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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
ORIGINAL ARTICLE  
Year : 2012  |  Volume : 23  |  Issue : 1  |  Page : 63-67
Inappropriate use of urinary catheters and its common complications in different hospital wards


1 Department of Infectious Disease, Hormozgan University of Medical Sciences, Hormozgan, Iran
2 Hormozgan University of Medical Sciences, Hormozgan, Iran
3 Tehran University of Medical Sciences, Tehran, Iran

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Date of Web Publication3-Jan-2012
 

   Abstract 

Inappropriate use of indwelling urinary catheters (IUCs) and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU) as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6%) had IUCs used appropriately while 42 of them (20.6%) were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%), 16 (19.0%) and 14 patients (24.6%), respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2%) and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.

How to cite this article:
Davoodian P, Nematee M, Sheikhvatan M. Inappropriate use of urinary catheters and its common complications in different hospital wards. Saudi J Kidney Dis Transpl 2012;23:63-7

How to cite this URL:
Davoodian P, Nematee M, Sheikhvatan M. Inappropriate use of urinary catheters and its common complications in different hospital wards. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2014 Oct 22];23:63-7. Available from: http://www.sjkdt.org/text.asp?2012/23/1/63/91304

   Introduction Top


Inappropriate usage of indwelling urinary catheters (IUCs) and their related complications is one of the most important problems in hos-pital wards, especially intensive care units (ICUs). It has been seen that among almost four million hospitalized patients who have IUCs annually, 5-20% developed urinary complications such as urinary tract infection (UTI). [1],[2]

Recent studies have shown that prolonged placement of IUCs can lead to catheter-associated urinary infections and can also increase the duration of hospital stay and cost of hospitalization. [3] Furthermore, an influence of inappropriate usage of urinary catheters on increasing the patients' mortality has been shown, so that each day of urinary bladder catheterization increased the risk of lethal outcome 5.5-times. [4] Thus, careful attention to the inappropriate use of catheters during their stay in hospitals can reduce the incidence of its complications and can reduce the patients' morbidity. [5],[6]

In the present study, we evaluated the inappropriate use of IUCs and the complications associated with it among patients in an Iranian hospital.


   Patients and Methods Top


Two hundred and six consecutive patients hospitalized in the ICU and medical and surgical wards of the Shahid Mohammadi Hospital in Bandarabbas, Iran, from September 1 to 30, 2005 and put on IUCs were studied. All catheters were placed using strict aseptic precautions. Data collected included the age of the patients, the original diagnosis, the indication for use of IUC and its complications. The use of IUCs was considered appropriate when it was used for surgery, accurate measurement of intake and output, urinary retention, urinary incontinence posing a risk to the patient, urinary obstruction, altered blood pressure or blood volume status requiring accurate urine measurement, urine measurement in an uncooperative patient, bladder irrigation for urinary tract hemorrhage and palliative care for the terminally ill. [2],[7]

Data collection and processing were approved by the institutional review board of our hospital and information was obtained by chart review by registered nurses.


   Results Top


In the present study, a total of 206 patients received an IUC, of whom 70.9% were more than 65 years old. Overall, 164 patients (79.6%) had IUCs appropriately placed and 42 (20.6%) were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%), 16 (19.0%) and 14 patients (24.6%), respectively. Overall, the most common indication for appropriate use of IUCs was management/monitoring of intake/output in all the wards [Table 1].
Table 1: Indications for use of appropriate and inappropriate indwelling urinary catheters in different wards.

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The duration of use of appropriate and inappropriate IUCs in different wards is shown in [Table 2]. In the ICU, inappropriate IUCs contributed to 22% of the duration of urinary catheterization, while the duration in medical and surgical wards was 18.2% and 19.6%, respectively. The duration of appropriate use of IUCs was commonly related to the monitoring of fluid intake and urine output in the three studied wards.
Table 2: Duration of use of appropriate and inappropriate indwelling urinary catheters in different wards.

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Overall, the most common complication of IUCs was UTI, which occurred in 91 patients (44.2%), and hematuria as a complication was seen in 3.9% of the patients. No other complications were observed in our study.


   Discussion Top


The mechanisms by which the indwelling catheters produce infection are now well established. In this process, ascending colonization of the urine within the catheter lumen and, eventually, along the space between the urethra and the catheter surface has been identified as the main cause. [5] Therefore, attention should be paid to recommendations for managing indwelling urinary catheters, including screening for risk factors and evaluating urinary white blood cell count for infection, and assessment of the continued need for a catheter. [8]

In the present study, among all patients who were candidates for IUCs, inappropriate placement of IUCs was reported in 20.6% of the patients. This frequency was different in previous studies. In a study by Hazelett et al, 139 (49%) of the elderly had inappropriately placed IUCs. [2] Also, Gardam et al showed that 50% of studied patients were catheterized for unjustfiable indications. [9] In addition, in the study of Gokula et al, an appropriate indication for catheterization was observed in only 46% of their patients. [10] This frequency in the study of Jain was 21%. [11] It seems that the inappropriate use of IUCs in patients is dependent on several factors that can be related to both physicians and nurses. Furthermore, the patients' plan of care of their catheters is necessary. [12] In some reports, the patients found the catheter uncomfortable and depended on nursing support. [13] The role of clinical personnel has also been highlighted. In the study of Gokula et al, it has been shown that a physician or nurse explicitly documented the reason for catheter placement in only 13% of the cases. Also, in their study, no order for catheterization was written in 33% of the charts. [1] Therefore, presentation of suitable guidelines for evaluation of the indications and care of IUCs for physicians, nurses and even patients can be beneficial.

