July 10, 2018 1:00 PM

More Than Half of Catheterized Hospital Patients Experience Complications

Infections are only one problem related to urinary catheterization. A new study finds that other problems, including pain and affected sexual function, also can occur.

A new study puts large-scale evidence behind what many hospital patients already know: Having a urinary catheter may help empty the bladder but it can also be painful, lead to urinary tract infections and cause other issues in the hospital and beyond.

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More than half of catheterized hospital patients experienced a complication, according to in-depth interviews and chart reviews from more than 2,000 patients. The results are published in JAMA Internal Medicine.

Although many patient safety experts have focused on UTIs that can arise from indwelling urinary catheters, also called Foley catheters, that risk is five times less common than noninfectious problems, the study found.

Those issues include pain, bloody urine and activity restrictions while the catheter was still in; trouble with urinating and sexual function can occur after the device was removed.

“Our findings underscore the importance of avoiding an indwelling urinary catheter unless it is absolutely necessary and removing it as soon as possible,” says Sanjay Saint, M.D., MPH, lead author of the new study.

He is also chief of medicine at the VA Ann Arbor Healthcare System, George Dock professor of internal medicine at the University of Michigan and director of the U-M/VA Patient Safety Enhancement Program.

"Our findings underscore the importance of avoiding an indwelling urinary catheter unless it is absolutely necessary and removing it as soon as possible."
Sanjay Saint, M.D., MPH

Pain, infection from catheter use

For the new study, Saint and his colleagues from U-M, the Ann Arbor VA and two Texas hospitals analyzed data from 2,076 patients who had recently had a catheter placed for short-term use. Most of them received the catheter because they were having surgery.

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The team went back to each patient twice two weeks and one month after their catheter placement, respectively and asked about their catheter-related experiences.

Because two of the hospitals in the study are Veterans Affairs hospitals, nearly three-quarters of the patients were male. The catheter was removed within three days of insertion for 76 percent of the patients.

In all, 57 percent of the patients said they’d experienced at least one complication.

Key findings include:

  • Infections were reported by just over 10 percent of patients. Those include both formal diagnoses and symptoms consistent with one that required a doctor’s attention.

  • At least one noninfectious complication was reported by 55 percent of patients.

  • Not many patients said the catheter hurt going in, although most were having an operation and were not awake when the catheter was placed. But 31 percent of those whose catheter had already been removed at the time of the first interview said it hurt or caused bleeding coming out. More than half of those who were interviewed while they still had a catheter in said it was causing them pain or discomfort.

  • One in 4 patients said the catheter had caused them to experience bladder spasms or a sense of urgency about urinating; 10 percent said it had led to blood in their urine.

  • Among those who were interviewed while a catheter was still in place, nearly 40 percent said it restricted their daily activities, and 44 percent said it restricted their social activities.

Among those who had already had their catheter removed, about 20 percent said they had experienced urine leakage or difficulty starting or stopping urination. Nearly 5 percent said it had led to sexual problems.

Improving the catheter experience

Saint, a longtime champion of efforts to measure and prevent catheter-associated infections, plans to conduct further research on the topic.

“While there has been appropriate attention paid to the infectious harms of indwelling urethral catheters over the past several decades, recently we have better appreciated the extent of noninfectious harms that are caused by these devices,” he says.

Better monitoring of catheter patients and more education efforts are also important.

“Given our findings, we believe it is important to develop strategies for better tracking noninfectious complications of the urethral catheter and prepare patients for dealing with these types of issues, especially after they leave the hospital,” says senior author Sarah Krein, Ph.D., R.N., of the Ann Arbor VA and U-M.

Saint, Krein and co-authors John Colozzi, Karen Fowler and David Ratz are members of the VA Center for Clinical Management Research. Saint, Krein and co-author John Hollingsworth, M.D., of the U-M Department of Urology, are all members of the U-M Institute for Healthcare Policy and Innovation. Other co-authors on the paper are Barbara Trautner, M.D., Ph.D., and Erica Lescinskas, M.D., of the Baylor College of Medicine.