Removal Of Indwelling Catheter Research Articles

Timing of Catheter Removal and Effect on Urinary Retention After Cesarean Birth

ObjectiveTo determine the association between timing of indwelling catheter removal and urinary retention after cesarean. DesignRetrospective cohort study. SettingEight hospitals in suburban, rural, and urban Colorado and Montana. ParticipantsWomen who gave birth by cesarean from January 1, 2021, to April 30, 2022 (N = 3,493). MethodsWe categorized participants who gave birth between January 1, 2021, and June 30, 2021, (before implementation of the Enhanced Recovery After Surgery initiative) into Group A and participants who gave birth between July 1, 2021, and April 30, 2022, (after implementation of the Enhanced Recovery After Surgery initiative) into Group B. We used descriptive statistics to report the proportion of participants in both groups who experienced urinary retention after birth. We performed chi-square tests to determine the association between the time of catheter removal and incidence of urinary retention. We used the Wilcoxon rank sum test to determine the association between length of stay and urinary retention. ResultsUrinary retention rates were 5.8% in Group A and 12.6% in Group B (p < .001). In both groups, participants who received epidural anesthesia experienced significantly more urinary retention than those who received spinal anesthesia (p < .001). Participants who received epidural anesthesia and experienced urinary retention pushed 16.9% longer than those without urinary retention (p < .001). The proportion of participants who experienced urinary retention after catheter removal was 19.4% at 7 hours, 4.6% at 16 hours, and 9.9% at 12 hours after birth. Length of stay was determined to be inconclusive. ConclusionWe determined that the optimal time of catheter removal to minimize the rate of urinary retention was 12 to 16 hours after cesarean among women who received morphine sulfate as the anesthesia.

Impact of a Rounding Checklist Implementation in the Trauma Intensive Care Unit on Clinical Outcomes.

We aimed to evaluate the effectiveness of an intensive care unit (ICU) round checklist, FAST HUGS BID (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, Ulcer prophylaxis, Glycemic control, Spontaneous breathing trial, Bowel regimen, Indwelling catheter removal, and De-escalation of antibiotics-abbreviated as FD hereafter), in improving clinical outcomes in patients with severe trauma. We included patients admitted to our trauma ICU from 2016 to 2020 and divided them into two groups: before (before-FD, 2016-2017) and after (after-FD, 2019-2020) implementation of the checklist. We compared patient characteristics and clinical outcomes, including ICU and hospital length of stay (LOS) and in-hospital mortality. Survival analysis was performed using Kaplan-Meier curves and multivariable logistic regression models; furthermore, multiple linear regression analysis was used to identify independent factors associated with ICU and hospital LOS. Compared with the before-FD group, the after-FD group had significantly lower in-hospital mortality and complication rates, shorter ICU and hospital LOS, and reduced duration of mechanical ventilation. Moreover, implementation of the checklist was a significant independent factor in reducing ICU and hospital LOS and in-hospital mortality. Implementation of the FD checklist is associated with decreased ICU and hospital LOS and in-hospital mortality.

Postoperative Urinary Health Related to Timing of Indwelling Catheter Removal

Urinary retention rates were statistically higher in the immediate removal group compared to the delayed removal group.

Assessment of patient satisfaction with home vs office indwelling catheter removal placed for urinary retention after female pelvic floor surgery: a randomized controlled trial

To assess patient satisfaction with location of indwelling catheter removal placed for urinary retention after urogynecologic surgery. All adult women who were diagnosed with urinary retention requiring post-operative indwelling catheter insertion after undergoing surgery for urinary incontinence and/or pelvic organ prolapse were eligible for this randomized controlled study. They were randomly assigned to catheter removal at home or in the office. Those who were randomized to home removal were taught how to remove the catheter prior to discharge, and discharged home with written instructions, a voiding hat, and 10 mL syringe. All patients had their catheter removed 2-4 days after discharge. Those patients who were allocated to home removal were contacted in the afternoon by the office nurse. Subjects who graded their force of urine stream 5, on a scale of 0-10, were considered to have safely passed their voiding trial. For patients randomized to the office removal group, the voiding trial consisted of retrograde filling the bladder to maximum they could tolerate up to 300 mL. Urinating >50% of instilled volume was considered successful. Those who were unsuccessful in either group had catheter reinsertion or self-catheterization training in the office. Primary study outcome was patient satisfaction, measured based on patients' response to a question "How satisfied were you with the overall removal process of the catheter?". A visual analogue scale was created to assess patient satisfaction and 4 secondary outcomes. A sample size of 40 participants per group were needed to detect a 10 mm difference in satisfaction between groups on the visual analogue scale. This calculation provided 80% power and an alpha of 0.05. Final number accounted for 10% loss to follow up. We compared the baseline characteristics including urodynamic parameters, relevant perioperative indices, and patient satisfaction between the groups. Of the 78 women enrolled in the study, 38 (48.7%) removed their catheter at home and 40 (51.3%) had an office visit for catheter removal. Median and interquartile range (IQR) for age, vaginal parity, and body mass index (BMI) were 60 (49-72) years, 2 (2-3), and 28 (24-32) kg/m2, respectively, in the overall sample. Groups did not differ significantly in age, vaginal parity, body mass index, prior surgical history, or type of concomitant procedures. Patient satisfaction was comparable between the groups, with a median score (IQR) of 95 (87-100) in the home catheter removal group and 95 (80-98) in the office catheter removal group (p=0.52). Voiding trial pass rate was similar between women who underwent home (83.8%) versus office (72.5%) catheter removal (p=0.23). No participants in either group had to emergently come into the office or hospital due to inadequate voiding afterwards. Within 30 days post operatively, a lower proportion of women in the home catheter removal group (8.3%) had urinary tract infection, compared to patients in the office catheter removal group (26.3%) (p=0.04). In women with urinary retention after urogynecologic surgery, there is no difference in satisfaction with regards to location of indwelling catheter removal when comparing home and office.

