Article

Reducing the incidence of indwelling urinary catheter (IUC) use and
early removal of the devices that are inserted are appropriate priorities for
quality patient care. Just like symptomatic bacteriuria, failed catheter removal
as a complication of IUC use is associated with considerable morbidity. In the
ideal setting, patients who need IUCs have them, and patients who do not need
them will have them removed safely, with the goal of reducing medical
complications and facilitating the rehabilitation phase of care. OBJECTIVE: To
determine the incidence of failed removal of IUCs and the factors associated with
failed removal in persons hospitalized with acute stroke. DESIGN: Retrospective
review of medical records and associated clinical data collection platforms.
SETTING: Comprehensive stroke center at a tertiary care hospital. PATIENTS: The
study cohort included 175 stroke patients admitted to the hospital and managed
with IUCs. Mean age was 66.1 years (standard deviation = 15), 55% were female.
METHODS: Univariable and multiple logistic regression analyses were performed.
Variables assessed included age, gender, race, duration of hospital stay, stroke
subtype, National Institutes of Health Stroke Scale, and 6-Clicks Scale, which is
a measure of functional status. MAIN OUTCOME MEASUREMENTS: The dependent variable
was occurrence of a failed attempt at removal of an IUC, defined as removal
followed by a catheter reinsertion. RESULTS: During the study period, 175 of 432
patients with acute hospital admission for new stroke had an IUC removal event.
Of these patients, 46 (26%) experienced a failed catheter removal. On univariate
analysis, factors significantly associated with failed removal included presence
of a hemorrhagic stroke (P = .005), lower level of physical function (by 6-Clicks
and NIHSS scores), hospital length of stay (P < .001), and discharge location (P
= .005). Bedside bladder ultrasound testing by nursing staff was used more
frequently in the group of patients who had unsuccessful IUC removals (95%
confidence interval 4.56-21.67, P < .001). Length of stay (P < .001), white race
(P = .001), and hemorrhagic stroke (P = .009) were associated independently with
failed catheter removal after adjustment for other clinical variables.
CONCLUSIONS: This single-site study identified a high incidence of failed urinary
catheter removal in patients with stroke, along with factors associated with
failed removal. This is the first step in developing a predictive model that
could reduce the incidence of this adverse event. Policies, penalties, and
protocols designed to reduce catheter days must be sensitive to the special
situations in which IUCs are medically necessary and equal consideration given to
identifying the patients for which catheter removal poses a greater risk than
continued catheter use. LEVEL OF EVIDENCE: III.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS