Welcome to the Augs Industry Webinar Series. I'm Dr. Carly Phillips, moderator for today's webinar. Today's webinar is the PURWIC system, an innovative solution for women with urinary incontinence presented by Dr. Nicole Zell. Dr. Zell will present for roughly 45 minutes. The last 15 minutes of the webinar will be dedicated to Q&A. Dr. Nicole Zell is a board certified urologist originally from Cleveland, Ohio. Dr. Zell completed her bachelor's in biology and chemistry at Radford University and earned her medical degree at the Michigan State College of Osteopathic Medicine in East Lansing, Michigan. She completed an internship and residency in urologic surgery in Detroit, Michigan through the St. John Providence Health System. She also completed a clinical fellowship through the Bladder Health and Reconstructive Urology Institute at Memorial Hospital in Miami, Florida. Dr. Zell currently practices at the Advanced Urology Institute in Clearwater, Florida, where she specializes in general voiding dysfunction, female pelvic floor disorders and urologic reconstruction. Before we begin, I'd like to review some housekeeping items. This webinar is being recorded and live streamed. Please use the Q&A feature of the Zoom webinar to ask the speaker questions. You can also use the chat feature if you have any technical issues. AUG staff will be monitoring the chat and can assist. Dr. Zell, I'll turn it over to you. Thank you, Carly. Welcome everyone, and thank you for being here tonight. And without further ado, we will start our presentation. Urinary incontinence is a very common, debilitating and expensive health problem. This health problem is commonly managed with pads, diapers, briefs, or even indwelling Foley catheters. Common problems that arise with management of incontinence include skin irritation and breakdown, discomfort from the patient, falls due to frequent bathroom trips, and even catheter-associated UTIs. More Americans today are providing care for aging loved ones in an at-home setting. Most Americans spend an average of 40 hours caregiving per week. Incontinence issues at home can lead to falls, which are the leading cause of injuries in people over 65 years of age. Incontinence is a catalyst for transitioning loved ones to nursing home care, as this adds a physical and psychological burden to caregiving that is significant. Caregivers then become vulnerable themselves to health problems over time, including depression, fatigue, weight changes, social and emotional changes, and even mental illness. Weight changes, social isolation, and financial problems. The BD PureWIC external female catheter system can fill a much-needed gap in the standards of incontinence care. The PureWIC system provides an alternative to traditional methods of incontinence management. The PureWIC system draws urine away from the body externally, keeping the skin dry. It can be worn seated or laying down, and if worn laying in bed, it can even help to reduce nighttime bathroom trips. The external catheter is tucked between the labia and buttocks and held in place with the body is in anatomic position. The patient voids or leaks as they normally would, and the soft material of the catheter itself wicks urine away from the body down to the very face of the catheter. There is continuous low-pressure suction at the base that wicks the urine away into the suction canister for disposal. Prior to placing the external catheter, you may obtain gloves and peri-care wipes and explain the procedure to the patient. And now I'm gonna go through how it works. You connect the canister to the wall suction at a pressure of 40 millimeters of mercury suction pressure and turn the unit on. Verify that the suction is working by covering the open end of the tubing and checking the pressure dial for an increase in pressure. Connect the external catheter to the collection catheter, I'm sorry, to the collection canister with the suction tubing. Next, you should perform perineal care to ensure the skin is clean and dry. The anatomic marker here is the pubic bone. Place the top of the gauze side at the pubic bone between the patient's spread legs and the bottom at the gluteal cleft. Close the legs over the catheter once this is positioned appropriately. Remove the external catheter, separate the legs and pull the catheter completely outward. The suction should be on in the on position when removing the catheter. Dispose of as biohazard guidelines. The external catheter should be replaced roughly about every eight to 12 hours if soiled. For further recommendations, please remember to perform each step with clean technique. In the home setting, this involves washing your hands thoroughly and using gloves as needed. Ensure that the female external catheter remains in the correct position even after turning the patient. Properly placing the Purwick female external catheter snugly between the labia and gluteus holds the external catheter in place for most patients. Mesh underwear or briefs can be used on top and can be useful, but they are not necessary for securing the Purwick for some patients. Assess device placement and the patient's skin integrity at least every two hours. Replace the canister and tubing for each patient at least every 60 days. The Purwick system is not recommended for any patients who are combative or agitated. Those patients with heavy menstruation or bowel incontinence with possible contamination should also not use this product. Barrier creams should not be used between the perineal skin and the Purwick system itself. These are our safety warnings and guidelines. The Purwick urine collection system is to be used with Purwick external catheters, which are intended for non-invasive urine output management in female patients. Do not use the Purwick urine collection system with Purwick external catheters on any individual with urinary incontinence. Do not use the Purwick urine collection system with Purwick external catheters on any individual with urinary retention who cannot urinate on their own. Always unplug the urine collection system before cleaning or when not in use. Do not immerse the entire system in water. This device