Catheter design for effective manual bladder irrigation.

PURPOSE: We compared the efficiency of clearance of a simulated clot from a bladder model using a 6-hole irrigation catheter, a traditional Malecot catheter and a modified Malecot catheter with additional side holes.

MATERIALS AND METHODS: Latex balloons 12 inches in diameter served as the bladder model. They were filled with 300 cc Jell-O® gelatin, which had been partially solidified for 8 hours at 36F. Five manual irrigation/aspiration cycles with a 60 cc catheter tip syringe were performed to remove simulated clot from the bladder models and the amount of clot removed was measured. Five bladder models were used to test the efficiency of clot removal for each 22Fr catheter design, including a standard 22Fr Model 361222 Malecot latex 4-wing catheter (Rusch, High Wycombe, United Kingdom) and a 22Fr Bardex® Model 606118-22 latex 6-hole catheter. Two modified versions of the Malecot catheter design involving 2 and 4 additional holes were also tested to determine the effect of a hybrid 6-hole/Malecot design.

RESULTS: The 6-hole catheter was more efficient for clot evacuation than the Malecot catheter (p = 0.014). The modified Malecot catheter with 4 additional holes was more efficient than the original Malecot catheter (p = 0.020). However, it was not significantly better than the 6-hole catheter. After 5 irrigation/aspiration cycles 77.0% of residual clot remained in the bladder with the Malecot catheter compared to 60.4% and 54.0% for the 6-hole and modified 4-hole Malecot catheters, respectively.

CONCLUSIONS: The 6-hole catheter showed an advantage in clot removal over the Malecot catheter design. The enhanced ability of the 6-hole design to remove simulated clot may be attributable to the larger area covered by the holes at the catheter tip. Further investigation to determine the effect of spacing between the holes and the number of holes on the ability to break apart and remove clot is recommended for a more thorough understanding of differences among catheter models and methods of improvement.