Izinkonzo Zemithambo Yokuqondisa Umzimba Ngokusebenza Kwezincwadi ZesiSilicone

Ukuphepha okuhle kwe-biocompatibility nokuphepha okuhle kwehypoallergenic

Ngani amacatheter eSilicone ekuhlanzini akunciphisa iziphumo zokuhlukana kubantu abanemphilo yase-latex nabo abanemiphilo engenakwenzeka

Izicatheter zokugcina umfusi zase-silicone zihlula amaprothini we-natural rubber latex (iziquketho ze-Hev b) ezinokuthi zibangela ukuzimisela kwe-IgE. Ngaphandle kwe-latex—okubangela ukuzimisela okukhulu kusukela ku-urticaria kuze kwa-anaphylaxis kubantu abaningi ababili ngamashumi abalili (6%) kanye nabafundi basebantwana ababili ngamashumi abahlanu (17%)—izicatheter zase-silicone eziqhubekayo ngokuphelele azithumeli amaprothini angakutholakaliyo okubangela ukuzimisela. Lokhu kukhulu kakhulu kubantu abanokuzimisela kwe-latex kanye nabantu abanokuvula ukuthembeka kwemithombo, abazokwenzela ukuthi ukuzimisela okuncane kwe-mucosal kungabangela ukuthi kubhekwe kwe-systemic infection.

Ukuchazwa kwezinkampani eziningi kweminyaka ya-2023 yezinkinga zokugcina izihlalo zokugcina kubonisa ukuthi iziphumo zokugcina kuzo zibonakala kungaphezulu kwe-0.5% yabantu abasebenzisa izikhathula zesiSilicone, ngaphandle kwe-3–8% yezikhathula zesiLatex (I-Journal ya Urological Nursing, 2023). I-Silicone ibhekisele kwezinhlobo zezinkampani zokugcina njenge-di-(2-ethylhexyl) phthalate (DEHP), okusebenziswako kakhulu kwezikhathula zesiPVC futhi kuyaziwa ukuthi kubangela ukugcina kwezihlalo zokugcina ngokuphambuka. Kuma-pacients abane-phakathi lwezinkampani zokugcina noma abasebenzisa izikhathula zokugcina, isurface esingasitholakali sika-Silicone isindisa ukuphuma kwe-cytokine emaphakathini, isindisa umdlalo wokugcina wezihlalo zokugcina futhi isindisa isivumelwano sokugcina kwezinhlobo zokugcina. Lezi zindlela ziyenza i-Silicone yinkampani yokugcina eyinkulu kuma-pacients abanamandla amancane noma abanamandla amancane.

Ukulinganisa ukuthi yikuphi inkampani yokugcina eyinkulu: i-Silicone vs. i-PVC noma i-latex urinary catheters kuma-standards yezikhathula zokugcina

Izindlela zokuphatha ezizwenzekileyo zaseNingizimu Afrika njenge-ISO 10993 ne-USP Class VI zinakho umkhondo omkhulu wokubaluleka kwezinto ezenziwe ngazo izicathulo. Ithabuli engezansi iyakubonisa ukuchaphazela kwezinto ezenziwe ngazo isilicone, i-plasticized PVC, ne-latex kuzo zonke izindilinga zokubaluleka.

Ukubhalwa kweminyaka yase-2024 kwenziwe ngabantu abangaphili kuthi wonke amakathetha e-silicone esetshenziswa emedhizinini ayagcina izimboni zonke zokuthi azikho imiphumela yokugcina amaseli nokuthi akhululeka, ngakho-ke amakathetha e-PVC ayagcina amabili nesikhombisa (76%) futhi amakathetha e-latex ayagcina inkimbinkimbi (12%) (Ukubhalwa Kweminyaka Kwezinhlangano Zemithambo Yemidhizinini, 2024). Lezi zidinga ziyaphinda kusilicone esingasemthwakathwakeni siloxane—okungasiza i-toll-like receptors futhi asikwazi ukuthi amaprothini aqondwe kulo—okunika umsebenzi wokuthi uyisafu kakhulu phakathi kwezinto zokusebenza kwezinhlangano zemithambo yemidhizinini.

Ukuvikelwa Okwengeziwe Kwemithambo Yomzimba Wokuthi Uyisafu Futhi Ukukhulula Ukuthi Izinkrithali Zizofakwa

Izindlela Zokuthi Isibonelo Sizobala Ngokushesha Kuyakuncamisa Ukufakwa Futhi Ukuncamisa Ukuthi Kukhona Umphumela Ongcono Kwemithambo Yokuthi Uyisafu

Izicatheter zokugcwalisa umbono wasezinsukwini zasemhlabathini zinamaphuzu amancane okungafani noma kubonakala ngokupheleleyo, okunika ukuthi ukusakaza kwezinye izicatheter zokugcwalisa umbono wasezinsukwini zasemhlabathini (latex noma PVC) kungaba ngaphezu kwe-60%, njengoba kuchazwa ngokulinganisa kwe-ISO 20696:2021. Le mbona yomphakathi oyisilki, engaqondi umdla, iyagcwalisa ngokushesha kuzinsukwini zasemhlabathini ngokungafani kakhulu, ekhuselela izihlangothi zomlando zokugcwalisa umbono wasezinsukwini zasemhlabathini kusukela ekusakazeni kuze kufika ekusakazeni kwezinkulungwane. Ngaphandle kwezicatheter ezinamaphuzi okugcwalisa umbono wasezinsukwini zasemhlabathini ezingaqondi umdla—ezidinga ukuthi zihlale ziqondi umdla futhi zingadry out, okuvula ukuthi ukusakaza kwezinye izicatheter kungaba kakhulu—ukuthi ukusakaza kwe-silicone kungabuyi kuhle kanye noma kungahle kanye.

