626 Female External Urinary Collection Device Utilization in a Female Burn ICU Patients: A Quality Improvement Project

Abstract

Introduction A significant portion of intensive care unit (ICU) patients require a Foley catheter during their admission. Foley use has become more criticized as nationwide quality improvement processes attempt to reduce catheter associated urinary tract infections (CAUTI). Burn patients in the ICU have a higher rate of catheter utilization due to difficult fluid management, need for accurate volume measurements, and significant wound care. Males may have a condom catheter exchanged once they are stabilized. Historically, a noninvasive alternative to the Foley has not been available for females. While the female external catheter has existed for quite some time and hospital systems are increasingly encouraging their use, there is no standard of practice for when they are best utilized. Specific to the burn population, potential barriers include body habitus, perineal burns, and pain on frequent changing of the device. Our study aims to evaluate the current female external catheter use in our burn ICU in order to develop a standard protocol to increase utilization while thoughtfully delineating the contraindications. Methods A quality improvement project for guidelines on the use of a female external urinary collection device was conducted. All female patients admitted to the burn ICU during 2019 were included. Data was collected on burn TBSA, anatomic location, ICU days, ventilator days, and foley catheter days. Foley catheter days, external urinary catheter days, urinary tract infection (UTI) rates, and incidence of failure of external device were collected. Results Of the 46 total female burn patients, 31 required a foley catheter at some point during their stays. 11 patients used an external urinary collection device. Of the 11 users, one urinary device had to be removed due to skin breakdown. One other patient required replacement with a Foley catheter as a result of oliguria and the need for closer fluid management. 5 of the successful users of the external catheter were clinically obese. No patients contracted a UTI while using the external catheter. 3 UTI’s developed in women while using a Foley catheter. Patients who had altered mental status and perineal wounds were not eligible to use the external catheter. Conclusions In our practice, we found contraindications to external female catheter use to include altered mental status and perineal wounds. Obesity was not a contraindication and device usage may be most beneficial in incontinent patients. Further investigation is needed to better optimize female external urinary collection device usage within the burn ICU setting. This may help minimize CAUTI’s among female burn patients.

Efficacy, effectiveness, usability and acceptability of devices for female urinary incontinence: A scoping review

“…Twenty‐one articles were selected among which 2 systematic reviews (Lipp et al, 2014; Mugita et al, 2021), 1 randomised controlled trial (Sugama et al, 2012), 1 quasi experimental study (Teerawattananon et al, 2015), 1 prospective interventional cohort study (Moore et al, 2021), 1 prospective descriptive study (Motta & Milne, 2017), 2 cross‐sectional descriptive studies (Grzybowska & Wydra, 2017; Gümüşsoy et al, 2019), 2 retrospective studies (Warren et al, 2021; Zavodnick et al, 2020), 1 product evaluation trial (Long et al, 2015), 1 pilot study (Jeong et al, 2016), 1 open‐label uncontrolled trial (Farage et al, 2011), 1 cost analysis study (Fader et al, 2010), 1 quality improvement project (Eckert et al, 2020), 1 qualitative study (Ostaszkiewicz et al, 2018; Raepsaet et al, 2021), 1 case study (Beeson & Davis, 2018), 4 conference paper (Dublynn & Episcopia, 2019; Fritsch et al, 2019; Maydick‐Youngberg et al, 2020; Mueller, 2019; Peters et al, 2021).…”

“…Population included in the studies was women with severe urinary incontinence recruited in urogynaecology outpatients (Grzybowska & Wydra, 2017; Gümüşsoy et al, 2019), women with all incontinence type (Lipp et al, 2014), patients with all incontinence types both urinary and faecal (Mugita et al, 2021), older women with urinary incontinence recruited from outpatient clinics and general practice surgeries (Long et al, 2015), older women with urinary incontinence in geriatric medical hospital (Sugama et al, 2012), women with both urinary and faecal incontinence and their caregivers in rehabilitation unit (Teerawattananon et al, 2015), women and caregivers at home (Jeong et al, 2016), women in intensive care unit (Beeson & Davis, 2018; Mueller, 2019; Warren et al, 2021; Zavodnick et al, 2020), women in burn care unit (Peters et al, 2021), women in no intensive hospital setting (Mueller, 2019; Warren et al, 2021), women in bed community hospital (Dublynn & Episcopia, 2019; Eckert et al, 2020), patients in a skilled nursing facility (Motta & Milne, 2017). One study explores nursing home staff members' beliefs and expectations about what constitutes “quality continence care” for people living in nursing, included registered nurses, enrolled nurses and personal care workers in a nursing home (Ostaszkiewicz et al, 2018).…”

“…The devices explored in the studies were as follows: female external urinary catheter, an external device used to manage urinary incontinence in a no‐invasive way in women without cognitive impairment, faecal incontinence, perineal wounds or even with menstruation (Beeson & Davis, 2018; Dublynn & Episcopia, 2019; Eckert et al, 2020; Fritsch et al, 2019; Mueller, 2019; Peters et al, 2021; Warren et al, 2021; Zavodnick et al, 2020); pads, disposable diapers or under‐pads used to manage both urinary and faecal incontinence in women and men (Grzybowska & Wydra, 2017; Gümüşsoy et al, 2019; Ostaszkiewicz et al, 2018; Sugama et al, 2012; Teerawattananon et al, 2015); mechanical devices, such as a continence dish, positioned to sit underneath the urethra, creating a support similar to the sub urethral sling, such as pessary or disposable intravaginal device, a single‐use and disposable device, which provide tension‐free support whenever the pressure is transferred from the abdominal cavity to the pelvic floor, or such as tampon (Farage et al, 2011; Lipp et al, 2014; Moore et al, 2021), a new prototype of underwear described as a pair of washable fixation pants with sewn‐in conductive threads that track where pads leak (Long et al, 2015), reusable underwear market for light incontinence (urinary leakage volumes up to approximately 25–30 ml daily), designed to be worn all day and machine washable (Alam et al, 2020), a new intelligent system pad, a system comprises of a urine collection cup made of medical‐grade silicone, a connecting hose between the urinal cup and the main body (Jeong et al, 2016). A summary of results is reported in Table 2.…”

“…The introduction of FEUC decreases the indwelling catheter days in female population (Dublynn & Episcopia, 2019; Fritsch et al, 2019), in intensive care unit (ICU) female population (Warren et al, 2021; Zavodnick et al, 2020) and in female burn patients (Peters et al, 2021). The reduction in CAUTI resulted associated with reduced catheter use permanence (Dublynn & Episcopia, 2019; Eckert et al, 2020; Fritsch et al, 2019; Mueller, 2019; Peters et al, 2021; Zavodnick et al, 2020). Effectiveness and efficacy were also reported in terms of accurate monitoring of urine output by Mueller (2019), stated that the female external urinary catheter accurately monitored urine output.…”

“…Effectiveness, efficacy and safety of female external urinary catheter (FEUC) was investigated in terms of indwelling catheter days and catheter associated urinary‐tract infections (CAUTI). The introduction of t FEUC decreases the indwelling catheter days in female population (Dublynn & Episcopia, 2019; Fritsch et al, 2019), in intensive care unit (ICU) female population (Warren et al, 2021; Zavodnick et al, 2020)and in female burn patients (Peters et al, 2021). The reduction in CAUTI resulted associated with reduced catheter use permanence (Dublynn & Episcopia, 2019; Eckert et al, 2020; Fritsch et al, 2019; Mueller, 2019; Peters et al, 2021; Zavodnick et al, 2020).…”