Reducing urinary tract infection in female pelvic surgery: A retrospective cohort study.

To compare prebundle versus postbundle implementation urinary tract infection (UTI) rates among inpatients within 6 weeks of clean-contaminated pelvic reconstructive surgery. The authors conducted a retrospective cohort study from September 2019 to December 2021 at a tertiary hospital. The bundle strategy included the following: universal preoperative UTI check with treatment if positive, replacing prolonged postoperative voiding trials on the ward with earlier discharge and indwelling catheter removal by a nurse continence advisor the next day, and daily cranberry extract for 6 weeks postoperatively. UTI was defined as positive urine culture (≥100 000 colony-forming unit per mL) in a symptomatic patient. Data analysis involved hypothesis testing and logistic regression. The authors reviewed 132 postbundle inpatient charts and retained 93 for analyses. The results were compared with 204 prebundle inpatient charts. The rate of postoperative UTI decreased from 17.6% in the prebundle group to 6.5% after bundle implementation (P = 0.01). The adjusted odds ratio for postbundle versus prebundle likelihood of UTI was 0.35 (95% confidence interval, 0.13-0.98; P = 0.045). Significantly more postbundle patients compared with prebundle patients were discharged home on the first day postoperatively (76.3% vs. 37.7%, P < 0.001). A clinical bundle can significantly decrease both UTI rates and hospital stay after pelvic reconstructive surgery.

Using clinical decision support to improve urine testing and antibiotic utilization.

Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes. This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present >7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods. The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; P < .001) and antibiotic use for UTI indications (2.3% decrease per month; P = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion. CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection.

Contribution of Retzius-sparing robot-assisted radical prostatectomy to the mechanism of urinary continence as demonstrated by dynamic MRI

Retzius-sparing robot-assisted radical prostatectomy (RARP) has been reported to exhibit better postoperative urinary continence, but the reasons behind this are unknown. This study included 254 cases who underwent RARP and underwent postoperative dynamic MRI. We measured the urine loss ratio (ULR) immediately after postoperative urethral catheter removal and investigated its affecting factors and the mechanisms. Nerve-sparing (NS) techniques was performed in 175 (69%) unilateral and 34 (13%) bilateral cases, whereas Retzius-sparing in 58 (23%) cases. The median ULR early after indwelling catheter removal in all patients was 4.0%. The multivariate analysis was performed on factors that reduce ULR and found that the following factors were associated with ULR: younger age, NS and Retzius-sparing, which were significant. Additionally, dynamic MRI findings showed that membranous urethral length and the anterior rectal wall movement toward the pubic bone during abdominal pressure were significant factors. The movement observed on the dynamic MRI during abdominal pressure was thought to reflect an effective urethral sphincter closure mechanism. Long membranous urethral length and an effective urethral sphincter closure mechanism during abdominal pressure were considered effective for favorable urinary continence after RARP. NS and Retzius-sparing were clearly shown to have an additive effect in preventing urinary incontinence.

Overnight removal of urinary indwelling catheter following vaginal prolapse surgery (OVERACT)

ObjectivePelvic organ prolapse is a common condition in women. Adequate timing of urinary catheter removal after vaginal prolapse surgery is essential to reduce post-operative morbidity. We compared midnight removal of the indwelling urinary catheter to removal next morning. MethodsWe performed a retrospective cohort study among 266 women undergoing vaginal prolapse surgery, of whom 132 women had urinary catheter removal at midnight and 134 women morning after surgery. We compared the occurrence of urinary retention, time till first micturition, need for clean intermittent catherization and duration of hospital admission. Also, we assessed risk factors for the occurrence of retention. ResultsRetention occurred less after midnight removal of the urinary catheter, compared to removal next morning (6.1 % versus 23.9 %, p < 0.001). Furthermore, the time till catheter removal and discharge from hospital were shorter and the need for clean intermittent catheterization during hospital admission was lower after midnight compared to next morning removal of the urinary catheter. We identified anterior colporrhaphy as a risk factor for retention. ConclusionOur results suggest that early removal of the indwelling urinary catheter after vaginal prolapse surgery seems save with respect to urinary retention and leads to earlier mobilization and shorter hospital admission.

