Analysis of the Reasons for Urinary Catheterization in the Emergency Service

Öz

Objective: The study aims to determine the rate of urinary catheter insertions with an inappropriate indication in the emergency room, to analyze justifications for these insertions, and to revise these justifications revealing catheter-related complication rates. Material and Method: This study has been retrospectively conducted by analyzing records of patients having urinary catheterization at the emergency department, between 01/05/2022-01/11/2022. The age, gender, medications, comorbidities, operation history, urinary catheterization reason, catheterization complications, laboratory data that might be related to the complications, and final disposition of the patient. Results: The mean age of the cases was 65.04±19.85 years, and the median age was 68 years. Hypertension was the most common comorbidity with a percentage of 50.3 (n=264). Daily diuresis measurement for diagnosis and treatment, and daily hydration and diuresis follow-up were the most common reason for urinary catheter insertion with a rate of 38.3% (n=201). The rate of insertions with inappropriate indication was %14.7. The complication percentage was 8,6%. Bacteriuria rate was 5.3%. Hematuria with a rate of 2.7% and urethral injury with a rate of 0.6% was observed among the cases. Conclusion: These data enabled the analysis of urinary catheter insertions in the emergency department. It provided more accurate data for emergency rooms and assisted in the identification of inappropriate indication catheterization rates and complications at the emergency department. This study will contribute to the emergency physicians and health workers reducing catheterizations with inappropriate indications and related complications.

Anahtar Kelimeler

• Bacteriuria
• Emergency service
• Inappropriate indication
• Urinary catheter
• Urinary catheterization

Acil Serviste İdrar Sondası Takılma Nedenlerinin Analizi

Öz

Amaç: Acil serviste hastalara uygulanan idrar sondası işleminin nedenleri analiz edildi. Bu şekilde uygunsuz endikasyonla takılan idrar sondalarının ve sondaya bağlı komplikasyonların oranlarını göstererek bu tıbbi uygulamanın gözden geçirilmesi hedeflendi. Gereç ve Yöntem: Bu çalışma 01/05/2022-01/11/2022 tarihleri arasında yetişkin acil serviste idrar sondası takılan hastaların dosyaları ve hastane sistemindeki bilgileri incelenerek retrospektif olarak gerçekleştirildi. Hastaların yaşı, cinsiyeti, kullandığı ilaçlar, bilinen hastalıklar, geçirilmiş operasyon öyküsü, idrar sondası takılma nedenleri, komplikasyonlar ile ilişkili olabilecek laboratuvar verileri, gelişen komplikasyonlar, acil servisten çıkış durumları kayıt edilerek analiz edildi. Bulgular: Olguların yaş ortalaması 65,04±19,85 yıl, ortanca yaş 68 olarak tespit edildi. Hipertansiyon %,50,3 (n=264) ile en sık görülen ek hastalıktı. Günlük aldığı çıkardığı takibi ile tanı ve tedavi amaçlı günlük diürez ölçümü %38,3 (n=201) ile en sık sonda takılma nedeni idi. Uygunsuz endikasyonla takılan sonda oranı %14,7 olarak bulundu. Olgular incelendiğinde tespit edilen komplikasyon gelişimi %8,6 olarak tespit edilmiştir. %5,3’ünde bakteriüri geliştiği görülmüştür. Hematürinin %2,7 ve üretral yaralanmanın %0,6 olguda yaşandığı izlendi Sonuç: Bu veriler sonda takma nedenlerini acil servise yönelik özelleşmesine ve analizine yardımcı olmuştur. Acil servis için daha gerçekçi bir veri oluşturmuş, acilde uygunsuz endikasyonla sonda takılmasının ve komplikasyonlarının belirlenmesini sağlamıştır. Bu istenmeyen durumlara karşı azaltıcı yönde acil hekimlerine ve sağlık personeline katkı sağlayacaktır.

Anahtar Kelimeler

• Bakteriüri
• Acil servis
• Uygunsuz endikasyon
• İdrar sondası
• İdrar sondası takılması

