What are the proper care and management guidelines for a patient using a pure wick external catheter?

PureWick External Catheter Care and Management

Overview and Primary Indication

The PureWick female external catheter is a non-invasive urine collection system designed specifically for incontinent women to avoid the significant infection risks associated with indwelling urinary catheters while maintaining accurate urine output monitoring and skin integrity. 1, 2

This device represents a critical alternative to indwelling catheterization, which carries a 5-10% daily risk of bacteriuria and should be avoided whenever possible in favor of external collection methods 3, 4.

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Device Setup and Positioning

Initial Placement

• Position the soft, flexible wick externally between the labia and buttocks, ensuring it sits against the perineal area without internal insertion 2
• Connect the device to low continuous suction (typically wall suction set to continuous low pressure) through a collection canister 5
• The vacuum gently draws urine away from external genitalia into the collection system 5, 2

Key Positioning Principles

• Ensure the wick maintains contact with the perineal area to effectively capture urine flow 2
• Avoid excessive pressure that could cause skin irritation or discomfort 2
• Verify proper suction function before leaving the bedside 5

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Routine Maintenance and Monitoring

Device Replacement Schedule

• Replace the PureWick device every 8-12 hours or when visibly soiled 2
• Change immediately if the device becomes saturated, malpositioned, or contaminated with fecal matter 2
• More frequent changes may be necessary in patients with heavy urinary output or significant diaphoresis 3

Skin Assessment and Care

• Inspect perineal skin at each device change for signs of moisture damage, pressure injury, or infection 3, 2
• Perform gentle perineal cleansing with each device change using mild soap and water 2
• Allow skin to dry completely before applying a new device 3
• Apply barrier cream or moisture barrier ointment if skin shows early signs of breakdown 2

Collection Canister Management

• Empty the collection canister when it reaches approximately 75% capacity or at least every 8-12 hours 2
• Document urine output accurately with each emptying 2
• Replace the entire collection system (tubing and canister) every 24 hours to minimize bacterial colonization risk 3

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Infection Prevention Protocols

Hand Hygiene and Aseptic Technique

• Perform hand hygiene before and after any contact with the device or perineal area 3, 6
• Use clean gloves for all device changes and perineal care 6
• Maintain clean technique throughout the process, though sterile technique is not required for this external device 6

Avoiding Indwelling Catheter Complications

• The PureWick eliminates the need for indwelling catheterization in most incontinent women, thereby avoiding the 1.11 per 1000 catheter-days CAUTI rate associated with indwelling devices 1
• Studies demonstrate significant reductions in CAUTI rates (from 1.11 to 0% per 1000 device-days) when external collection replaces indwelling catheters 1
• Unlike indwelling catheters, the PureWick does not require antimicrobial prophylaxis at insertion or during use 3

Daily Skin Cleansing

• Consider daily perineal cleansing with 2% chlorhexidine-impregnated washcloths in high-risk patients to reduce bacterial colonization 3
• This practice has demonstrated effectiveness in reducing multidrug-resistant infections in catheterized patients and may provide similar benefits with external devices 6

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Urine Specimen Collection

Laboratory Testing Validity

• Urine collected via PureWick is appropriate for most routine urinalysis and urine chemistry tests 5
• The device does not significantly affect urine strip semi-quantitative results or automated chemistry analysis 5
• Important caveat: Microscopic white blood cell and crystal counts may be statistically lower in PureWick-collected samples compared to direct void specimens 5

Collection Technique for Laboratory Samples

• Collect urine directly from the collection canister rather than from the wick itself 5
• Obtain samples as soon as possible after collection to minimize bacterial overgrowth 5
• Label specimens appropriately, noting the collection method if microscopic analysis is critical 5

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Patient Selection and Contraindications

Ideal Candidates

• Incontinent women requiring accurate urine output monitoring 1, 2
• Patients at high risk for pressure ulcers who need to remain dry 1, 2
• Women who would otherwise require indwelling catheterization for urinary management 1, 2
• Postoperative patients, ICU patients, or those with limited mobility 1

Relative Contraindications

• Patients with urinary retention requiring bladder decompression (indwelling catheter or intermittent catheterization is necessary) 3, 4
• Women with severe perineal wounds or active perineal infections where device placement would compromise healing 2
• Patients who cannot tolerate the device due to anatomical variations or extreme agitation 2

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Troubleshooting Common Issues

Inadequate Urine Collection

• Verify suction is functioning properly and set to appropriate continuous low pressure 5, 2
• Reposition the wick to ensure proper contact with the perineal area 2
• Check for kinks in the tubing that may obstruct flow 2
• Ensure the patient is positioned appropriately (supine or semi-recumbent positions work best) 2

Skin Irritation or Breakdown

• Increase frequency of device changes if moisture accumulation is occurring 3
• Apply moisture barrier products more liberally 2
• Consider temporary discontinuation if significant skin breakdown develops, allowing time for healing 2
• Evaluate for fungal infection if erythematous rash with satellite lesions appears 2

Device Displacement

• Secure the external tubing to prevent tension on the wick 2
• Educate the patient about the device and encourage them to notify staff if it feels displaced 3
• Consider more frequent monitoring in confused or agitated patients 2

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Critical Pitfalls to Avoid

• Never use the PureWick as a substitute for treating urinary retention—this requires bladder decompression via indwelling or intermittent catheterization 3, 4
• Avoid leaving a saturated device in place, as this defeats the purpose of keeping skin dry and may increase infection risk 3, 2
• Do not use the device in patients with active perineal infections without addressing the underlying infection first 2
• Never insert the wick internally—it is designed for external placement only 2
• Avoid relying solely on PureWick-collected urine for critical microscopic analysis (particularly WBC counts) without considering the potential for underestimation 5
• Do not neglect regular skin assessment—external devices can still cause pressure injury if not monitored appropriately 2

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Quality Improvement and Monitoring

Outcome Metrics to Track

• CAUTI rates before and after PureWick implementation 1
• Indwelling catheter utilization rates in female patients 1
• Incidence of hospital-acquired pressure ulcers in the perineal area 1, 2
• Patient comfort scores and satisfaction with urinary management 2

Staff Education Requirements

• Train all nursing staff on proper device placement, maintenance, and troubleshooting 1, 2
• Emphasize the importance of regular skin assessment and documentation 2
• Educate staff on appropriate patient selection criteria 1, 2
• Implement competency validation for device application 1