Ukucindezeleka okuncishisiwe kwe-shear kubaluleke kakhulu ezigulini ezine-urethra ebucayi, kuhlanganise nalezo ezinomphimbo we-neurogenic, izinguquko zangemva kwemisebe, noma i-catheterization engapheli. Ucwaningo lokubuka olwenziwe ezindaweni eziningi lwaphawula ukwehla okungu-45% kweziqephu ze-hematuria encane phakathi kwabasebenzisi be-catheter besikhathi eside abashintshela kumadivayisi asebenza ngesililikoni (Urology Times, 2023). Ukugcina ubuqotho be-epithelial kunciphisa ingozi yokuqina futhi kuthuthukise ukunethezekakusekela ukugeleza okungaphazanyiswa kanye nekhwalithi yokuphila.

Isakhiwo esingenamthungo esivimbela ukunamathela kwamagciwane kanye nokufakwa kwe-calcium phosphate

Udonga lwe-silicone olungenawo ama-porous, oluhlangene alubonisi ukungahleleki kobuso ukuze kuhlalwe amagciwane. I-in-vitro scanning electron microscopy ibonisa ukuthi izindawo ze-silicone zibamba amabhaktheriya amancane angama-7080% kunelatex noma i-PVC ngemuva kokuchayeka komchamo wamahora angama-24 (Journal of Hospital Infection, 2023). Ubuhle bayo bubuye buthinte ukufakwa kwe-calcium phosphate kanye nama-struvite crystals izakhi eziyinhloko ze-catheter-blocking encrustation.

Izindatha zokuhlola kusukela ku-2023 kubonisa ukuthi abasebenzisi bamacatheteri ase-silicone bafunda ukuthi ubungakanani be-biofilm buphansi kwe-33% kulabo abasebenzisa amacatheteri ase-latex. Ngoba isilicone ayikwazi ukugwala ngokuguqula kwe-pH yamaphakathi nezilubricants ezingenziwa ngamandla, kuyadlula kakhulu ukuthi kubhekisele kwezinhlobo zokudlula—kuyadlula kakhulu ukuthi kubhekisele kwezinhlobo zokudlula. Lokhu kubhekisele kuzo zonke izindlela zokubeka izinkampani ezinkulu kanye nezindlela zokubeka izinkampani ezinkulu, futhi kubhekisele kuzo zonke izindlela zokubeka izinkampani ezinkulu kanye nezindlela zokubeka izinkampani ezinkulu.

Ukuhlelwa kwezinkinga zomuntu nokubhekisele kwezinkinga zokuhlola kwezinkulungwane

Ukuchitha, ukuflexa, nokuthi kubhekisele kwezinkinga zokuhlola kwezinkulungwane (abasidini, abantwana, abantu abanemiphumela yezinyawo)

Amacatheter ethu esilicone ayasebenza ngokuphambana kancane kwezinhlobo zezinyawo zokuhamba kwezinyawo, ngokuthi yenza ngokuphambana kancane kwezinyawo zokuhamba kwezinyawo, okuyisilinganiso sokuphambana kancane kwezinyawo zokuhamba kwezinyawo. Kusukela ku-2022, emaphakathi amabili ezingaphansi kwezinsuku, abadokotela bafunda ukuthi kukhona ukuphambana kwezinyawo zokuhamba kwezinyawo ngokuphambana kwezinyawo zokuhamba kwezinyawo ngokuphambana kwezinyawo zokuhamba kwezinyawo ngokuphambana kwezinyawo zokuhamba kwezinyawo. Amasiko asezingaphansi ayasebenza ngokuphambana kwezinyawo zokuhamba kwezinyawo: isibonelo sokuphambana kwezinyawo zokuhamba kwezinyawo siyakunciphisa ukuphambana kwezinyawo zokuhamba kwezinyawo—okuyisibonelo esikhulu kwezinyawo zokuhamba kwezinyawo ezincane nezincane.

