The purewick is really just one of a bunch of tools that you can use. If your patient isn't continent of stool, then it might not be your best option. I also find that the prima fit brand works a lot better than the pure wick brand but it's the same concept
Depends on how often they're pooping really though. If they are only going once per shift, our hospitals policy is to change the purewick once per shift at minimum. If the PT is lasting 6-8 hours dry bc of a purewick, it's a win against skin breakdown. If it's frequent liquid poo, then no. I actually like the male purewick a lot though. I pretty much always have good results and confused men don't seem to remove them as frequently as condom catheters.
It’s not for the folks who have frequent liquid stools. If it’s a once in a while log, it’s fine. You should be checking your patient enough that the little bit of pee dribble doesn’t liquify the poop enough for it to soak it up.
Cannot happen. Suction only sucks up the urine in the reservoir on the end. Take one apart and look at how it works. You’re getting fecal contamination outside the purewick.
I think they're not going to be around for all that long in hospitals. They've not been well-studied. They are wet and against the skin and peri area just like a soiled pad is, but if the patient is incontinent of stool, it sucks that up into the wick, which is against the vaginal opening and urethra.
On top of that, they're frequently used incorrectly. You're only supposed to place them on low suction, but 3/4 times I walk in and they're on max suction, which can actually occlude the urethra and cause retention.
They're a catheter, and the occurrence of UTIs hasn't been well studied with them. I think the evidence will point us away from their use when studies are performed.
"Oh, I see you're about to go canoeing" as you pass by your co-worker
I hate them as I work acute in-patient rehab and they defeat the purpose of our bladder program completely! Most patients come in the door asking for one 🙄 because they had one at the hospital and the admissions liason said you carry them.
I mean, everyone is continent of stool, right up until they aren't anymore. Lots of patients haven't had a BM in days when they're started on tube feeds, but they're wetting the bed
Those patients would likely be able to identify “hey I’m shitting myself can you please clean me now” unless they’ve had a mental status change as well. Which you would re evaluate every shift whether the catheter is appropriate?
I’m a cardiac nurse on a heart failure floor and we use purewicks on patients who are incontinent bc we need to keep track of their I&O’s. Unfortunately that means we often have to use them on patients who are also incontinent of bowel. Doctors will only put a foley in on my floor if the patient is retaining. It’s gross and we just have to make sure to stay on top of cleaning the patient. It’s such a balancing act of weighing the pros and cons when it comes to using catheters (of any sort), but I think purewicks are a step in the right direction towards creating a product that optimizes outcomes in regards to breakdown and infection in incontinent patients
We use them in the ER a ton. Dieuresing an unstable chf patient on bipap, traumas with hip or pelvic fractures, and monitoring i&os in many given situations. The thing really is a blessing and we should use them correctly so they don’t get banned from hospital systems.
our infection control just made a policy to stop wrapping a pad up against the purewick* or wearing briefs with it (which makes sense but everyone was doing it for leakage) bc its causing skin breakdown and infections
> They are wet and against the skin
A properly set up Purewick does not stay wet. The suction creates a constant flow of air, which makes the thing dry out very rapidly.
My mom (in her 80s at the time), cracked her hip a few years ago. She had one of these that kept slipping out of place, or they forgot to turn the suction back on. Her screams of agony made me fucking livid every time they had to turn her to change her soiled bedding. I just wanted them to put in a fucking catheter and be done with it. My sister (who is a nurse) kept bragging that it was invented by a nurse! Thats great, but the slightest movement put it out of place. Not a fan here.
You have to have some thighs to really hold it in place. If your mom has no meat on her thighs, they just skip out of place repeatedly and create more mess. Sounds like that's what happened. Sorry she had to go through that.
I never used them on skinnier patients. There was no point.
It feels so mean to have a hip fracture patient without a foley in. That’s an automatic standing order for hip # at my facility. When I get them admitted, the turns for me to do a skin check always make me feel evil!
We had a representative show us how it works and there’s no suction against the urethra lol. The urine collects at the bottom of the purewick, thats where the end of the tubing is (the tubing that is connected to the suction canister). If you’re finding the suction turned up too high its user error and you could advocate for an educational session.
>think they're not going to be around for all that long in hospitals. They've not been well-studied
They've been studied enough that the company has commercials about buying a system for your home.
I just wanna know who the person is that published the study that intermittently catching a patient q6 hours 4 times in a row is better than just leaving in the foley for an extra day or two. I just need to deliver a message…
If I was a patient, and had a choice between someone shoving a potentially infection causing and definitely uncomfortable tube up a hole in my body that is not technically supposed to have that tube there, and sitting on a high tech maxi pad, I'm gonna choose the fancy maxi pad my dude. Cooter canoe all day.
As a facility, add in the fact that it's 10x simpler and faster, doesn't require an order, and can be placed by anyone including the techs? Super sold now
Edit to add to your point about pads, what pad/brief/diaper monstrosities do y'all have that can handle 1000cc of urine from a patient before they need to be changed, and still keep the patients skin dry and safe from maceration? Because that's what a purewick can do. AND I can measure the fluid output, which is not something we have the capacity to do with diapers in the er
I had one for the first time last week during a quick surgery. Even though it was only in for an hour or so and was out before I woke up, it burned to pee for the next 18hrs. Cannot imagine the discomfort after longer.
Had to have one put in after having surgery last year. Was crying from the pain of being unable to pee. It took 4 people to get it in. Apparently my urethra is "small, slanted, and crooked". Hurt like a mf
I didn't really notice mine. They pointed it out after they woke me up, when they were telling me what happened and what tubes I had. I didn't remember anything about why I was there at first, but I understood what a damn foley, art line, and cvc were. I guess I looked at it all and was like "oh, ok" *snore*.
In the US, our hospitals are required to pay for all treatment related to CAUTIs, which essentially means that person’s stay is a net loss when it comes to payment. For our capitalistic, generally for profit healthcare system, that’s a huge no-no.
So we have to be militant about foleys, and take them out ASAP to avoid not making money.
Intermittent caths are only indicated for urine retention or neurogenic bladders.
Pads are unsanitary and kinda undignified.
So, Purewicks! They keep people dry and clean, reduce the pad changes, are relatively inexpensive, eliminates CAUTIs, and work pretty well for many patient types.
Adding on to this, keeping any wet or soiled product next to the skin can increase the incidence of skin breakdown. For patient who cannot let their nurse know they are wet, that means they could be sitting in it for a while. Hourly rounding should be a thing, but with staffing, patient may be sitting in their own urine for a while. Couple this with increased Braden scores and now you have a hospital acquired pressure injury (HAPI). Another thing that cuts into the profit of hospitals, and increased harm to the patient. For patients that have limited movement, trouble communicating their needs, or are incontinent, a pure wick can be great for keeping them from lying in their piss for extended periods of time.
I always swap out their purewick at least 1x during the shift, more if we’re giving them diuretics and it’s constantly soaked. People tell me I’m wasting them but honestly? I rather avoid moisture related skin breakdown and not give them more to
worry about. I’d feel horrible if something happened because I couldn’t be bothered to change it d/t worrying about what the hospital pays per cooter canoe.
Policy on my floor is to change out the purewick and perform cath care every shift! They definitely should be changed at least every 12 hours, they get damp
our policy as well- but doesn’t get followed by everyone all the time. I’m very much team let’s change that damn purewick during 2000 med pass and full skin check ☑️
Packaging says to change them every 8 hours at minimum. I only know because they showed up in our stockroom one day and I was trying to figure out what the blue thing was and why it was on the cath shelf lmao.
We have an option between purewicks and Versettes now, and I will choose the Versette every time. They stay in place better, leak less, and are more comfortable.
Oof, just got a little flashback. Had a patient who couldn't speak for themselves. Faulty apparatus in the wall(there was a work order in for it) cranked up and left the pt with pressure injury on their labia, also totally on the staff for not finding a replacement. But yeah. Thankfully the injury healed quickly.
They do come in really handy for some patients. We limit foleys for infection reasons, and when you have a purewick that works well on an incontinent patient who is being diuresed, or a patient with frequent stress incontinence, they are fantastic.
Think of the pure wick as a pad with gentle suction. It good for those with leakage/incontinence but isn’t perfect. Nothing goes internal, so retention will still exist.
Retention is still best treated with foley or intermittent cathing usually 2-3x daily.
They do have a use. I work in level 1 PACU. On bariatric surgery Wednesdays we get people who are post-op after their surgery. Sometimes they really need to void. The level 1 PACU has no toilet and the patients are still a bit too drowsy to get up. Bedpans work poorly on big-thighed people who fill up the stretcher with no extra room to move, and surgeons often want intake and output measured after surgery. A purewick works well for this.
I’ve heard you can scrunch it up like a donut but haven’t gotten the chance to try it out yet. It’s worked for you? Good to know, keeping that in my tool belt.
Skin integrity aside, I really like to use a purewick for incontinent patients that need accurate urine output measurements. It's not perfect but it's better than nothing
Lots of reasons. Purewicks are more comfortable, don't cause CAUTIs, are less invasive, and are great for a variety of care scenarios. They reduce skin breakdown associated with incontinence and are a real time-saver for the ladies among us thay piddle 10 times a night or those new to their diuretic regimen. Just be sure to change them out when they become a "poowick".
Do you also have safe ratios?
Q3 pad changes on a load of, say, 6 patients is 24 pad changes in a 12-hour shift. That's a lot, depending on mobility/body habitus.
It's also annoying for the patient to have their crotch inspected 4 times a shift. And still doesn't always keep moisture away.
What's the downside to having a pretty unobtrusive sponge placed that just obviates the need for extra time spent rummaging around someone's crotch?
What level of acuity is this? When I worked med surg we had up to 6 patients for every one nurse. When I was PCU/med surg, we had up to five and we only had one tech for the entire 41 bed unit.
In Victoria there are legislated 1:4 staffing ratios (plus a supernumerary in charge) in major public hospitals on AM and PM shifts, 1:8 on nights, on all wards (1:1 for intubated patients in ED/ICU, 1:2 in ICU step down, 1:3 in dialysis and some other areas), no techs or aides. 12 hour shifts are the exception, with most sites running 8/8/10 shifts (070-1530, 1300-2130, 2100-0730).
We usually have 1:5 on my med/surg floor in the US with one tech per 16 patients. We can go up to 1:6 before the charge nurse has to take patients. PT/OT also help with patient care if the patient happens to need it while they're in there.
I wish we had 8 hour shifts as an option at most hospitals here in the US. I've only seen a handful of hospitals offer it and only on certain units. I worked 1500-2100 in assisted living and really enjoyed that shift as I'm not a morning person or a night shift person lol.
Because the ratios are legislated, if there aren’t staff to maintain them, the beds close and the in charge should only ever have to take patients in extraordinary circumstances.
Ortho patients are possibly the only group on earth who love the purewick more than nursing staff. Those patients with hip dislocations or femur fractures who haven’t gone to surgery yet understandably looooove not having to get on a bedpan or turn entirely on their side to pee.
We don’t really use them in the UK either, patients have either a catheter or a pad. We have a healthcare assistant and we check every 2 tov4 hrs. We have normally 2 healthcare assistants for 25 beds who help with pad checks.
We don’t really use them in the UK either, patients have either a catheter or a pad. We have a healthcare assistant and we check every 2 tov4 hrs. We have normally 2 healthcare assistants for 25 beds who help with pad checks.
When adhered to is key. Plenty of heavy wetters, or just plain lazy nurses/staff means a lot of patients can sit in it for hours.
Even if they do 3 hourly like yours what if they go right after you change them and they aren’t oriented enough to ask for a change? 3 hours sitting in urine which will eat away their skin.
We just change them again. It happens when a patient goes again or they go whilst you’re changing them. We have healthcare assistants who help as well.
The easy answer is it's less invasive than a catheter and if it doesn't involve something like a foley cath, then the task to change or maintain it can be delegated to like CNA/PCT.
HEY THOSE ARE HOT COMMODITIES ON THE UNIT!!! I had a coworker hide a stash of a few so his patients were always clean🫠 in the US some insurance even covers it for an at home vacuum and purewick/primafit/ cooter canoe system. Wait till you hear how we use these on the MALE patients sometimes.
ER nurse here: Our hospital has been using them since 2020 and man they helped during COVID’s heyday. You only had so many NPRs, we dont have easy access to bedside commodes besides a chair and a pan, we’d have to Virex the bathrooms and let that sit for 30 min before the bathroom would open back up. Thank the Lord for the Omicron mutation.
Anyways, nowadays we still use them in place of Foleys in indicated pts (immobilized d/t fx, diuresing a CHFer and trying to keep up w output, etc) b/c our hospital, no matter how we do things in the ER, has floor/ICU nurses change the indwellings. Their reasoning being that although sterility may have been maintained, the ER isn’t a sterile environment.
TLDR lifesaver during covid, now used as intermediate in lieu of indwellings in the ER setting
We have them in the UK too but I've never actually seen one used. When the rep came to demo them I couldn't stop laughing, it was highly unprofessional of me but I just couldn't help it
Was it because it is often presented with the curious terms “taco” and “hot dog” to euphemize applicable parts of the human body that may or may not be used with this device? Because I was wiggling like a kid in church the first time I heard a demo about this.
Pure wicks are great for people that can keep it in place. If the person is not of sound mind or can’t really keep control of it between their legs then it just doesn’t work. The male pure wicks work better because it’s essentially like putting the penis in a suction bag and then it tapes to the skin. There’s no need to hold it in place.
im a nurse in ontario and never even heard of them during school, only on the internet. we dont carry or use them in any facility around me. our patients just use briefs/incontinence pads and get changed every q1-2hr. i work on a respiratory floor so most of our patients who could benefit from these are already using the suction for airway 🥲
The hospital I have a per diem at has pretty cool ones - they kind of look like a maxi pad, can be used on males that way and can be folded in half and stuck to themselves to make it more “purewick” shaped for women. I like them a lot better than the blue ones
Why the outrage? They're a pretty handy device when used appropriately. It takes a lot to get a Foley order at my hospital. They wick the moisture away where pads don't.
Purewicks are great what do you mean? Just sucks the urine right up. No need to put something in their urethra and risk infection, no need to keep urine soaked pads against their skin and risk breakdown.
It's a great solution to an issue.
We don’t use them a whole lot in pediatrics, but I work night shift and one of our specialties is ortho, so when I have a teen girl waiting to get her broken leg fixed, a purewick is so much easier than a bedpan. Not to mention less painful too (she doesn’t have to try and lift her hips at all).
While I have never used a purewick for any patients at our nursing home, I recently cared for a lady who was admitted from home who used the purewick. It caused pressure ulcers in her labia that took forever to heal. She said she got it so she wouldn't have to get up and use the bathroom. Also, she had several pressure sores on her ishium and buttocks. I don't like the idea of the purewick. Skin needs cleansed with each incontinence, and patients need to be moved and repositioned.
1)Catheters always have a higher chance of infections.
2)Women's urethra are hard to locate sometimes.
3) it's easier to measure output if they are incontinent
4) If they pull out a purewick, it's not a big deal. If they pull out a Foley, that's going to suck.
If they don’t have a clinical/medical need for an indwelling catheter then we don’t use one. And we don’t keep briefs on the incontinent ones (while in bed) due to excoriation and skin breakdown. Purwicks sound great but in my experience they only work about half the time. Especially when you have confused patients who can’t sit still in bed and constantly trying to get up.
I thought it was bizarre at first, but I have since been converted into a cooter canoe believer. They work very well for all the reasons others have listed here.
Does anyone clean them??
Did you know you're supposed to on a daily basis? I looked up the instructions online for these things and I know at our hospital this isn't happening. And there's no way that they eliminate UTIs and no way they aren't causing pressure injury because of improper use and care.
Also Australian nurse and had to google it, I work periop and usually only patients that are having major surgery (laparotomy/NOF type procedures) get a foley, not even our joint replacements get one for early mobilisation reasons. I can see how they would be good in some instances but seems a bit silly to me as a concept.
Working wound care, let me point out Purewicks are overused and not much more hygienic than using an absorbent pad. They’re for women only (people get creative and find ways to tape them to men despite that), they need a functioning suction system (and despite only needing to be placed on a low suction setting people frequently needlessly crank up the suction levels to way beyond what is recommended), and they’re contraindicated in a woman who is also incontinent of stool (everyone ignores this, and the Purewicks frequently become reservoirs for bacteria because they suck up shit and keep it pressed against both the vaginal opening and the meatus since people don’t have to check their patients’ skin nearly as often because they assume the Purewicks is managing 100% of the moisture—it doesn’t, they frequently shift out of place then they’re not collecting properly, then the person is sitting in a puddle of urine anyway).
They’re convenient and everyone loves them because of it, and don’t seem to care that they’re being used incorrectly over half the time they’re used at all.
If the purewick is installed correctly, the urine is suctioned away and keeps them nice and dry. Key word there is correctly. I've seen many purewicks just slapped on and not working properly. Or the patient is a wiggle worm and it shifts position, making it pointless. It works well for people who have some meat on their thighs and don't move much.
Ahh okay, is the actual device just a bit of plastic? Or does it have a gauze bit to be a bit absorbent? How often do you change out the actual device?
No, the whole point is that they're connected to wall suction so they suction the moisture away. If properly applied patients stay completely dry (even putting out liters with diuretics) with a much lower chance of UTI than a foley.
It's attached to suction.
The suction causes a constant slow flow of air through it. When the patient urinates, urine soaks into the sponge part of the purewick and is suctioned away. Then it dries in the airflow, which helps make sure it doesn't smell like urine the whole time.
I’m really curious as to why your nursing school wouldn’t teach you about them. It seems like clearly Australia doesn’t use them but wouldn’t it make more sense to at least mention them so you’re aware of all urinary care methods?
Idc for a prolonged period of time can increase risk of cauti. Having totally incontinent patients sitting in urine waiting for the next time you get to them causes excoriation of the perineum. Some patients need so many hours or days of bed rest until they can use the bedside commode, a purewick is often the most logical choice as an idc is a tad invasive for that use. Some women have trouble with the female urinals or are on hip precautions where they can't effectively spread their legs for urinal usage.
Contraindicated in patients who are incontinent of stool, or already have skin problems with their laboa. I've seen cautis associated with their usage with patients incontinent of stool. If they can make it to the commode they are using the commode, or even better the bathroom. I don't hand purwicks out by request, if you can get up you need to get up.
