title: Alternatives to Indwelling Catheters Cause Unintended Complications.
abstract: To reduce the risk of catheter-associated urinary tract infection (CAUTI), limiting use of indwelling catheters is encouraged with alternative collection methods and early removal. Adverse effects associated with such practices have not been described. We also determined if CAUTI preventative measures increase the risk of catheter-related complications. We hypothesized that there are complications associated with early removal of indwelling catheters. We described complications associated with indwelling catheterization and intermittent catheterization, and compared complication rates before and after policy updates changed catheterization practices. We performed retrospective cohort analysis of trauma patients admitted between August 1, 2009, and December 31, 2013 who required indwelling catheter. Associations between catheter days and adverse outcomes such as infection, bladder overdistention injury, recatheterization, urinary retention, and patients discharged with indwelling catheter were evaluated. The incidence of CAUTI and the total number of catheter days pre and post policy change were similar. The incidence rate of urinary retention and associated complications has increased since the policy changed. Practices intended to reduce the CAUTI rate are associated with unintended complications, such as urinary retention. Patient safety and quality improvement programs should monitor all complications associated with urinary catheterization practices, not just those that represent financial penalties.
authors.affiliation: Department of Trauma Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Nguyen
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Harvey
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Lollar
authors.forename: Eric H
authors.initials: EH
authors.lastname: Bradburn
authors.forename: Mark E
authors.initials: ME
authors.lastname: Hamill
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Collier
authors.forename: Katie M
authors.initials: KM
authors.lastname: Love
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects*; D016055:Urinary Retention / Q000453:epidemiology*; D014552:Urinary Tract Infections / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*