Early Removal Of Indwelling Catheter Research Articles

Role for colorectal teams to support non-colorectal teams to improve clinical outcomes and adherence to ERAS guidelines for segmental colectomy: a cohort study

BackgroundTo identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommendations is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards.MethodsConsecutive elective colorectal surgeries (n = 770) between October 2012 and February 2019 were audited. Patients with non-segmental colectomies, multi-organ surgeries, LOS > 14 days, and those who died were excluded. Logistic regression was used to determine the relationship between patient demographics, compliance with ERAS guidelines, and suboptimal LOS (> 4 days).ResultsAnalysis included 376 patients. Age, surgery prior to 2014, surgical approach, non-colorectal surgical team, operation type, and complications were significantly associated with suboptimal LOS. Non-compliance with ERAS recommendations for laparoscopy [OR 8.9, 95% CI (4.52, 19.67)], removal of indwelling catheters (IDC) [OR 3.14, 95% CI (1.85, 5.51)], use of abdominal drains [OR 4.27, 95% CI (0.99, 18.35)], and removal of PCA [OR 8.71, 95% CI (1.78, 157.27)], were associated with suboptimal LOS (univariable analysis). Multivariable analysis showed that age, surgical team, late removal of IDC, and open approach were independent predictors of suboptimal LOS.ConclusionsNon-compliance with ERAS guidelines for laparoscopic approach and early removal of IDC was higher among procedures performed by non-colorectal surgery teams, and was also associated with adverse postoperative events and suboptimal LOS. This study demonstrates the importance of the surgical team’s expertise in affecting surgical outcomes, and did not find significant independent associations between most individual ERAS guidelines and suboptimal LOS once adjusting for other factors.

Research on the application of bladder volume evaluation under ultrasound radiography for early removal of indwelling catheter in critical patients

Objective To evaluate the influence of bedside ultrasound on indwelling catheter removal and bladder function recovery for critically ill patients with long-term indwelling catheter. Methods Use random sampling to choose 92 patients during October 2018 to December 2018 as research objects, objects were allocated into observation group and control group by random digits table method with 46 cases each. All patients had their indwelling catheter clamped 72 hours after insertion as per routine practice, control group had clamp opened and indwelling catheter drained third hourly during the day and fourth hourly through the night; for patients in observation group, bladder volume were evaluated with USS scanner hourly, indwelling catheter was opened and drained when bladder urine volume was about 300 ml, use the shortest bladder-filling time as the interval for indwelling catheter opening time, increasing the interval by one hour through the night. the leakage rate, first urination time, first urination volume, bladder residual volume, indwelling catheter reinsertion rate, voluntary urination rate for patients from two groups were compared. Results The incidence of urinary leakage in the observation group was 7.14%(3/42),which lower than that in the control group (25.58%, 11/43), the difference was statistically significant (χ2=5.251, P 0.05). The first urination time was (144.66± 66.13) in the observation group and (179.55± 87.50) in the control group, respectively. There was no significant difference between the two groups(t= 1.623, P > 0.05). Conclusions The use of bedside USS scan to evaluate the bladder volume of critical patients with indwelling catheter can help facilitate early indwelling catheter removal and encourage patients to regain bladder function. Key words: Urinary catheterization; Bladder function training; Urinary retention; Clamping of catheters

A prospective, randomized trial comparing immediate versus delayed catheter removal following hysterectomy

A prospective, randomized study was used to assess whether the immediate removal of an in-dwelling catheter after hysterectomy affects the rate of recatheterization, symptomatic urinary tract infections, time of ambulation, and hospital stay. We randomly assigned 96 women who underwent hysterectomy [44 vaginal hysterectomy (VH), 37 abdominal hysterectomy, and 15 laparoscopic assisted VH) to three groups. The in-dwelling catheter was removed immediately (group A), at 6 hr (group B), or at 12 hr (group C) after the operation. The association between clinical variables and the length of catheterization was assessed by Chi-square analysis. Recatheterization occurred in six patients (18.8%) of group A, all after VH under spinal anesthesia. All patients in the groups B and C could spontaneously void the bladder after catheter removal. Symptomatic urinary tract infection occurred in one patient in group A, compared with four patients in group B, and five in group C. The mean time to ambulation was 4.3 hr in group A, 6.5 hr in group B, and 9.4 hr in group C. Patients with immediate removal of urinary catheter had a shorter hospital stay. There could be an association between necessity of recatheterization and the type of surgery (VH) or the type of anesthesia (spinal). Despite recatheterization rate, early removal of in-dwelling catheters immediately after uncomplicated hysterectomy seems to decrease first ambulation time and hospital stay.

Are in-dwelling catheters necessary for 24 hours after hysterectomy?

OBJECTIVE: In-dwelling catheters for 24 hours after operation are used routinely in gynecologic surgery. This study assesses whether the immediate removal of an in-dwelling catheter after the operation affects the rate of recatheterization, febrile morbidity, symptomatic urinary tract infections, or subjective pain assessments. STUDY DESIGN: This study was a prospective randomized controlled trial comprised of 250 women who underwent hysterectomy and who did not require bladder suspension or strict fluid treatment. The in-dwelling catheter was removed either immediately after the operation or on the first day after the operation. The association between clinical variables and the length of catheterization were assessed by chi-squared analysis. RESULTS: Patients were assigned randomly into 2 groups, with no significant differences in the outcomes, only in the perception of pain. Clinical events included fever (≥38.5°C) that occurred in 6 patients in the in-dwelling catheter group compared with 5 patients in the early removal group ( P = .01), symptomatic urinary tract infections in 3 patients in both groups ( P = .99), and recatheterization in 3 patients in the in-dwelling catheter group compared with 5 patients in the early removal group ( P = .17). Subjectively, patients in the early removal group reported significantly less pain than did the in-dwelling group ( P<.001). CONCLUSION: The early removal of in-dwelling catheters after operation was not associated with an increased rate of febrile events, urinary tract infections, or need for recatheterization. In addition, subjective pain assessment was significantly less in the early removal group. Early removal of an in-dwelling catheter immediately after operation is not associated with adverse events.