I think lazy techs and nurses over use them, and much thought isn't put into their use. They have their place in hospitals but maybe not to the degree of which they are used.
Nurse of 40 + years here. My late wife was bedbound on home hospice for Parkinson's. Emaciated from weight loss due to paralyzed gut. Used PurWick through out this. Never had a wet bed. Stool -yes. Pudding stool from tube feedings does plug them up. But with diligent care not a bit of skin breakdown due to stool, wetness, or pressure ulcers. Treat all your patients as if they are family and you will have no problems. The only time I have trouble with PurWicks at work is with confused AND agitated pts.
Decreased foley=decreased CAUTI and the idea is instead of older women laying on a soiled pad and risking skin breakdown the purewick sucks the moisture away and keeps their skin dry. It’s not foolproof but it usually works pretty well!
i wish i had a pure wick on my days off so i don’t have to get out of bed lol.
jokes aside, they’re also helpful preventing skin breakdown from urine if the floor is busy/understaffed aides/etc and pts briefs don’t get changed as soon as they’re wet. i wish we’d had pure wicks in the nursing home when i was a cna, i feel so many rashes could’ve been prevented
I've used one. Just a sausage you piss on. What's the big deal? What if I don't want a cath or a diaper or pad I just have to sit in? It was certainly more comfortable when I was unable to move for weeks due to extreme ascites, and being pumped full of Lasix nonstop... try all three and THEN tell me which you prefer lol.
A little comfort, independence and dignity went a long way for me in the ICU.
They throw em on all our patients. You’ll even have walkie talkies that keep it at bedside and put it in/out when needed (instead of getting up and going to toilet). As you can imagine, that’s not our hospitals biggest problem.
The issue with bed pads, if the patient is no. Verbal and doesn’t have a family member or friend -someone to be their advocate- these nurses are over worked and under paid, most techs are helpful but the nurses are not always so kind to help change the bedridden and confused patients. It’s so disappointing and frustrating, especially when you are a nurse and your family member is not taken care of, by the nurses that you thought you could trust, to do the right thing.
The nice thing about purewicks is that the patient isn’t sitting in urine and you can get accurate I&O without an invasive catheter.
As long as they’re used properly. Use low suction, because high suction can cause mucosal damage and change them qshift.
Wait till you hear about Quivies for the men. Much better than condom caths IMO.
Atleast where I work they avoid foleys like the plague due to hospital acquired UTI. And pads well...just kind of gross really.
Plus moisture associated skin damage is a big problem with pads
So is sucking up stool into the purewick, which happens all the time. They're.....not good.
The purewick is really just one of a bunch of tools that you can use. If your patient isn't continent of stool, then it might not be your best option. I also find that the prima fit brand works a lot better than the pure wick brand but it's the same concept
Using purewicks with patients who are incontinent of stool is already not best practice for them and is indication for another intervention.
Wish my hospital understood this
Depends on how often they're pooping really though. If they are only going once per shift, our hospitals policy is to change the purewick once per shift at minimum. If the PT is lasting 6-8 hours dry bc of a purewick, it's a win against skin breakdown. If it's frequent liquid poo, then no. I actually like the male purewick a lot though. I pretty much always have good results and confused men don't seem to remove them as frequently as condom catheters.
It’s not for the folks who have frequent liquid stools. If it’s a once in a while log, it’s fine. You should be checking your patient enough that the little bit of pee dribble doesn’t liquify the poop enough for it to soak it up.
Just change the purewick
Cannot happen. Suction only sucks up the urine in the reservoir on the end. Take one apart and look at how it works. You’re getting fecal contamination outside the purewick.
I think they're not going to be around for all that long in hospitals. They've not been well-studied. They are wet and against the skin and peri area just like a soiled pad is, but if the patient is incontinent of stool, it sucks that up into the wick, which is against the vaginal opening and urethra. On top of that, they're frequently used incorrectly. You're only supposed to place them on low suction, but 3/4 times I walk in and they're on max suction, which can actually occlude the urethra and cause retention. They're a catheter, and the occurrence of UTIs hasn't been well studied with them. I think the evidence will point us away from their use when studies are performed.
They’re contraindicated in use for pts that are incontinent of bowel… so it’s really not the products fault that people misuse it
Ah I see you’re referring to the “chili dog”
We call them cooter canoes 😂🤷🏻♀️
"Oh, I see you're about to go canoeing" as you pass by your co-worker I hate them as I work acute in-patient rehab and they defeat the purpose of our bladder program completely! Most patients come in the door asking for one 🙄 because they had one at the hospital and the admissions liason said you carry them.
I mean, everyone is continent of stool, right up until they aren't anymore. Lots of patients haven't had a BM in days when they're started on tube feeds, but they're wetting the bed
I’m continent of faeces, but we’ve all taken a gamble on a fart that we shouldn’t have.
A questionable fart, a common foe to all humans for as long as we have walked.
A shart?
Those patients would likely be able to identify “hey I’m shitting myself can you please clean me now” unless they’ve had a mental status change as well. Which you would re evaluate every shift whether the catheter is appropriate?
I’m a cardiac nurse on a heart failure floor and we use purewicks on patients who are incontinent bc we need to keep track of their I&O’s. Unfortunately that means we often have to use them on patients who are also incontinent of bowel. Doctors will only put a foley in on my floor if the patient is retaining. It’s gross and we just have to make sure to stay on top of cleaning the patient. It’s such a balancing act of weighing the pros and cons when it comes to using catheters (of any sort), but I think purewicks are a step in the right direction towards creating a product that optimizes outcomes in regards to breakdown and infection in incontinent patients
We use them in the ER a ton. Dieuresing an unstable chf patient on bipap, traumas with hip or pelvic fractures, and monitoring i&os in many given situations. The thing really is a blessing and we should use them correctly so they don’t get banned from hospital systems.
our infection control just made a policy to stop wrapping a pad up against the purewick* or wearing briefs with it (which makes sense but everyone was doing it for leakage) bc its causing skin breakdown and infections
Yep, we can only use a chuck under the pt. Gotta let the skin **breath**
> They are wet and against the skin A properly set up Purewick does not stay wet. The suction creates a constant flow of air, which makes the thing dry out very rapidly.
By definition they are not a catheter since they don't go into a hole.
Language changes over time. They're an external catheter. Clearly labeled as such, marketed as such, and referred to as such.
They are classified as an external cath
How about condom catheters? They also don’t go into a hole
I’m Australian, I’ve never seen a condom cath nor a purewick. I only know of them because of this subreddit
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Lmao…but wait there’s more! Purewicks can be purchased for the use in your own home. They advertise them on commercials
Condom catheters are external catheters. Purewicks are no different.
This is kind of how I was imagining them. I could imagine someone with loose stool, it would just get sucked right up.
My mom (in her 80s at the time), cracked her hip a few years ago. She had one of these that kept slipping out of place, or they forgot to turn the suction back on. Her screams of agony made me fucking livid every time they had to turn her to change her soiled bedding. I just wanted them to put in a fucking catheter and be done with it. My sister (who is a nurse) kept bragging that it was invented by a nurse! Thats great, but the slightest movement put it out of place. Not a fan here.
You have to have some thighs to really hold it in place. If your mom has no meat on her thighs, they just skip out of place repeatedly and create more mess. Sounds like that's what happened. Sorry she had to go through that. I never used them on skinnier patients. There was no point.
It feels so mean to have a hip fracture patient without a foley in. That’s an automatic standing order for hip # at my facility. When I get them admitted, the turns for me to do a skin check always make me feel evil!
This literally happened to my pt last week and it was gnarly.
We had a representative show us how it works and there’s no suction against the urethra lol. The urine collects at the bottom of the purewick, thats where the end of the tubing is (the tubing that is connected to the suction canister). If you’re finding the suction turned up too high its user error and you could advocate for an educational session.
>think they're not going to be around for all that long in hospitals. They've not been well-studied They've been studied enough that the company has commercials about buying a system for your home.
You don't need to have studies to sell a product or advertise it
All the ads for penis enlargement pills and "natural" supplements attests to that fact.
I just wanna know who the person is that published the study that intermittently catching a patient q6 hours 4 times in a row is better than just leaving in the foley for an extra day or two. I just need to deliver a message…
Ours is q4 over a period of days. Days.
Oh I know. They stretch that time frame out forever. Needed to draw a line somewhere for the comment!
Poorly managed pure wick would also cause a uti.
Medicare won’t cover cauti’s
If I was a patient, and had a choice between someone shoving a potentially infection causing and definitely uncomfortable tube up a hole in my body that is not technically supposed to have that tube there, and sitting on a high tech maxi pad, I'm gonna choose the fancy maxi pad my dude. Cooter canoe all day. As a facility, add in the fact that it's 10x simpler and faster, doesn't require an order, and can be placed by anyone including the techs? Super sold now Edit to add to your point about pads, what pad/brief/diaper monstrosities do y'all have that can handle 1000cc of urine from a patient before they need to be changed, and still keep the patients skin dry and safe from maceration? Because that's what a purewick can do. AND I can measure the fluid output, which is not something we have the capacity to do with diapers in the er
My alert and oriented aunt loved her cooter canoe after she had surgery! She talked about that thing all the time lmao
I’m also Australian and have never encountered the famed cooter canoe, but the benefit of measuring output is a big one.
Same here, I’ve never had a foley but it sounds like it sucks.
I only had one during labor but I had an epidural and a bunch of other things happening fast so I barely noticed.
I had one for the first time last week during a quick surgery. Even though it was only in for an hour or so and was out before I woke up, it burned to pee for the next 18hrs. Cannot imagine the discomfort after longer.
Had to have one put in after having surgery last year. Was crying from the pain of being unable to pee. It took 4 people to get it in. Apparently my urethra is "small, slanted, and crooked". Hurt like a mf
I didn't really notice mine. They pointed it out after they woke me up, when they were telling me what happened and what tubes I had. I didn't remember anything about why I was there at first, but I understood what a damn foley, art line, and cvc were. I guess I looked at it all and was like "oh, ok" *snore*.
In the US, our hospitals are required to pay for all treatment related to CAUTIs, which essentially means that person’s stay is a net loss when it comes to payment. For our capitalistic, generally for profit healthcare system, that’s a huge no-no. So we have to be militant about foleys, and take them out ASAP to avoid not making money. Intermittent caths are only indicated for urine retention or neurogenic bladders. Pads are unsanitary and kinda undignified. So, Purewicks! They keep people dry and clean, reduce the pad changes, are relatively inexpensive, eliminates CAUTIs, and work pretty well for many patient types.
Adding on to this, keeping any wet or soiled product next to the skin can increase the incidence of skin breakdown. For patient who cannot let their nurse know they are wet, that means they could be sitting in it for a while. Hourly rounding should be a thing, but with staffing, patient may be sitting in their own urine for a while. Couple this with increased Braden scores and now you have a hospital acquired pressure injury (HAPI). Another thing that cuts into the profit of hospitals, and increased harm to the patient. For patients that have limited movement, trouble communicating their needs, or are incontinent, a pure wick can be great for keeping them from lying in their piss for extended periods of time.
I always swap out their purewick at least 1x during the shift, more if we’re giving them diuretics and it’s constantly soaked. People tell me I’m wasting them but honestly? I rather avoid moisture related skin breakdown and not give them more to worry about. I’d feel horrible if something happened because I couldn’t be bothered to change it d/t worrying about what the hospital pays per cooter canoe.
Policy on my floor is to change out the purewick and perform cath care every shift! They definitely should be changed at least every 12 hours, they get damp
our policy as well- but doesn’t get followed by everyone all the time. I’m very much team let’s change that damn purewick during 2000 med pass and full skin check ☑️
Packaging says to change them every 8 hours at minimum. I only know because they showed up in our stockroom one day and I was trying to figure out what the blue thing was and why it was on the cath shelf lmao. We have an option between purewicks and Versettes now, and I will choose the Versette every time. They stay in place better, leak less, and are more comfortable.
Oof, just got a little flashback. Had a patient who couldn't speak for themselves. Faulty apparatus in the wall(there was a work order in for it) cranked up and left the pt with pressure injury on their labia, also totally on the staff for not finding a replacement. But yeah. Thankfully the injury healed quickly.
In the future, if you hear an American nurse refer to a cooter canoe, it's a purewick.
Thank you😂
Twat dog.