In the present study, we noticed UTI in 44.2% of the patients, while other complications were rare. This frequency was also different in other studies; however, almost all of them emphasized that UTI was the most important complication seen in patients with IUCs. Moreover, our data support the association between use of IUCs and the occurrence of UTI, a finding that has been shown in previous studies also. In the study of Hazelett et al, 28% of the patients with IUCs were diagnosed with UTI during their hospitalization. [2] In the study of Adukauskiene, the risk of UTI increased significantly by 21.7% with each day of catheterization. [4] Also, Apisarnthanarak et al showed that catheter-associated UTI occurred in 14% of the patients, and the duration of catheterization was longer in patients with UTI. [6] Overall, the incidence of catheter-associated UTI has been reported to be between 11 and 73.3% among catheterized patients. [11],[12],[13],[14],[15],[16],[17] Although we did not consider the cause(s) of urinary infection in these patients, the main predictor of this infection included prolonged catheterization. [13],[14],[17],[18]

In conclusion, it is recommended to minimize the duration of catheterization in hospitalized patients, especially in the ICU. Careful evaluation of the indications for IUC, strict aseptic procedures and shortened indwelling time of the catheter may help prevent the occurrence of complications.


   Acknowledgment Top


The author would like to thank Farzan Institute for Research and Technology for their technical assistance.

 
   References Top

1.Gokula RR, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a Midwestern community teaching hospital. Am J Infect Control 2004;32(4):196-9.  Back to cited text no. 1
    
2.Hazelett SE, Tsai M, Gareri M, Allen K. The association between indwelling urinary catheter use in the elderly and urinary tract infection in acute care. BMC Geriatr 2006;6:15.  Back to cited text no. 2
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3.Centers for Disease Control and Prevention. Public health focus: surveillance, prevention and control of nosocomial infections. MMWR Morb Mortal Wkly Rep 1992;41:783-7  Back to cited text no. 3
    
4.Adukauskiene D, Kinderyte A, Tarasevicius R, Vitkauskiene A. Etiology, risk factors, and outcome of urinary tract infection. Medicina (Kaunas) 2006;42(10):805-9.  Back to cited text no. 4
    
5.Kunin CM. Indwelling Catheter: Nosocomial urinary tract infections and the indwelling catheter: what is new and what is true? Chest 2001;120:10-2  Back to cited text no. 5
    
6.Apisarnthanarak A, Rutjanawech S, Wichansa-wakun S, et al. Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes. Am J Infect Control 2007;35(9):594-9.  Back to cited text no. 6
    
7.Nickel JC. Catheter-associated urinary tract infection: new perspectives on problems. Can J Infect Control 1991, 6(2):38-42.  Back to cited text no. 7
    
8.Madigan E, Neff DF. Care of patients with long-term indwelling urinary catheters. Online J Issues Nurs 2003;8(3):7.  Back to cited text no. 8
    
9.Gardam MA, Amihod B, Orenstein P, Con-solacion N, Miller MA. Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections. Clin Perform Qual Health Care 1998;6(3):99-102.  Back to cited text no. 9
    
10.Gokula RR, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control 2004;32(4):196-9.  Back to cited text no. 10
    
11.Jain P, Parada JP, David A, Smith LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995;155(13):1425-9.  Back to cited text no. 11
    
12.Brennan ML, Evans A. Why catheterize?: audit findings on the use of urinary catheters. Br J Nurs 2001;10(9):580-90.  Back to cited text no. 12
    
13.Kohler-Ockmore J, Feneley RC. Long-term catheterization of the bladder: prevalence and morbidity. Br J Urol 1996;77(3):347-51.  Back to cited text no. 13
    
14.Danchaivijitr S, Dhiraputra C, Cherdrungsi R, Jintanothaitavorn D, Srihapol N. Catheter-associated urinary tract infection. J Med Assoc Thai 2005;88 Suppl 10:S26-30.  Back to cited text no. 14
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15.Huang WC, Wann SR, Lin SL, et al. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Control Hosp Epidemiol 2004;25(11):974-8.  Back to cited text no. 15
    
16.Loeb M, Hunt D, O'Halloran K, Carusone SC, Dafoe N, Walter SD. Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: a randomized controlled trial. J Gen Intern Med 2008;23(6):816-20.  Back to cited text no. 16
    
17.Stamm AM, Coutinho MS. Urinary tract infection associated with indwelling bladder catheter: incidence and risk factors. Rev Assoc Med Bras 1999;45(1):27-33.   Back to cited text no. 17
    
18.Zhou HZ, Yin FH. Causes of urinary tract infection and its prevention in patients with indwelling urinary catheter: report of 152 cases. Di Yi Jun Yi Da Xue Xue Bao 2003;23(5):510-1.  Back to cited text no. 18
    

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Correspondence Address:
Parivash Davoodian
P.O. Box 13185-1678, Tehran
Iran
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PMID: 22237221

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    Abstract
   Introduction
   Patients and Methods
   Results
   Discussion
   Acknowledgment
    References
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