Kubantu abanemiphumela yezinyawo zokuhamba kwezinyawo abazifuna ukusebenzisa amacatheter ngokuphambana kwezinyawo zokuhamba kwezinyawo, lokhu kucatshangelwa ngokuphambana kwezinyawo zokuhamba kwezinyawo kusiza ekuphambaneni kwezinyawo zokuhamba kwezinyawo kanye nokuphambana kwezinyawo zokuhamba kwezinyawo kwezinyawo zokuhamba kwezinyawo. Isibonelo sokuphambana kwezinyawo zokuhamba kwezinyawo kanye nokuphambana kwezinyawo zokuhamba kwezinyawo kunciphisa ukuphambana kwezinyawo zokuhamba kwezinyawo, kusiza ekuphambaneni kwezinyawo zokuhamba kwezinyawo kwezinyawo zokuhamba kwezinyawo. Lokhu kunciphisa ukuphambana kwezinyawo zokuhamba kwezinyawo—kusiza kakhulu kwezinyawo zokuhamba kwezinyawo ezincane nezincane kwezinyawo zokuhamba kwezinyawo ezincane nezincane kwezinyawo zokuhamba kwezinyawo ezincane nezincane kwezinyawo zokuhamba kwezinyawo ezincane nezincane.

Ukubonakala kwezindlela ezihlukene ngokwemithombo yokubonakala kwezinkinga zokugcina isikhumba kanye nezinkinga zokugcina umsila wokuphuma kwamanzi: Izindlela zokufunda kusuka ku-2022–2024 ezisemaphakathini amaningi

Izindaba zokugcina izikhumba ezisemaphakathini amaningi zazibonisa ukuthi isilikon inamandla okuvikela isifo. Ukuhlukaniswa kwezindaba kusuka ku-2023 kusuka kumakhospitali emayi ezilandelana e-Europe yavona ukuthi kunezinkinga zokugcina isikhumba zokuphuma kwamanzi (CAUTIs) ezinkulu ngama-40% ngezikhumba zase-silikon konke ngaphezu kwezikhumba zokugcina isikhumba zokuphuma kwamanzi ezinamagama e-latex, kusukela ekugcineni isikhumba kusukela ku-28 izinsuku. Isilikon sinesipho sokungabonakali kanye nokuthi sisikhumbi esihle, futhi singasivikela ukuthi izinhlobo zezinto ezingavikeli (biofilm) ngama-50% ngaphezu kwezinye izikhumba, njengoba kubonakalile ngokubhalwa kwezinhlobo zezinto ezingavikeli (bacterial colony counts) kusuka kwezindlela zokugcina isikhumba zokuphuma kwamanzi kusuka ku-2024.

Kwizindlela zokuphatha izikhathi eziningi zokuphatha kwe-urology ne-rehabilitation, abasebenzisi bezicatheter ezidingekayo zokusebenza ngeminyaka yaba yisilinganiso sezibambo zokusebenza ngokusebenzisa i-silicone, bafunda ukuthi kubhekwa ngokufanayo kwe-cystoscopic ukuthi kunezibambo zokusebenza zokugcina umsila wokuhamba kwamaphakathi (urethral strictures) ngokulingana ne-28% futhi kunezinkinga zokugcina umsila wokuhamba kwamaphakathi (mucosal trauma) ngokulingana ne-33%. Lezi zimfundo zibonisa ukuthi i-silicone inezindiza zokusebenza ezingaphansi kanye nezindiza zokungahambani nesikhalo (hydrophobic nature) — okuyisivumelwano sokungabonakala kokugcina amaphakathi we-calcium phosphate. Ngokuhlanya ngokuhlanganisa izinkulungwane zokuphatha kwezifo nezinkinga zokusebenza ngokwezimali, izicatheter zesi-silicone zinokunika isibonelo sokuvumela ukuthi sibe sigcwele, sokuthuthukisa ukusebenzisa kakhulu kwezinhloso ezingaphansi kakhulu, kusukela ku-abantu abadala, abantu abanemiphumela yokuqhubeka kwe-spinal cord, kanye nabantu abadinga ukusebenzisa izicatheter ngeminyaka.

Imibuzo Evame Ukubuzwa

Kungani izicatheter zesi-silicone zihlaziywa ngokuphelele kubantu abanemiphumela yokuqhubeka kwe-latex?

Izicatheter zesi-silicone zingasivumeli ukuthi zihlaziywe ngokuphelele futhi zihlaziywa ngokuphelele amaproteni we-natural rubber latex okuyoba yisibonelo sokuthi siyahlaziywa ngokuphelele ngokuphatha kwe-IgE.

I-silicone isenza kanjani ukuthi ishindise izinkinga zokugcina umsila wokuhamba kwamaphakathi?

Isilikon isebenzelwano esiphakeme kakhulu esingaphansi kwezinyathelo zokufaka futhi isindisa ukugqibela kwemucosa, ekhuluma izinto ezinzima.

Yini okwenza amakathitha ase-silikon akhathazeka ukubambeka kwebakteriya?

Isilikon inesitruktcha esingasolwa, esihlanu ekhathazeka ukubambeka kwebakteriya nokwakha kwebiofilm.

Ngabe amakathitha ase-silikon ayisafeli kakhulu kuzo zonke izindlela zokusebenzisa ngokuqhubekayo?

Yebo, ubukhanyana bawo, ubukhanyane bawo nobukhanyane bawo bakhiqiza isilikon njengendlela eyodwa yokusebenzisa ngokuqhubekayo.