Removal of Short-term Indwelling Urethral Catheters

A prospective randomized controlled comparison of immediate versus late removal of urinary catheter after abdominal hysterectomy

Objective:

Indwelling transurethral catheter is frequently used after gynecological surgeries in order to prevent urinary retention. There is controversy about the ideal time to remove the catheter after surgery. This randomized controlled study was undertaken to determine whether the immediate removal of urinary catheter after abdominal hysterectomy affects the rate of symptomatic urinary tract infection (UTI), recatheterization, subjective pain perception and febrile morbidity.

Study Design:

This prospective randomized controlled trial included 70 women undergoing abdominal hysterectomy with or without salpingoophrectomy for benign diseases. Patients were divided into two equal groups on the basis of timing of removal of urinary catheter (Group I — Immediate removal after surgery, Group II — Removal after 24 h and evaluated for benefits versus risks of immediate catheter removal. The results were compared by the Chi-square test.

Results:

Recatheterization was required in three patients of immediate removal group and none in late removal group (P = 0.07). Higher incidence of positive urine cultures (25.9%) and febrile morbidity (10%) was found in Group II when compared to immediate removal group (8%). Pain perception was not statistically different in both groups (P = 0.567).

Conclusions:

The early removal of an indwelling catheter after surgery was not associated with an increased rate of febrile events, UTI. Pain perception was also lower in early removal group. Although need of recatheterization was higher in early removal group, but not statistically significant.

Incidence and duration of urinary catheters in hospitalized older adults: before and after implementing a geriatric protocol

This study examined the incidence and duration of urinary catheters in acute care older adults before and after the implementation of a protocol developed to make clinicians aware of the appropriate use of catheters and the parameters for catheter removal. A total of 187 patients (99 pre-intervention, 88 post-intervention) age 65 and older admitted to a community hospital were assessed for the insertion of an indwelling urinary catheter using retrospective record review. A significant reduction was found in the incidence of indwelling urinary catheters in the post-intervention sample (from 33% to 15.3%, p = 0.006). There was a 20.4% reduction in the mean duration of urinary catheterization (from 4.9 days to 3.9 days). The catheter device-days were significantly reduced (from 136 to 44, p < 0.000). This study supports the use of a nurse-driven protocol to reduce the incidence of catheterization and improve the quality of care for hospitalized older adults.