title: Urinary catheter 'deflation cuff' formation: clinical audit and quantitative in vitro analysis.
abstract: OBJECTIVE
  To investigate reports from district nursing staff of difficulty in removing long-term urinary catheters (LTCs) because of the formation of a 'cuff' on deflating the self-retaining balloon.
  
  
  METHODS
  Problems experienced by district nurses when removing urethral and suprapubic LTCs were audited, noting the type of problem, the catheter and any action taken. Quantitative in vitro studies were conducted on the deflated self-retaining balloons after incubating a similar range of catheters in saline at 37 degrees C for 6 weeks, using suprapubic profilometry to assess the resistance to withdrawal (retention force).
  
  
  RESULTS
  Questionnaires were returned on 154 patients with LTCs; 56% had urethral and 44% suprapubic catheters. The catheters were hydrogel-coated (83%), all-silicone (13%) and PTFE-coated (3%). Twenty-two (14%) of the sample reported problems with catheter removal in the previous year, including 15 (68%) with all-silicone catheters and 15 (68%) with suprapubic catheters; cuff formation was noted in 60%. In the laboratory, 10 of the balloons formed a 'cuff' on deflation, but there was great variability in the effect this had on the retention force, with values of 0.5-3 N for different catheters.
  
  
  CONCLUSIONS
  Most problems with catheter removal involved all-silicone and suprapubic catheters. Suprapubic profilometry confirmed increased resistance to withdrawal by formation of a 'cuff' on deflation of the balloon of all-silicone catheters. These results suggest that the first choice of catheter material for long-term urethral and suprapubic use should be hydrogel-coated latex.
authors.affiliation: Department of Urology, Southmead Hospital, University of the West of England, Bristol, UK. jkparkin@hotmail.com
authors.forename: J
authors.initials: J
authors.lastname: Parkin
authors.forename: J
authors.initials: J
authors.lastname: Scanlan
authors.forename: M
authors.initials: M
authors.lastname: Woolley
authors.forename: D
authors.initials: D
authors.lastname: Grover
authors.forename: A
authors.initials: A
authors.lastname: Evans
authors.forename: R C L
authors.initials: RC
authors.lastname: Feneley
mesh_terms: D002404:Catheterization / Q000295:instrumentation; D002408:Catheters, Indwelling; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D008297:Male; D008485:Medical Audit; D011138:Polytetrafluoroethylene; D012826:Silicone Elastomers; D014546:Urinary Catheterization / Q000295:instrumentation*; D014570:Urologic Diseases / Q000451:nursing
chemical_list: D012826:Silicone Elastomers; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D011138:Polytetrafluoroethylene