Forgetful Doctors Means Catheter Misuse

ByMelissa Schorr

B O S T O N, Oct. 13, 2000 -- Are doctors and nurses more concerned with their work relief than your bladder relief?

In a small study of four medical centers, published in the current issue of the American Journal of Medicine, researchers found that 31 percent of hospitalized patients who receive urinary catheters don’t need them.

Why the over-catheterization? Catheters make it easier for nursing staff not to clean up a soiled sheet, say, of an elderly patient who may or may not be able to control his or her bladder. Once inserted, the devices often remain too long because doctors either forget or don’t know they are there.

Concern Over Catheters Prolonged catheter use is a concern because the practice can lead to painful urinary tract infections and longer hospital stays, says Dr. Sanjay Saint, assistant professor of internal medicine at the University of Michigan in Ann Arbor and lead author of the study.

“Inappropriate catheter use is an important patient safety issue,” Saint says. “Often, caregivers are doing something patients do not like for indications the patients do not have. If they don’t need the device, it should be removed as soon as possible.”

The study found that 25 percent of all hospitalized patients will receive a catheter at some point in their stay. A catheter is a latex or silicon tube which is inserted into a patient’s urethra and bladder and allows urine to be emptied into a bag.

Catheters are considered necessary when a patient is bed-ridden, incontinent or unable to control urine flow, is in post-operative recovery, has a bladder obstruction such as an enlarged prostate, or needs to have urine levels observed.

Catheters can make it easier for health-care professionals to monitor fluids and to see blood in the urine, says Dr. Martin Resnick, secretary of the American Urology Association and a urologist with Case Western Reserve University in Cleveland. “It’s certainly not essential, but it is more convenient to have it,” he says. “I’m not sure it’s harmful, as long as it’s not used long term.”

Infection Risk Rises But every day a catheter is left in, researchers have found, a patient has a 5 percent chance of developing a urinary tract infection. Such an infection occurs when bacteria, typically from the patient’s genital area, migrate up the outside of the catheter and infect the otherwise sterile bladder. Occasionally, the infection spreads to the bloodstream.

While these infections can usually be cured with antibiotics, they have the potential to lengthen hospital stays and cause more serious side effects that can be life-threatening.

One of the reasons unnecessary catheters are left in place is because doctors often plumb forget about their patients’ plumbing, the Michigan researchers discovered.

In their survey of 256 doctors from four university-affiliated medical centers in California, the Midwest and the Pacific Northwest, they found that 28 percent of the time, the doctors had forgotten or never knew which of their patients still had a catheter inserted.

And these “forgotten” catheters were the ones more likely to be medically unjustified — probably the reason doctors failed to realize they were being used in the first place.

Catheter Check

Saint is calling for a mandatory “stop-order” on all hospital catheterizations after 48 hours of use, with a daily review thereafter, as a way to remind health-care workers to justify continued catheterization. He is currently hoping to launch a pilot study testing whether this would ultimately reduce unnecessary catheterizations and infections.

In the meantime, Saint says, patients — or their family members — should simply ask the doctor every day: Do I still need the catheter? “A proactive patient in this case helps,” he says.

“Patients have to become more engaged,” Resnick agrees. “It’s reasonable to question [health-care professionals] what’s being done.”

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