Indwelling Urinary Catheters

Table of Contents

Introduction1

The Evidence1

Best Practices3

Implementation Plan5

Helping the Patient Cope6

Conclusion8

References9

Indwelling Urinary Catheters

Introduction

Indwelling urinary catheters are widely used in hospitalized patients and can be an appropriate means of therapeutic management under specific circumstances. However, many indwelling urinary catheters are used without clear indications, thus putting patients at an unnecessary risk for complications during their hospitalization. Catheter-associated complications include physical and psychological discomfort to the patient, bladder calculi, renal inflammation, and most frequently, catheter-associated urinary tract infections (CAUTI). The development of CAUTI in older adults can result in falls, delirium, and immobility (Warren 1997).

In this paper, we will be discussing the indwelling urinary catheters and the evidence found from past studies. Also, we will be studying the best practices based on past researches and the implementation plan suggested for future indwelling urinary catheters.

The Evidence

Urinary Tract Infections (UTIs) account for at least 35% of all hospital- acquired infections, with 80% of those being attributed to the use of indwelling catheters. In addition to the impact on quality of life, CAUTIs place a financial burden on the health care system in terms of treatment and increased length of stay. The exact cost of CAUTI is difficult to calculate due to changes in clinical and billing practices. However, in the U.S., concern over care costs resulting from a largely preventable problem has resulted in changes to the Centers for Medicare & Medicaid Services' (CMS) reimbursement system, with hospitals no longer receiving additional payment for CAUTIs that were not present at the time of admission. In addition to financial cost, CAUTIs affect patient well-being. In a systematic review that examined the clinical and economic consequences of bacteriuria from catheters, 3.6% of those with symptomatic UTI also developed bacteremia, and mortality from bacteremia can be as high as 10% (Muzzi-Bjornson et al. 2011). Although morbidity and mortality rates are relatively low from CAUTIs compared to other hospital-acquired infections, the use of urinary catheters in hospitalized patients leads to a large cumulative risk burden for mortality. Potentially serious complications associated with indwelling urethral catheters and the possible development of CAUTI warrant efforts to restrict the use of these devices by having clear indications for insertion and discontinuation.

Indications for short-term catheterization (less than 30 days) have been described by several authors. These include a) urinary retention, b) obstruction to the urinary tract, c) close monitoring of the urine output of critically ill patients, d) urinary incontinence that poses a risk to the patient because of Stage 3 or greater ulcer to the sacral area, and e) comfort care for terminally ill patients. Despite such recommendations and guidelines, catheters are often placed for in appropriate or poorly documented reasons. Among hospitalized patients, the rate of unnecessary urethral catheterization has been reported between 21% and 50% (Jahn et al. 2009). The majority of inappropriately placed catheters are initiated and inserted in the emergency department. Urinary catheters are inserted without a physician order in as many as one-third of patients, and even if an order is recorded, no documented ...