should not be used in oxygen-rich environments or in any other environment. Do not use the Purwick female external catheter with a bedpan or any material that does not allow for sufficient airflow. Do not insert the Purwick female external catheter into the vagina, anal canal, or any other body cavity. Do not use the external catheter with a bedpan or any material that does not allow for sufficient airflow. Do not insert the Purwick female external catheter into the vagina or any other body cavity. Do not insert the Purwick female external catheter into the vagina or any other body cavity. Do not insert the Purwick female external catheter into the vagina or any other body cavity. Do not insert the Purwick female external catheter into the vagina or any other body cavity. Do not insert the Purwick female external catheter into the vagina or any other body cavity. Yes, thank you, Dr. Zell. Audience members, please submit your questions in the Q&A section. I can go ahead and get us started with our first question. Dr. Zell, does the external catheter require tape or securement to keep it in place? Good question, Hartley. So it does not require anything else other than what comes with the device. I have had a lot of patients ask me about mesh underwear, underwear, undergarments, anything like that. It can be used, and it can be used over top of it. It's not going to hurt anything, but it's not necessary to be used with the external catheter. That is secured on its own. All right, thank you for that. How often does the tubing and canister need to be replaced? So the tubing and canister, I'm going to go back. If you look at this last line under our recommendations, the canister and tubing for each patient should be about every two months. Thank you very much. Our next question is, is there any way for this device to be used at home or without suction? So the device is actually designed for home use. I know that commonly there's other systems that are used in hospitals. This has been used in some skilled nursing facilities, long-term care facilities. But one of the big things that we like to pride ourselves on is the fact that this device can be used at home because we have so many more people, aging, elderly, who are being cared for at home on a regular basis. So ideally used at home. And I'm sorry, Carly, what was the second part of your question? Yes, it was at home or without suction. Without suction. Without suction, it's just not designed for that. The whole reason this system works is because our patients feel clean and dry. So that careful wicking, that careful suction away from the body, really helps people to feel like they're not sitting in their own urine, they're not sitting in a wet diaper, they're not sitting with a wet pad. So that's really the advantage of the whole system. Thank you, Dr. Zell. Our next question is, is the Pure Wick system covered by insurance, specifically Medicare? So specifically right now we're working with Medicare alone for full coverage. The coverage is going to be different for both the suction canister and the wicks. But right now we're still working with Medicare for both of those, if I'm not mistaken. Thank you, Dr. Zell. If you're using it at home, can you explain where the suction comes from? So it's an actual portable suction canister. People may be familiar with these. If you've ever seen it for home care, if you're using suctioning of a patient's lungs. So it's the same type of portable suction canister that's connected to the tubing that then you can use on your own at home. We have a question here. Would patient use as often as they would for intermittent self-cath two to three times per day? Excellent question. So the answer to that is no. So this is actually designed for patients specifically at home and a lot of times specifically at nighttime. So it's been designed that we use it at bedtime and we take it off in the morning. So for a lot of patients that's up to 8 to 12 hours. So not nearly as often as you would need to self-cath. The difficulty with, and then kind of getting back into your question, with using this on patients who self-cath. If you have a urinary retention patient, you should not be using the suction canister external catheter system. This is for patients who leak and void on their own without the need for catheterization. Thank you, Dr. Zawal. We have another question. Do patients need a prescription? Yes. So you actually need a referral from a physician that would then go through the BD company as well as through Medicare in order to have the device. Thank you, Dr. Zawal. Are there any more questions? Please feel free to type them into the Q&A chat box. Looks like we're getting a lot of questions about pictures. So this is actually what it looks like. I know it looks almost like an artist's rendering, but this is actually what the PureWick itself looks like. So this is an actual picture. We have another question. Are there local reps who can help office staff getting this set up for patients? So there are. So any of your reps that are associated with BD or BARD are a fantastic resource to helping get this set up. And then this is actually what the suction canister tubing everything looks like as well. So these are actual pictures. Thank you, Dr. Zawal. Some great questions. Any more questions? Please type them into the Q&A box. Any last questions from the audience? Oh, Carly, just one more thing I wanted to cover on this. We had mentioned this prior at the beginning of the presentation as well. This is also ideally used for patients that are in wheelchairs or wheelchair bound. It can work specifically for these patients because they're not really changing position much. They're in a seated position most of the time. So for a lot of those patients, during the day that are wheelchair bound, this is an option as well. Thank you, Dr. Zawal. On behalf of AUGS, I'd like to again thank you, Dr. Zawal, and thank everyone for joining us today. For a complete webinar series schedule, please visit the AUGS website to sign up. Thank you. Thank you.

PURWIIC system

urinary incontinence

Dr. Carly Phillips

Dr. Nicole Zell

external catheter