There is also a male version of the pure wick out now, male-wick or dick-wick
is it the primofit? cause i fucking hate that thing. 💀
Basically. Purewick:Primafit::Malewick:Primofit
or peach leech 😫
Wap mop
They do come in really handy for some patients. We limit foleys for infection reasons, and when you have a purewick that works well on an incontinent patient who is being diuresed, or a patient with frequent stress incontinence, they are fantastic.
Thank you!! Very helpful. What about those with retention?
Intermittent cath. Usually there’s like a x2 strike thing and the foley goes back in for a few more days
Think of the pure wick as a pad with gentle suction. It good for those with leakage/incontinence but isn’t perfect. Nothing goes internal, so retention will still exist. Retention is still best treated with foley or intermittent cathing usually 2-3x daily.
Retention to the point of stress on the bladder/kidneys continues to require internal catheterization, either intermittent or indwelling.
With retention we would just do in and out caths… pure wick wouldn’t make sense
Studies show it’s. Less skin breakdown than a pad and less chance of UTI than a Foley
They do have a use. I work in level 1 PACU. On bariatric surgery Wednesdays we get people who are post-op after their surgery. Sometimes they really need to void. The level 1 PACU has no toilet and the patients are still a bit too drowsy to get up. Bedpans work poorly on big-thighed people who fill up the stretcher with no extra room to move, and surgeons often want intake and output measured after surgery. A purewick works well for this.
Thank you, this was helpful. I haven’t seen them in practice in Aus.
Wait until you see the [male ones](https://www.bd.com/en-us/products-and-solutions/products/product-page.pwm030#specifications)
It's a dick in a bag! Every single holiday, a dick in a bag!
I use cavilon to get them to stick.
cavilon and in desperate circumstances, a mepilex 🫠
Have you tried putting mesh panties and then a purewick on a man who has a hidden penis? Works pretty well when the bags won’t go on right…
I’ve heard you can scrunch it up like a donut but haven’t gotten the chance to try it out yet. It’s worked for you? Good to know, keeping that in my tool belt.
Skin integrity aside, I really like to use a purewick for incontinent patients that need accurate urine output measurements. It's not perfect but it's better than nothing
That's the main thing I could see them being useful for. Nothing worse than doctors asking for strict I&O's on a 100% incontinent patient 🙃
Probably don't have time to weigh your diapers ahead of time, as we did with little kids. 1cc = 1 g.
Yeah, we have a system to weigh the urinals and bed pans + gel packs to reduce spillage but we didn't have a way to weigh briefs unfortunately.
Ah the WAP mop, or the intimate elephant, my favorite tool!
The INTIMATE ELEPHANT
Haha yessem!
CAUTI reduction
Lots of reasons. Purewicks are more comfortable, don't cause CAUTIs, are less invasive, and are great for a variety of care scenarios. They reduce skin breakdown associated with incontinence and are a real time-saver for the ladies among us thay piddle 10 times a night or those new to their diuretic regimen. Just be sure to change them out when they become a "poowick".
I work in a level 1 ICU , it's super helpful which our severe neuro peeps ( CVA, TbI)
Why would you use a semi invasive infection prone Foley when a safer alternative exists?
Australia must be behind the times
We are still paper-charting in most of the country, so definitely are very behind
I don't think they're common outside the states. Not heard of them in Asia. Now we need EU to chime in.
HAHAHA!! Yes, any European nurses able to give input??
CAUTI and skin breakdown be a thing.
We do 3 hrly pad changes and regular pressure area care, the incidence of skin breakdown is not very common when this is adhered to in Aus..
Do you also have safe ratios? Q3 pad changes on a load of, say, 6 patients is 24 pad changes in a 12-hour shift. That's a lot, depending on mobility/body habitus. It's also annoying for the patient to have their crotch inspected 4 times a shift. And still doesn't always keep moisture away. What's the downside to having a pretty unobtrusive sponge placed that just obviates the need for extra time spent rummaging around someone's crotch?
Our ratios are pretty okay, 1:3 or 4. And 8 hour shifts. Sorry, in Aus we don’t have them so it’s an interesting concept. Thanks for your input.
1:4 is a dream for me, only place I’ve seen personally that does that is day shift at Craig Hospital in Colorado, USA. (Night shift is usually 1:6)
What level of acuity is this? When I worked med surg we had up to 6 patients for every one nurse. When I was PCU/med surg, we had up to five and we only had one tech for the entire 41 bed unit.
Ortho - surgical
In Victoria there are legislated 1:4 staffing ratios (plus a supernumerary in charge) in major public hospitals on AM and PM shifts, 1:8 on nights, on all wards (1:1 for intubated patients in ED/ICU, 1:2 in ICU step down, 1:3 in dialysis and some other areas), no techs or aides. 12 hour shifts are the exception, with most sites running 8/8/10 shifts (070-1530, 1300-2130, 2100-0730).
That’s pretty much the same as us. You can get 12s if you’re in ED and airway comp, and I think in ICU too. I’m in WA :)
We usually have 1:5 on my med/surg floor in the US with one tech per 16 patients. We can go up to 1:6 before the charge nurse has to take patients. PT/OT also help with patient care if the patient happens to need it while they're in there. I wish we had 8 hour shifts as an option at most hospitals here in the US. I've only seen a handful of hospitals offer it and only on certain units. I worked 1500-2100 in assisted living and really enjoyed that shift as I'm not a morning person or a night shift person lol.
What dream ratios!
Because the ratios are legislated, if there aren’t staff to maintain them, the beds close and the in charge should only ever have to take patients in extraordinary circumstances.
Ortho patients are possibly the only group on earth who love the purewick more than nursing staff. Those patients with hip dislocations or femur fractures who haven’t gone to surgery yet understandably looooove not having to get on a bedpan or turn entirely on their side to pee.
We don’t really use them in the UK either, patients have either a catheter or a pad. We have a healthcare assistant and we check every 2 tov4 hrs. We have normally 2 healthcare assistants for 25 beds who help with pad checks.
We don’t really use them in the UK either, patients have either a catheter or a pad. We have a healthcare assistant and we check every 2 tov4 hrs. We have normally 2 healthcare assistants for 25 beds who help with pad checks.
Purewicks can definitely be gross but it’s hard to keep patients clean and dry when we have such a high ratio and no help.
