Advice
The technology
The technology
The U‑Drain drainage system (U‑Drain) is permanently installed in the homes of people who need night urine collection or are having automatic peritoneal dialysis, so avoiding the need for night drainage bags. It allows urine and dialysis fluid to be drained directly into the external waste system (soil pipe) on the outside of the home, while the user is asleep.
The U‑Drain system is provided as a set that includes the tubing, wall socket, clips, screws and other items needed to install the system. To fit the U‑Drain, the wall socket is installed in an external wall near the bedside. A 13 mm diameter tube passes through this socket and connects to the soil pipe on the outside of the house.
At night, the user connects their urinary catheter bag or sheath, urostomy pouch or automated peritoneal dialysis (APD) waste drain line to the inside face of the socket, using a clear drainage tube that connects to the drainage port of the catheter bag or urostomy pouch or the APD waste line. Urine or waste fluid drains through this tube, through the wall socket and into the soil pipe via the external tubing, throughout the night. The socket has a 1‑way valve so that fluid cannot flow back up the tube. This also prevents unpleasant smells from the soil pipe from entering the room. In the morning, the user disconnects the drainage tube from their catheter bag, pouch or APD waste drain and flushes it through with 100 ml of water containing a disinfectant (U‑Drain supplies disinfectant, but any disinfectant can be used). The tube is then disconnected from the wall socket and stored. The internal tubing is changed every 7 days for urology patients and every day for APD patients.
The innovation
U‑Drain is the only available permanently installed night drainage system. It is designed to replace overnight urine or dialysis fluid drainage bags, which the user has to empty each morning. This can be inconvenient and unpleasant for the user. The company claims that the U‑Drain system is clean, odour-free and hygienic.
Current care pathway
Current practice for overnight urine or dialysis waste collection involves connecting the user's catheter bag, urinary sheath, urostomy pouch or APD drain line to a night drainage bag. Urine waste bags are usually 2 litres in capacity and are hung from a floor stand by the side of the bed or placed in a bowl. APD waste bags are 15 litres in capacity and are placed on the floor. Patients may use 2 bags to reduce the weight of each bag, because these can be very heavy for patients or their carers to lift.
In the morning, the bag is emptied into the toilet. Night collection bags can be for single use, after which they are thrown away, or they can be reusable and are washed out with tap water and disinfectant daily for up to 1 week. Once the U‑Drain is installed, night collection bags are only needed if the external pipe blocks or freezes, or the person sleeps away from home. Apart from this, no other changes to current practice are anticipated with the use of the U‑Drain.
NICE guidance on using long-term urinary catheters states that a link system should be used to help overnight drainage and keep the catheter and catheter bag intact. These same procedures would apply to the U‑Drain system.
NICE is not aware of any CE‑marked devices that appear to fulfil a similar function as the U‑Drain.
Population, setting and intended user
The U‑Drain is designed for home use. It can also be installed in hospitals and care homes, but these settings are not within the scope of this briefing.
The U‑Drain is suitable for people with long-term urinary catheters, sheaths or urostomy pouches. It can also be used to drain dialysis fluid from the APD.
In 2008, there were about 90,000 people with long-term catheters in the UK (Gage et al. 2016). Long-term catheter use can be needed for a variety of conditions, including spinal cord injury, multiple sclerosis, prostate problems, diabetes, stroke and Parkinson's disease (Wilde et al. 2013). Although people of any age may need a long-term catheter, they are more commonly used in older people (Gage et al. 2016).
A urostomy is a surgical procedure to permanently divert urine from the kidneys and ureters into a stoma that is created from a small section of the bowel. There are various indications for having a urostomy, including bladder cancer and neurological conditions. Urine is collected in a bag or pouch worn on the abdomen. There are around 11,000 people with a urostomy in the UK (Urostomy Association 2016).
Peritoneal dialysis can be used for people with renal failure. It can be done at home and some users have it overnight, using APD. According to the NICE full guideline on peritoneal dialysis, the prevalence in the UK is age dependent; for adults between 70 and 80 years, it is 1,600 to 2,000 people per million of the population. Up to 30% of adults with chronic kidney disease use peritoneal dialysis, but there are variations in local practice. Peritoneal dialysis is used in about 10% of children with end-stage kidney disease (Pruthi et al. 2013).
Users would need to make some adjustments when first using the U‑Drain, but very little training in addition to that needed for using overnight drainage bags would be needed. Training would be on the cleaning and hygiene aspects of using the U‑Drain.
Costs
Device costs
Installation of the U‑Drain costs £350, which includes the installation materials. Consumables for the system (internal drainage tubes) cost £130 per year for urine drainage and £500 per year for automated peritoneal drainage.
Table 1 Device costs excluding VAT
|
Description |
Cost |
Additional information |
|
Installation charge (includes U‑Drain installation pack) |
£350 |
Paid by patient needing urine drainage at home. Paid by renal unit for users of automated peritoneal dialysis. Includes consumables for first 6 months. Lifetime of the equipment is estimated to be 10 years. |
|
U‑Drain 12‑monthly consumables kit |
£130 for urine drainage £500 for automated peritoneal dialysis drainage |
Contains internal tubing. The manufacturer recommends that the internal tubing that connects the user to the socket is changed every 7 days, or for automated peritoneal dialysis, every day. |
|
U‑Drain disinfectant |
£6.40 |
Recommended for use, lasts about 3 months. |
Costs of standard care
Two types of overnight bags for urinary catheters are typically used in the home setting. The first is a non-drainable, single-use bag. These are non-sterile, 2‑litre bags with a tear strip for emptying. They cost about £2.25 for 10 bags, which equates to about £82 per year. Alternatively, some people use sterile urine bags with a drainage tap that are changed every 7 days. The cost of these ranges from about £2.60 to £7.50 for 10 bags. This equates to about £13.52 to £39.00 per year. Reusable night urine drainage bags that connect to urostomy pouches cost about £12.20 to £18.20 for 10 bags, equating to £61 to £91 per year if changed weekly. There may be additional costs for some pouches that need add‑ons. Costs of peritoneal dialysis waste drainage bags are about £2.40 each, equating to around £800 per year or £1,600 if 2 bags per night are used.
Resource consequences
People using U‑Drain for urine drainage need to pay the installation charge themselves. For people using U‑Drain for APD, installation is paid for by the renal unit. The U‑Drain consumables for urine drainage are available on NHS prescription.
Because urine or waste fluid from dialysis is not stored within the system, the risk of users developing bacterial infections could be reduced, but there is currently no evidence to support this. Any reduction in bacterial infection could decrease NHS resource use. There may be an increased risk of infection from cleaning and reapplying the U‑Drain drainage tube to a urinary catheter in people who currently change drainage bags daily.
The U‑Drain system could reduce resource use from delivering urine or fluid drainage bags to people's homes and storing large quantities of bags. The manufacturer claims that U‑Drain reduces carbon footprint because drainage bags are not needed, and it reduces water usage needed to wash out drainage bags.