I recently admitted a woman who was status post extensive cervical spine decompression and fusion for severe spinal stenosis. In the hospital, her urinary urgency incontinence was managed with a PureWick external urinary catheter which worked well and avoided painful transfers while she was weak, immobile, and slowly regaining muscle strength and function. She assumed we would provide the PureWick system on transfer to our facility, but we do not have wall suction in our rooms and the system is not inexpensive. The starter kit on the BD website that includes the collecting system with lithium Pump and #30 external catheters cost $608 (10% discount available). The external catheter component is available on the BD site for $209/ #30 flex external female catheters. Each catheter can be used for 8-12 hours but needs to be changed if there is blood or stool contamination. 

None of the SNFs in my area are budgeted to supply this service. My facility advises patients to privately pay for them, which this patient was willing to do, but found the Amazon options confusing, and delivery would take one week. As I witnessed her disappointment, I wished my facility and I could have been more helpful.

The PureWick External Female Catheter System was developed by a home care physician in southern California, Dr. Camille Newton, who observed a research scientist develop a wicking external system for his wife’s troublesome urinary incontinence. She and her husband partnered with this scientist to develop the BD PureWick System, which was licensed in 2017. Since then, multiple hospital systems have adopted their use in place of internal catheters. In my county, the local Kaiser, Sutter, and Providence Hospital systems have been using them for about the last 5 years for women immobile from various causes who have a tendency for urinary incontinence. My experience and a brief literature search documents a much higher patient acceptance rate for this product when compared to traditional external “brief” type incontinence products and compared to indwelling catheters. The literature on the risk of UTIs with this device compared to indwelling internal catheters has been mixed to date. 

The BD website for this product is user friendly for both patients and clinicians and allows the system to be customized to your facilities capacities and provides good training videos for patients and staff. A link to this website can be found below as well as a video on the development of the device and then articles about the proper suction pressure and its use in post op surgical patients. Amazon does carry the full system and its various components, which may lower costs with long term use. but to the novice, the choices are a bit overwhelming. 

I hope that your facility will be better prepared to offer this service to patients in advance of their admission to your facility. I suspect this will remain a private expense in most facilities, but even then, making it more accessible would be helpful to our residents who desire and can afford it. 

If you are a part of a multi-facility system, It might be cost effective to purchase 2-4 complete kits, which could be used for other patients with subsequent future cost for the external catheters reduced by bulk buying and less use of briefs and staff time.  I know my patient would have welcomed this option at the time of admission, and I suspect referring hospitals would also appreciate this option.

https://www.purewickathome.com/

https://www.youtube.com/watch?v=fBrmQnno0sA

https://www.promed-dme.com/resource/maximum-suction-for-purewick

https://www.sciencedirect.com/science/article/pii/S246804512200027X