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• W1573559679 abstract "Spinal cord injury and disorders (SCI&D) cause significant impairment of the lower urinary tract called neurogenic bladder dysfunction. This condition affects the vast majority of individuals with SCI&D [1]. Furthermore, many individuals who void spontaneously may be doing so in an obstructed manner because their injuries have resulted in a lack of coordination between the urinary sphincter and the bladder known as detrusor sphincter dyssynergia [2]. Thus, in many individuals with SCI&D, spontaneous voiding may be impossible or associated with dangerously high pressures. These elevated pressures are a risk factor for kidney failure [3]. As a result, many individuals with SCI&D must use catheters to help empty their bladders in a safe and effective manner.The simplest method for long-term management of neurogenic bladder is placement of an indwelling catheter into the urinary bladder that can be changed every 3–4 weeks. However, chronic use of indwelling urinary catheters is associated with severe complications [4]. Because of these complications, use of chronic indwelling catheters is discouraged by urologists. Clean intermittent self-catheterization (CISC) involves placing a new or clean catheter into the bladder to drain urine at defined time points or at times when the individual feels a need to urinate [5]. This method is much safer than the use of indwelling catheters [6]. Unfortunately, due to limited manual dexterity or lack of dedicated care providers, many individuals with SCI&D are unable to perform CISC and continue management with indwelling catheters despite significant evidence demonstrating that this method is inferior to CSIC.Individuals with limited manual dexterity can maintain functional independence when managed with indwelling catheters. However, individuals with similar disabilities managed with CISC must directly depend on care providers to perform catheterization. In studies evaluating factors which predict compliance to long-term CSIC, maintenance of continence and ability to perform catheterization independently were the main factors associated with success [7]. The central problem that this design addresses is how to improve CSIC so that individuals with SCI&D and impairments of manual dexterity will be able to choose this method of bladder management without sacrificing so much functional independence.This paper presents a design for a simple, lightweight device to help men with SCI&D who have limited manual dexterity perform CISC using existing catheter designs.Preliminary work was completed as part of a 1-yr senior design project of two undergraduate biomedical engineering students and included consultation with health care professionals and individuals with SCI&D. The “Cath-Assist” was designed based on the following criteria: the design must enable an individual with SCI&D to perform independent CSIC without fine finger manipulation, accommodate a variety of catheter diameters, be useable in seated or recumbent positions, accommodate bag collection or open emptying of urine, be easily loaded with catheters by a caregiver, require minimal assembly, be lightweight and easily stored, be usable without maintenance for up to 1 week, not increase risks of infection or urethral trauma, have no sharp edges, mechanically limit excessive resistance, be able to advance and retract a catheter through the urethra, facilitate placement of the catheter tip into the urethral opening, provide lubrication to reduce friction, fit in a stable position between the legs, weigh less than 2 pounds, withstand repeated use, resist corrosion, be easily cleaned, be easily gripped, and have a relatively low-cost.The Cath-Assist design is shown in Fig. 1. A preloaded cartridge with a urinary catheter will be mounted onto a lightweight base, which features a penile alignment trough. The key component is reusable, easily cleaned/sterilized lightweight cartridges, which can be preloaded by care providers. As shown in Fig. 2, the catheter is preloaded in a cartridge, and the cartridge is closed. The catheter is pinched between two feed wheels and advanced or retracted by an interface wheel that can be turned easily using the side of the thumb, heel of the hand, wrist, or forearm (Fig. 3). The catheter is aligned between the feed-wheels, and friction against the catheter allows for forward insertion or reverse retraction. An individual with SCI&D and limited manual dexterity can place the cartridge into a light-weight base, grip the base between the forearms or wrists, and place it between the legs (Fig. 3). The individual will then align the urethral opening with the catheter tip by placing the penis in the alignment trough. The opposite end of the catheter will be positioned over a basin or commode. At this point, the individual will advance the catheter using the interface wheel until return of urine is noted and will retract the catheter by reversing the direction of the wheel after return of urine ceases. The cartridge is hinged to open for preloading catheters and to expose internal components for cleaning. The cartridge will be designed to be reusable and dishwasher and/or autoclave safe.The Cath-Assist prototype is shown in Fig. 3. Several design alternatives have been investigated. A modified cartridge has been designed to hold, advance, and retract a catheter that is contained within a sterile, closed-system catheterization kit. A second pair of feed wheels was added to provide additional friction to advance a catheter contained in a sterile bag. Different bases will be used to account for differences in height or anatomy and to allow positioning either under or between the legs. To accommodate a variety of positions (sitting or recumbent) and penis angles, a hinge can be added at the front of the cartridge-base assembly to allow the insertion angle to be tilted forward. Resistance to catheter advancement could indicate entrance into a false passage or tightening of the urethral sphincter, and could be felt as increased resistance to turning the wheel; therefore, a mechanical slip could be incorporated prevent advancement once a maximum resistance threshold is reached. Future systems could also be designed for females and/or could be motorized for individuals with greater hand dysfunction.At present, devices are available that aid individuals with limited hand function in the process of grasping a catheter, in positioning a catheter more precisely and stabilizing the penis, leaving the hands free for CISC. The Cath-Assist differs from present technology and is the only device to specifically assist in the insertion and removal of urinary catheter.The expected benefits of the Cath-Assist will be a reduction in morbidity and mortality associated with the use of indwelling catheters and improved functional independence. Additional potential benefits are a reduction in skilled nursing costs, lessening of burden of care on family members and other care-providers, and use in non-SCI&D individuals who have similar disabilities. The Cath-Assist may only be useful for a small subset of individuals with both SCI&D and limited manual dexterity and may not be useful in all situations; however, prevention of severe morbidity and mortality associated with the use of indwelling catheters in even a small subset of individuals with SCI&D should justify the development of this device.VCU School of Engineering students Patrick Headley, Hersch Bhatia, and Brian Arrington made significant contributions to the Cath-Assist design." @default.
• W1573559679 created "2016-06-24" @default.
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• W1573559679 date "2015-06-01" @default.
• W1573559679 modified "2023-10-16" @default.
• W1573559679 title "The Cath-Assist: A Self-Catheterization Assistive Device1" @default.
• W1573559679 cites W1995832182 @default.
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• W1573559679 doi "https://doi.org/10.1115/1.4030129" @default.
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