Attitudes towards Enhanced Recovery after Surgery (ERAS) interventions in colorectal surgery: nationwide survey of Australia and New Zealand colorectal surgeons

BackgroundWhilst Enhanced Recovery after Surgery (ERAS) has been widely accepted in the international colorectal surgery community, there remains significant variations in ERAS programme implementations, compliance rates and best practice recommendations in international guidelines.MethodsA questionnaire was distributed to colorectal surgeons from Australia and New Zealand after ethics approval. It evaluated specialist attitudes towards the effectiveness of specific ERAS interventions in improving short term outcomes after colorectal surgery. The data were analysed using a rating scale and graded response model in item response theory (IRT) on Stata MP, version 15 (StataCorp LP, College Station, TX).ResultsOf 300 colorectal surgeons, 95 (31.7%) participated in the survey. Of eighteen ERAS interventions, this study identified eight strategies as most effective in improving ERAS programmes alongside early oral feeding and mobilisation. These included pre-operative iron infusion for anaemic patients (IRT score = 7.82 [95% CI: 6.01–9.16]), minimally invasive surgery (IRT score = 7.77 [95% CI: 5.96–9.07]), early in-dwelling catheter removal (IRT score = 7.69 [95% CI: 5.83–9.01]), pre-operative smoking cessation (IRT score = 7.68 [95% CI: 5.49–9.18]), pre-operative counselling (IRT score = 7.44 [95% CI: 5.58–8.88]), avoiding drains in colon surgery (IRT score = 7.37 [95% CI: 5.17–8.95]), avoiding nasogastric tubes (IRT score = 7.29 [95% CI: 5.32–8.8]) and early drain removal in rectal surgery (IRT score = 5.64 [95% CI: 3.49–7.66]).ConclusionsThis survey has demonstrated the current attitudes of colorectal surgeons from Australia and New Zealand regarding ERAS interventions. Eight of the interventions assessed in this study including pre-operative iron infusion for anaemic patients, minimally invasive surgery, early in-dwelling catheter removal, pre-operative smoking cessation, pre-operative counselling, avoidance of drains in colon surgery, avoiding nasogastric tubes and early drain removal in rectal surgery should be considered an important part of colorectal ERAS programmes.

A collaborative approach intended to reduce the duration of short term urinary catheters in adult patients at a tertiary care medical center also significantly reduced the duration of hospitalization

BackgroundUrinary tract infections are the leading cause of nosocomial infections in the United States. The major contributing factor is the placement of indwelling urinary catheters. MethodsFollowing a chart review of adult patients hospitalized at a tertiary care medical center who required the use of a short-term (≤ 2 weeks) indwelling urinary catheter, a collaborative effort was initiated by an Infectious Diseases physician to develop protocols focused on the clinical service involved for the expeditious removal of short-term indwelling urinary catheters. The protocols relied in part on the standards of practice by pertinent medical/surgical subspecialty societies. Usage of urinary catheters and duration of hospitalization following implementation of the protocols was assessed. ResultsBased on a multivariate analysis controlling for demographic variables, comorbidities, medical vs surgical service, and indication for the urinary catheterization, the median duration of catheterization was significantly reduced from 6.7 days to 3.6 days after the protocols were initiated (P < .001), and the median duration of hospitalization was significantly reduced from 9.5 days to 5.9 days (P < .001). No patient had to have the urinary catheter reinserted. ConclusionsDevelopment of collaborative protocols for the removal of short-term indwelling urinary catheters significantly reduced both the duration of catheterization and the duration of hospitalization.

MP15-16 VERY EARLY CATHETER REMOVAL ON POSTOPERATIVE DAY 2 AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: REPORTING ON EARLY COMPLICATIONS AND FUNCTIONAL RESULTS

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-16 VERY EARLY CATHETER REMOVAL ON POSTOPERATIVE DAY 2 AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: REPORTING ON EARLY COMPLICATIONS AND FUNCTIONAL RESULTS Dries Develtere, Giuseppe Rosiello, Pietro Piazza, Abhishek Pandey, Camille Berquin, Sinatti Celine, Hannah Van Puyvelde, Stefano Puliatti, Marco Amato, Rui Farhina, Elisabeth Pauwels, Ruben De Groote, Peter Schatteman, Geert De Naeyer, Frederiek D'Hondt, and Alexandre Mottrie Dries Develtere Dries Develtere More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Abhishek PandeyAbhishek Pandey More articles by this author , Camille BerquinCamille Berquin More articles by this author , Sinatti CelineSinatti Celine More articles by this author , Hannah Van PuyveldeHannah Van Puyvelde More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Marco AmatoMarco Amato More articles by this author , Rui FarhinaRui Farhina More articles by this author , Elisabeth PauwelsElisabeth Pauwels More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Peter SchattemanPeter Schatteman More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Frederiek D'HondtFrederiek D'Hondt More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Presence of an indwelling urinary catheter following robot-assisted radical prostatectomy (RARP) is reported as a significant bother. