PD22-07 INCIDENCE, RISK FACTORS, AND COMPLICATIONS OF TRAUMATIC URETHRAL CATHETERIZATION IN A SINGLE ACADEMIC CENTER: A PROSPECTIVE MULTIDISCIPLINARY QUALITY IMPROVEMENT PILOT STUDY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-07 INCIDENCE, RISK FACTORS, AND COMPLICATIONS OF TRAUMATIC URETHRAL CATHETERIZATION IN A SINGLE ACADEMIC CENTER: A PROSPECTIVE MULTIDISCIPLINARY QUALITY IMPROVEMENT PILOT STUDY Andrew Chen, Hanson Zhao, Patricia Hain, Steven Simons, Jonathan Grein, and Maurice Garcia Andrew ChenAndrew Chen More articles by this author , Hanson ZhaoHanson Zhao More articles by this author , Patricia HainPatricia Hain More articles by this author , Steven SimonsSteven Simons More articles by this author , Jonathan GreinJonathan Grein More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An estimated 25% of inpatients require urethral catheterization during their hospital stay. Complications from iatrogenic traumatic urethral catheterization (TUC) are not uncommon and can result in significant morbidity. We aimed to identify the incidence and risk factors for TUC at our institution, describe short-term sequelae, and reduce incidence through a multi-disciplinary intervention. METHODS: Data on TUC was prospectively collected at our tertiary care institution from 9/2019 to 5/2020. TUC was defined as: request for urologic consult in patients with hematuria following catheterization, pain with a non-draining catheter, or cystoscopic findings of trauma. Cases of traumatic self-removal and pre-existing hematuria were excluded. A pilot intervention was performed by providing standardized in-service (use of Coudé catheters & insertion technique) to all nurses in cardiac surgery operating rooms. Anonymous pre- and post-didactic questionnaires were collected. All cardiac surgery patients were then standardized to routine Coudé placement. RESULTS: Over 9 months we recorded 79 cases of TUC. Incidence was 18.9 per 1,000 catheterizations in males. Management of cases is shown in Figure 1A. Two patients (6%) required complex operative interventions (1 required 3 operations and suffered a PE). Intubated patients were significantly more likely to require more invasive management, defined as any endoscopic or operative intervention (p=0.023).After teaching in-service, nurse comfort with Coudé insertion increased from 5.1 to 9.5/10. TUC decreased from 1.2% (5/430) to 0% (0/133) (p=0.24).Legal costs associated with TUC were estimated and found to be substantial (Figure 1B). CONCLUSIONS: TUC is not common- but is known to occur regularly. It can be associated with very significant morbidity and legal costs. While reduction in TUC was statistically insignificant in our early pilot data, clinical and financial benefits were recognized and supported hospital-wide use of Coudé catheters and regular teaching in-service by urology. The associated increased hospital cost is $34,500/year for our 900-bed hospital. Improvements to catheter design and teaching interventions to prevent such injuries is warranted. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e382-e382 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Chen More articles by this author Hanson Zhao More articles by this author Patricia Hain More articles by this author Steven Simons More articles by this author Jonathan Grein More articles by this author Maurice Garcia More articles by this author Expand All Advertisement Loading ...