Kaynakça

1. Lachance CC, Grobelna A. Management of Patients with Long-Term Indwelling Urinary Catheters: A Review of Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 May 14. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545495/
2. Gilbert B, Naidoo TL, Redwig F. Ins and outs of urinary catheters. Aust J Gen Pract. 2018;47:132–6.
3. Bianchi A, Leslie SW, Chesnut GT. Difficult Foley Catheterization. [Updated 2022 Nov 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564404/
4. Kim B, Pai H, Choi WS, Kim Y, Kweon KT, Kim HA, et al. Current status of indwelling urinary catheter utilization and catheter-associated urinary tract infection throughout hospital wards in Korea: A multicenter prospective observational study. PLoS One. 2017;12(10):e0185369.
5. Thomas AZ, Giri SK, Meagher D, Creagh T. Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital. BJU Int. 2009;104:1109–12.
6. Schuur JD, Chambers JG, Hou PC. Urinary catheter use and appropriateness in U.S. emergency departments, 1995-2010. Acad Emerg Med. 2014;21:292–300.
7. Laan BJ, Maaskant JM, Spijkerman IJB, Borgert MJ, Godfried MH, Pasmooij BC, et al. De-implementation strategy to reduce inappropriate use of intravenous and urinary catheters (RICAT): a multicentre, prospective, interrupted time-series and before and after study. Lancet Infect Dis. 2020;20:864–72.
8. Katayama K, Meddings J, Saint S, Fowler KE, Ratz D, Tagashira Y, et al. Prevalence and appropriateness of indwelling urinary catheters in Japanese hospital wards: a multicenter point prevalence study. BMC Infect Dis. 2022;22(1):175.

9. Jiang W, Song Y, Zhang H, Huang R, Yin Y, Tan B. Inappropriate initial urinary catheter placement among older Chinese hospital inpatients: An observational study. Int J Nurs Pract. 2020;26(2):e12791.
10. Laan BJ, Vos MC, Maaskant JM, van Berge Henegouwen MI, Geerlings SE. Prevalence and risk factors of inappropriate use of intravenous and urinary catheters in surgical and medical patients. J Hosp Infect. 2020;105:698–704.
11. Saint S, Trautner BW, Fowler KE, Colozzi J, Ratz D, Lescinskas E, et al. A Multicenter Study of Patient-Reported Infectious and Noninfectious Complications Associated With Indwelling Urethral Catheters. JAMA Intern Med. 2018;178:1078–85.
12. Hu FW, Shih HI, Hsu HC, Chen CH, Chang CM. Dynamic changes in the appropriateness of urinary catheter use among hospitalized older patients in the emergency department. PLoS One. 2018;13(3):e0193905.
13. Tiwari MM, Charlton ME, Anderson JR, Hermsen ED, Rupp ME. Inappropriate use of urinary catheters: a prospective observational study. Am J Infect Control. 2012;40:51–4.
14. Almeida P, Duque S, Araújo A, Vilas-Boas A, Novais A, Gruner H, et al. The UriCath study: characterization of the use of indwelling urinary catheters among hospitalized older patients in the Internal Medicine Departments of Portugal. Eur Geriatr Med. 2020;11:511–5.
15. Kuriyama A, Takada T, Irie H, Sakuraya M, Katayama K, Kawakami D, et al. Prevalence and Appropriateness of Urinary Catheters in Japanese Intensive Care Units: Results From a Multicenter Point Prevalence Study. Clin Infect Dis. 2017;64 suppl_2:S127–30.
16. Sánchez-Ortiz M, García-Simón E, Mateo-Abad A, Soguero-Pérez M del M, Castro-Vilela ME. [Bladder catheterization in hospitalized elderly people]. Rev Esp Geriatr Gerontol. 2021;56:96–9.
17. Caramujo N, Carvalho M, Caria H. Prevalência da algaliação sem indicação: um factor de risco evitável [Prevalence of inappropriate urinary catheterization: a preventable risk factor]. Acta Med Port. 2011;24 Suppl 2:517-522.
18. 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.
19. Bhatia N, Daga MK, Garg S, Prakash SK. Urinary Catheterization in Medical Wards. J Glob Infect Dis. 2010;2:83.
20. Hollingsworth JM, Rogers MAM, Krein SL, Hickner A, Kuhn L, Cheng A, et al. Determining the noninfectious complications of indwelling urethral catheters: A Systematic review and meta-analysis. Ann Intern Med. 2013;159:401–10.
21. Komiya A, Kitamura H, Wakasugi M, Okudera H. Efficacy of an educational program for medical staff in preventing incidents related to Foley catheter insertion and maintenance: A single-institution retrospective study. Int J Urol. 2021;28:645–9.
22. Davis NF, Bhatt NR, MacCraith E, Flood HD, Mooney R, Leonard G, et al. Long-term outcomes of urethral catheterization injuries: a prospective multi-institutional study. World J Urol. 2020;38:473–80.
23. Hu FW, Chang CM, Su PF, Chen HY, Chen CH. Gender differences in inappropriate use of urinary catheters among hospitalized older patients. J Women Aging. 2019;31:165–75.
24. Jansen IAV, Hopmans TEM, Wille JC, van den Broek PJ, van der Kooi TII, van Benthem BHB. Appropriate use of indwelling urethra catheters in hospitalized patients: results of a multicentre prevalence study. BMC Urol. 2012;12:25.
25. Fakih MG, Shemes SP, Pena ME, Dyc N, Rey JE, Szpunar SM, et al. Urinary catheters in the emergency department: very elderly women are at high risk for unnecessary utilization. Am J Infect Control. 2010;38:683–8.