomy channel has been formed. Only then is the retainer used as described. For additional safety, some patients, especially with bilateral nephrostomies, prefer to use, in addition, a 6 inch elastic belt with holes to permit the exit of the catheters. This "girdle" reinforces the retainers and is also excellent as a support if postoperative muscle weakness is present (fig. 6). SUMMARY
A simple, inexpensive method of making nephrostomy, pyelostomy, ureterostomy or suprapubic retainers has been described. A very satisfactory method of keeping the "catheter retainer" in place is presented.