A closed loop audit on ureteric stent with extraction string (tether) and a nurse led stent removal service - highlighting benefits to the patient and the urology service
BAUS ePoster online library. Mukherjee S. 06/25/19; 259492; P12-8 Disclosure(s): Nil
Mr. Subhabrata Mukherjee
Mr. Subhabrata Mukherjee
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Abstract
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Introduction:
A ureteric stent with extraction string can save resources by obviating the need for flexible cystoscopic removal. Also stents can be removed sooner reducing the duration of stent symptoms.

METHODS:

We performed a prospective audit of patients who had ureteric stent with extraction string. Our stone nurse specialist removed the stents in a newly created stent removal clinic.

Results:

In the first cycle over four months (n=10) the stents were removed within 7 days. The morbidity rate was high (50%) with accidental stent dislodgement in three cases, string retraction in one case and pulling out of the string by a recovery nurse in one case. The shortcomings were addressed subsequently and it was felt that suprapubic fixation has lesser risk of stent dislodgement than thigh fixation in females. In the second cycle over three months (n=8) the outcome was far better with only one accidental stent dislodgement (13%). Over the 7 months complication rate has reduced by 37% and we have saved 18 flexible cystoscopy slots. This equates to just over 2 saved flexible cystoscopy sessions, saving the cost of 3 doctor-sessions and ancillary staff, sterilization of equipment costs and consumable costs (roughly £760/session). These sessions have been able to be utilized for more urgent cases.

Conclusion:
Careful case selection, proper string fixation, a defined stent removal pathway and general awareness amongst the urology team and other staff are crucial for managing a ureteric stent with extraction string which could save valuable resources and reduce duration of stent symptoms.
Introduction:
A ureteric stent with extraction string can save resources by obviating the need for flexible cystoscopic removal. Also stents can be removed sooner reducing the duration of stent symptoms.

METHODS:

We performed a prospective audit of patients who had ureteric stent with extraction string. Our stone nurse specialist removed the stents in a newly created stent removal clinic.

Results:

In the first cycle over four months (n=10) the stents were removed within 7 days. The morbidity rate was high (50%) with accidental stent dislodgement in three cases, string retraction in one case and pulling out of the string by a recovery nurse in one case. The shortcomings were addressed subsequently and it was felt that suprapubic fixation has lesser risk of stent dislodgement than thigh fixation in females. In the second cycle over three months (n=8) the outcome was far better with only one accidental stent dislodgement (13%). Over the 7 months complication rate has reduced by 37% and we have saved 18 flexible cystoscopy slots. This equates to just over 2 saved flexible cystoscopy sessions, saving the cost of 3 doctor-sessions and ancillary staff, sterilization of equipment costs and consumable costs (roughly £760/session). These sessions have been able to be utilized for more urgent cases.

Conclusion:
Careful case selection, proper string fixation, a defined stent removal pathway and general awareness amongst the urology team and other staff are crucial for managing a ureteric stent with extraction string which could save valuable resources and reduce duration of stent symptoms.
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