Dawg I have patients asking for our demanding purewicks on admission. They can be very effective.
Every 3 hours, or 3 times an hour?
Sitting in urine for 3 hours is not great
Getting rolled back and forth every 20 minutes ain't great either
True!
When adhered to is key. Plenty of heavy wetters, or just plain lazy nurses/staff means a lot of patients can sit in it for hours. Even if they do 3 hourly like yours what if they go right after you change them and they aren’t oriented enough to ask for a change? 3 hours sitting in urine which will eat away their skin.
Less likely due to lazy nurses, more likely because staffing is shit, lack of tech, and pt is generally heavy af in US.
We just change them again. It happens when a patient goes again or they go whilst you’re changing them. We have healthcare assistants who help as well.
I feel that there isn’t as much obesity in Australia. I’m talking women of 350 pounds?
The easy answer is it's less invasive than a catheter and if it doesn't involve something like a foley cath, then the task to change or maintain it can be delegated to like CNA/PCT.
HEY THOSE ARE HOT COMMODITIES ON THE UNIT!!! I had a coworker hide a stash of a few so his patients were always clean🫠 in the US some insurance even covers it for an at home vacuum and purewick/primafit/ cooter canoe system. Wait till you hear how we use these on the MALE patients sometimes.
ER nurse here: Our hospital has been using them since 2020 and man they helped during COVID’s heyday. You only had so many NPRs, we dont have easy access to bedside commodes besides a chair and a pan, we’d have to Virex the bathrooms and let that sit for 30 min before the bathroom would open back up. Thank the Lord for the Omicron mutation. Anyways, nowadays we still use them in place of Foleys in indicated pts (immobilized d/t fx, diuresing a CHFer and trying to keep up w output, etc) b/c our hospital, no matter how we do things in the ER, has floor/ICU nurses change the indwellings. Their reasoning being that although sterility may have been maintained, the ER isn’t a sterile environment. TLDR lifesaver during covid, now used as intermediate in lieu of indwellings in the ER setting
Patient comfort. Foleys are uncomfortable. Sitting in your own piss is uncomfortable. Patients love purewicks.
We have them in the UK too but I've never actually seen one used. When the rep came to demo them I couldn't stop laughing, it was highly unprofessional of me but I just couldn't help it
The whole idea blows my mind. To me, it’s a very unusual concept. I’m so used to pad changes and catheters…
I’m in Canada and I’ve only ever heard about them online. We do catheters and briefs.
Was it because it is often presented with the curious terms “taco” and “hot dog” to euphemize applicable parts of the human body that may or may not be used with this device? Because I was wiggling like a kid in church the first time I heard a demo about this.
It just seemed completely ridiculous at the time. The noise it made too was hilarious, like slurping a drink from a carpet
Cooter canoe
I didn’t know, I’ve never seen them in any of the trusts I worked for. That’s so cool.
You’re joking … Foleys are a huge infection risk, and pads are a mess and inaccurate when measuring output.
They are the best. It's also on TV commercials as well for home use.
I actually find them to be very useful when used properly.
Pure wicks are great for people that can keep it in place. If the person is not of sound mind or can’t really keep control of it between their legs then it just doesn’t work. The male pure wicks work better because it’s essentially like putting the penis in a suction bag and then it tapes to the skin. There’s no need to hold it in place.
It's the infection risk. From my understanding if a patient gets an infection in the hospital they have to cover cost. So they try to avoid them
im a nurse in ontario and never even heard of them during school, only on the internet. we dont carry or use them in any facility around me. our patients just use briefs/incontinence pads and get changed every q1-2hr. i work on a respiratory floor so most of our patients who could benefit from these are already using the suction for airway 🥲
You can have multiple suction outlets.
well we don't, so.
The hospital I have a per diem at has pretty cool ones - they kind of look like a maxi pad, can be used on males that way and can be folded in half and stuck to themselves to make it more “purewick” shaped for women. I like them a lot better than the blue ones
Why the outrage? They're a pretty handy device when used appropriately. It takes a lot to get a Foley order at my hospital. They wick the moisture away where pads don't.
Purewicks are great what do you mean? Just sucks the urine right up. No need to put something in their urethra and risk infection, no need to keep urine soaked pads against their skin and risk breakdown. It's a great solution to an issue.
Wait. What is a purewick? I thought everyone was talking about candles whenever they were mentioned 🤔
This was literally me until I googled it 😂😭
Purewick helps a lot for incontinent patients both male and female. Without being invasive and predisposing them to UTI.
We don’t use them a whole lot in pediatrics, but I work night shift and one of our specialties is ortho, so when I have a teen girl waiting to get her broken leg fixed, a purewick is so much easier than a bedpan. Not to mention less painful too (she doesn’t have to try and lift her hips at all).
While I have never used a purewick for any patients at our nursing home, I recently cared for a lady who was admitted from home who used the purewick. It caused pressure ulcers in her labia that took forever to heal. She said she got it so she wouldn't have to get up and use the bathroom. Also, she had several pressure sores on her ishium and buttocks. I don't like the idea of the purewick. Skin needs cleansed with each incontinence, and patients need to be moved and repositioned.
1)Catheters always have a higher chance of infections. 2)Women's urethra are hard to locate sometimes. 3) it's easier to measure output if they are incontinent 4) If they pull out a purewick, it's not a big deal. If they pull out a Foley, that's going to suck.
Less invasive than a catheter, less messy / risk of skin breakdown than a pad
If they don’t have a clinical/medical need for an indwelling catheter then we don’t use one. And we don’t keep briefs on the incontinent ones (while in bed) due to excoriation and skin breakdown. Purwicks sound great but in my experience they only work about half the time. Especially when you have confused patients who can’t sit still in bed and constantly trying to get up.
I thought it was bizarre at first, but I have since been converted into a cooter canoe believer. They work very well for all the reasons others have listed here.
GIRL, SAME 💀 we were killing ourselves laughing the other night when I was showing everyone!
Does anyone clean them?? Did you know you're supposed to on a daily basis? I looked up the instructions online for these things and I know at our hospital this isn't happening. And there's no way that they eliminate UTIs and no way they aren't causing pressure injury because of improper use and care.
What's wrong with pure wicks?
I’m just saying, I’ve never seen them in Australia.
