Determining the Noninfectious Complications of Indwelling Urethral Catheters

Hollingsworth, John M.; Rogers, Mary A.M.; Krein, Sarah L.; Hickner, Andy; Kuhn, Latoya; Cheng, Alex; Chang, Robert W.; Saint, Sanjay

doi:10.7326/0003-4819-159-6-201309170-00006

Cited by 150 publications

(101 citation statements)

References 52 publications

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“…5 In addition to urinary tract infections, this population is more susceptible to the noninfectious side effects of IUCs, including falls from tethering, delirium, urethral trauma, and pain. 6,7 While potentially appropriate for critically ill patients or those with acute urinary obstruction, urinary catheters are often placed unnecessarily, [8][9][10][11] at times for staff convenience. 1 Research suggests that as many as half of catheters placed in hospitalized patients do not have documented physician orders, 1,4,8 and nearly half are unnecessary.…”

mentioning

confidence: 99%

A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department

Mulcare

Rosen

Clark

et al. 2015

Academic Emergency Medicine

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Objectives: Indwelling urinary catheters (IUCs) are placed frequently in older adults (age ≥ 65 years) in the emergency department (ED) and carry significant risks. The authors developed, implemented, and assessed a novel clinical protocol to assist ED providers with appropriate indications for placement, reassessment, and removal of IUCs in elders in the ED.Methods: A comprehensive, evidence-based clinical protocol was built from an extensive literature review and ED provider focus groups. It was implemented at a university-based medical center with a 20-minute scripted slide presentation. Written surveys were administered before, after, and at 6 months to assess providers' baseline practice and the protocol's effects. Surveys included asking providers for IUC management decisions in 25 unique clinical scenarios. Rates of IUC placement and catheterassociated urinary tract infections (CAUTIs) were compared in ED older adult patients admitted to the hospital in the 6 months before and after protocol implementation.Results: A total of 111 ED providers participated in the all three surveys. Immediately after protocol introduction, providers anticipated that this intervention would reduce rates of IUC use and increase patient safety. At 6-month follow-up, 81% felt the protocol had changed their practice, and 39% reported frequently referencing the protocol. In the clinical vignettes, ED providers correctly identified the appropriate approach for IUC placement in 63% of cases at baseline with an increase of 22% (95% confidence interval [CI] = 19% to 25%) postintervention and an increase of 8% (95% CI = 6% to 12%) between baseline and 6 months. An absolute reduction in the use of IUCs of 3.5% (p < 0.001) for older adults admitted to the hospital was observed after implementation of the protocol. There were three CAUTIs attributable to the ED in the 6 months prior to implementation and none in the 6 months after.Conclusions: This comprehensive, evidence-based clinical protocol was well received by participants and was associated with a sustained change in self-reported practice, as supported by a reduction in IUC placement in admitted older adults and a reduction in CAUTIs attributable to the ED for this vulnerable population over the 6-month study period.ACADEMIC EMERGENCY MEDICINE 2015;22:1056-1066 by the Society for Academic Emergency Medicine C atheter-associated urinary tract infections (CAUTIs) have been one of the most prevalent hospital-acquired infections, with significant associated morbidity, mortality, and cost.1,2 Recent research found it to be the fourth most active, accounting for 12.9% of all health care-associated infections. Older adult patients (aged ≥ 65 years) are disproportionately affected, as they more commonly receive indwelling urinary catheters (IUCs) 2,4 and are more susceptible to associated complications. 5 In addition to urinary tract infections, this population is more susceptible to the noninfectious side effects of IUCs, including falls from tethering, delirium, urethral trauma...

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confidence: 99%

A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department

Mulcare

Rosen

Clark

et al. 2015

Academic Emergency Medicine

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“…2,3 The urinary catheter is also associated Inserting catheters only for appropriate indications and leavwith other patient safety problems, such as trauma, 4 increased ing in place only for as long as medically necessary is 1 of patient discomfort, 5 and immobility. 6 CAUTI prevention has the strong (category IB) recommendations.…”

mentioning

confidence: 99%

Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative

Greene

Fakih

Fowler

et al. 2014

Infect. Control Hosp. Epidemiol.

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OBJECTIVE. To examine regional variation in the use and appropriateness of indwelling urinary catheters and catheter-associated urinary tract infection (CAUTI). DESIGN AND SETTING. Cross-sectional study.PARTICIPANTS. US acute care hospitals.METHODS. Hospitals were divided into 4 regions according to the US Census Bureau. Baseline data on urinary catheter use, catheter appropriateness, and CAUTI were collected from participating units. The catheter utilization ratio was calculated by dividing the number of catheter-days by the number of patient-days. We used the National Healthcare Safety Network (NHSN) definition (number of CAUTIs per 1,000 catheter-days) and a population-based definition (number of CAUTIs per 10,000 patient-days) to calculate CAUTI rates. Logistic and Poisson regression models were used to assess regional differences.RESULTS. Data on 434,207 catheter-days over 1,400,770 patient-days were collected from 1,101 units within 726 hospitals across 34 states. Overall catheter utilization was 31%. Catheter utilization was significantly higher in non-intensive care units (ICUs) in the West compared with non-ICUs in all other regions. Approximately 30%-40% of catheters in non-ICUs were placed without an appropriate indication. Catheter appropriateness was the lowest in the West. A total of 1,099 CAUTIs were observed (NHSN rate of 2.5 per 1,000 catheter-days and a population-based rate of 7.8 per 10,000 patient-days). The population-based CAUTI rate was highest in the West (8.9 CAUTIs per 10,000 patient-days) and was significantly higher compared with the Midwest, even after adjusting for hospital characteristics (P = .02).CONCLUSIONS. Regional differences in catheter use, appropriateness, and CAUTI rates were detected across US hospitals.

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“…52 In women with SCI, UCs have been shown to cause urethral stricture or erosion in 37.2% of patients. 53 SPCs seem especially relevant in MS patients with impaired urethral or perineal sensation who are wheelchair-bound. They eliminate the risk of urethral injury or iatrogenic hypospadias from excessive tension/sitting on catheter tubing.…”

Section: Indwelling Urinary Drainagementioning

confidence: 99%

Treatment of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines

Aharony

Lam

Corcos

2017

CUAJ

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Multiple sclerosis (MS) is a unique neurological disease with a broad spectrum of clinical presentations that are time-and disease course-related. Lower urinary tract symptoms (LUTS) are highly prevalent in this patient population, with approximately 90% showing some degree of voiding dysfunction and/or incontinence 6-8 years after the initial MS diagnosis. Major therapeutic goals include quality of life improvement and the avoidance of urological complicationsOwing to the wide divergence of clinical symptoms and disease course, evaluation and treatment differ between patients. Treatment must be customized for each patient based on disease phase, patient independence, manual dexterity, social support, and other medical-or MS-related issues. Ablative or irreversible therapies are indicated only when the disease course is stable. In most cases of "safe" bladder, behavioural treatment is considered first-line defense. Antimuscarinic drugs, alone or in combination with intermittent self-catheterization, are currently the mainstay of conservative treatment, and several other medications may help in specific disease conditions. Second-line treatment includes botulinum toxin A injection, neuromodulation, indwelling catheters, and surgery in well-selected cases.

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Determining the Noninfectious Complications of Indwelling Urethral Catheters

Abstract: Agency for Healthcare Research and Quality.

Cited by 150 publications

References 52 publications

A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department

A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department

Regional Variation in Urinary Catheter Use and Catheter-Associated Urinary Tract Infection: Results from a National Collaborative

Treatment of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines

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