Urethral Catheter Insertion Forces: a Comparison of Experience and Training

Purpose: This study was undertaken to evaluate the insertion forces utilized during simulated placement of a urethral catheter by healthcare individuals with a variety of catheter experience. Materials and Methods: A 21F urethral catheter was mounted to a metal spring. Participants were asked to press the tubing spring against a force gauge and stop when they met a level of resistance that would typically make them terminate


INTRODUCTION
The insertion of a urethral catheter is one of the most commonly performed hospital procedures.
a standardized training protocol and by a variety of healthcare workers with varying degrees of experience.We hypothesized that we could establish competency parameters for professionals in-training Investigative Urology Investigative Urology by measuring urethral catheter exertion forces and not only the future design of catheters and virtual simulators but also the rate of urethral trauma and stricture.

MATERIALS AND METHODS
Healthcare personnel at the Veterans Affairs eter until you feel a level of resistance that would make you stop if you were putting in a real urethral catheter".Participants held the catheter at the same marked area and were instructed and monitored by the same two researchers to ensure procedure conformity. groups.
blinded to their own results.
The statistical software package SAS was compare different groups with respect to continuous was estimated by regressing the force applied by each -

RESULTS
Fifty-seven healthcare workers participated insertion force was averaged by group and ranged 2.0 ence in the amount of simulated force used to insert compared to those with less than 25 years experience

COMMENTS
The urethral catheter is an instrument as old as   ing health care workers in catheter placement exists.
of patient preparation and catheterization by someone catheter can feel the resistance given by the catheter.Although improvements in catheter design and comcatheter placement was the cause of approximately perforation have all been reported as consequences of catheter forces that could be used for modeling purposes and potential competency parameters.emphasize that we have measured only one element than a silicone or latex catheter and does not buckle prior to the participant reaching the point of maximal used and the study design yielded reproducible and precise results.placed catheter should not require a great deal of experienced urologists had the lowest catheter inser-more than 25 years experience had even lower forces considered the standard-of-care model in regards to urethral catheter insertion force.Future clinical studies should evaluate not only force but also the ability for providers to appreciate and adapt to variances in Several catheter methods of simulation have ates the sense of catheterization of the female or male.been shown to reduce both risk and pain experienced by patients in addition to avoiding urethral injuries lization of an in vitro model allows standardization of signs of excess force that could be noted in a clinical by higher catheterization intervals or in high risk slightly stiffer than silicone and latex materials used in a clinical trial of a larger group of providers using commercially available catheters.

CONCLUSION
we propose that the maximum force that should be utilized during urethral catheter insertion is 5 Newlimit" utilized for urethral catheter insertion.Future ments in cadavers or anesthetized patients undergoing the range of forces used during normal circumstances.be avoided unless they are collected from experienced insertion forces may aid in the design of future cathestablishing competency parameters for health care ACKNOWLEDGEMENT statistical analysis.

EDITORIAL COMMENT
This work is a highly valuable unprecedented initiative towards systemization of urethral catheter insertion.Although urethral catheter insertion is a standardization.
The use of diverse groups in the study serves to show that aptitude in catheter placement implicates an extremely long learning curve for all healthcare placement of the catheter is the principal factor leading to acute complications.creation of catheter simulators designed for healthcare more studies must be conducted in order to validate all these data.

Section of Urology Fluminense Federal University (UFF)
Niteroi, Rio de Janeiro, Brazil E-mail: carvalho.jpm@gmail.com of iatrogenic rupture of the urethra with a retrovesical -plications of undergraduate simulator-based education.

Figure 1 -
Figure 1 -Photograph of the hand-position taken by a lefthanded individual being tested on an Extech TM Digital Force Gauge -model 475040.Participants were asked to hold the silicone portion and press on the tubing similar to advancing a catheter.A plastic shield (not shown) was placed between the force gauge and catheter to blind participants to their results.

Figure 2 -
Figure 2 -Average urethral catheter insertion force in Newtons, by group.