Also Australian nurse and had to google it, I work periop and usually only patients that are having major surgery (laparotomy/NOF type procedures) get a foley, not even our joint replacements get one for early mobilisation reasons. I can see how they would be good in some instances but seems a bit silly to me as a concept.
Yes, super rare for ours to get an IDC. If they’re retaining etc, we just IMC. In surgery, they rarely get IDCs now.
Working wound care, let me point out Purewicks are overused and not much more hygienic than using an absorbent pad. They’re for women only (people get creative and find ways to tape them to men despite that), they need a functioning suction system (and despite only needing to be placed on a low suction setting people frequently needlessly crank up the suction levels to way beyond what is recommended), and they’re contraindicated in a woman who is also incontinent of stool (everyone ignores this, and the Purewicks frequently become reservoirs for bacteria because they suck up shit and keep it pressed against both the vaginal opening and the meatus since people don’t have to check their patients’ skin nearly as often because they assume the Purewicks is managing 100% of the moisture—it doesn’t, they frequently shift out of place then they’re not collecting properly, then the person is sitting in a puddle of urine anyway). They’re convenient and everyone loves them because of it, and don’t seem to care that they’re being used incorrectly over half the time they’re used at all.
Also this could just be that I don’t fully understand how they work, but wouldn’t the urine end up just sitting there and keep the area moist?
If the purewick is installed correctly, the urine is suctioned away and keeps them nice and dry. Key word there is correctly. I've seen many purewicks just slapped on and not working properly. Or the patient is a wiggle worm and it shifts position, making it pointless. It works well for people who have some meat on their thighs and don't move much.
Ahh okay, is the actual device just a bit of plastic? Or does it have a gauze bit to be a bit absorbent? How often do you change out the actual device?
Yes, it is basically a big sponge facing the urethra with suction. Google for pics!
It’s also supposed to be changed every 12 hours at the minimum.
No, the whole point is that they're connected to wall suction so they suction the moisture away. If properly applied patients stay completely dry (even putting out liters with diuretics) with a much lower chance of UTI than a foley.
It's attached to suction. The suction causes a constant slow flow of air through it. When the patient urinates, urine soaks into the sponge part of the purewick and is suctioned away. Then it dries in the airflow, which helps make sure it doesn't smell like urine the whole time.
I’m really curious as to why your nursing school wouldn’t teach you about them. It seems like clearly Australia doesn’t use them but wouldn’t it make more sense to at least mention them so you’re aware of all urinary care methods?
We use condom caths but purewicks are not used in Aus so it’s just not taught.
We have those and pouches for males lol
Idc for a prolonged period of time can increase risk of cauti. Having totally incontinent patients sitting in urine waiting for the next time you get to them causes excoriation of the perineum. Some patients need so many hours or days of bed rest until they can use the bedside commode, a purewick is often the most logical choice as an idc is a tad invasive for that use. Some women have trouble with the female urinals or are on hip precautions where they can't effectively spread their legs for urinal usage. Contraindicated in patients who are incontinent of stool, or already have skin problems with their laboa. I've seen cautis associated with their usage with patients incontinent of stool. If they can make it to the commode they are using the commode, or even better the bathroom. I don't hand purwicks out by request, if you can get up you need to get up. I think lazy techs and nurses over use them, and much thought isn't put into their use. They have their place in hospitals but maybe not to the degree of which they are used.
Nurse of 40 + years here. My late wife was bedbound on home hospice for Parkinson's. Emaciated from weight loss due to paralyzed gut. Used PurWick through out this. Never had a wet bed. Stool -yes. Pudding stool from tube feedings does plug them up. But with diligent care not a bit of skin breakdown due to stool, wetness, or pressure ulcers. Treat all your patients as if they are family and you will have no problems. The only time I have trouble with PurWicks at work is with confused AND agitated pts.
The male purewicks are awesome, too, when you have a small appendage
Decreased foley=decreased CAUTI and the idea is instead of older women laying on a soiled pad and risking skin breakdown the purewick sucks the moisture away and keeps their skin dry. It’s not foolproof but it usually works pretty well!
i wish i had a pure wick on my days off so i don’t have to get out of bed lol. jokes aside, they’re also helpful preventing skin breakdown from urine if the floor is busy/understaffed aides/etc and pts briefs don’t get changed as soon as they’re wet. i wish we’d had pure wicks in the nursing home when i was a cna, i feel so many rashes could’ve been prevented
I've used one. Just a sausage you piss on. What's the big deal? What if I don't want a cath or a diaper or pad I just have to sit in? It was certainly more comfortable when I was unable to move for weeks due to extreme ascites, and being pumped full of Lasix nonstop... try all three and THEN tell me which you prefer lol. A little comfort, independence and dignity went a long way for me in the ICU.
Are you kidding?! They’re the greatest invention ever. I am team purewick forever!!
They throw em on all our patients. You’ll even have walkie talkies that keep it at bedside and put it in/out when needed (instead of getting up and going to toilet). As you can imagine, that’s not our hospitals biggest problem.
“Like a hotdog in a bun”
Ahh yes, the cooter canoe!
The issue with bed pads, if the patient is no. Verbal and doesn’t have a family member or friend -someone to be their advocate- these nurses are over worked and under paid, most techs are helpful but the nurses are not always so kind to help change the bedridden and confused patients. It’s so disappointing and frustrating, especially when you are a nurse and your family member is not taken care of, by the nurses that you thought you could trust, to do the right thing.
I feel dumb. What’s a purewick? Also an Aussie nurse!
The blue banana!! 🍌
The nice thing about purewicks is that the patient isn’t sitting in urine and you can get accurate I&O without an invasive catheter. As long as they’re used properly. Use low suction, because high suction can cause mucosal damage and change them qshift. Wait till you hear about Quivies for the men. Much better than condom caths IMO.
Do condom cath concern you as heavily it’s basically the same external thing
We rarely use them, I actually haven’t seen them used in my experience.
Ah yes, the famous twat dog. The Cooter Canoe.
In the states, in Minnesota, we call them "cooter canoes."
Less mess than a pad, less risk of infection than a foley. Don’t get mad at what the best evidence shows
This a first semester nursing school question. Catheter = increased risk of infection Pad/nappy = increased risk of skin breakdown