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Patient reports suggest it’s better to avoid catheters

More than half of hospital patients who get a urinary catheter experienced a complication, in-depth interviews and chart reviews from more than 2,000 patients show.

“Our findings underscore the importance of avoiding an indwelling urinary catheter unless it is absolutely necessary and removing it as soon as possible.”

The new study, published in JAMA Internal Medicine, puts large-scale evidence behind what many hospital patients already know: Having a urinary catheter may help empty the bladder—but it can also be painful, lead to urinary tract infections, and cause other issues in the hospital and beyond.

Although many patient safety experts have focused on UTIs that can arise from indwelling urinary catheters, also called Foley catheters, that risk is five times less common than noninfectious problems, the study found.

Those issues include pain, bloody urine, and activity restrictions while the catheter was still in; trouble with urinating and sexual function can occur after the device was removed.

“Our findings underscore the importance of avoiding an indwelling urinary catheter unless it is absolutely necessary and removing it as soon as possible,” says Sanjay Saint, lead author of the new study and chief of medicine at the VA Ann Arbor Healthcare System, professor of internal medicine at the University of Michigan, and director of the University of Michigan/VA Patient Safety Enhancement Program.

For the new study, Saint and colleagues in Michigan and two Texas hospitals analyzed data from 2,076 patients who had recently had a catheter for short-term use. Most of them received the catheter because they were having surgery.

The team went back to each patient twice—two weeks and one month after their catheter placement, respectively—and asked about their catheter-related experiences.

Because two of the hospitals in the study are Veterans Affairs hospitals, nearly three-quarters of the patients were male. The catheter came out within three days of insertion for 76 percent of the patients.

In all, 57 percent of the patients said they’d experienced at least one complication.

Key findings include:

  • Just over 10 percent of patients reported infections. Those include both formal diagnoses and symptoms consistent with one that required a doctor’s attention.
  • 55 percent of patients reported at least one noninfectious complication.
  • Not many patients said the catheter hurt going in, although most were having an operation and were not awake when the catheter went in. But 31 percent of those whose catheter had already come out at the time of the first interview said it hurt or caused bleeding during removal. More than half of those who participated in interviews while they still had a catheter in said it was causing them pain or discomfort.
  • One in 4 patients said the catheter had caused them to experience bladder spasms or a sense of urgency about urinating; 10 percent said it had led to blood in their urine.
  • Among those who did the interviews while a catheter was still in place, nearly 40 percent said it restricted their daily activities, and 44 percent said it restricted their social activities.
  • Among those who had already had their catheter removed, about 20 percent said they had experienced urine leakage or difficulty starting or stopping urination. Nearly 5 percent said it had led to sexual problems.

Saint, a longtime champion of efforts to measure and prevent catheter-associated infections, plans to conduct further research on the topic.

Simple alerts can cut infections from catheters

“While there has been appropriate attention paid to the infectious harms of indwelling urethral catheters over the past several decades, recently we have better appreciated the extent of noninfectious harms that are caused by these devices,” he says.

Coauthors are from Baylor College of Medicine.

Source: University of Michigan

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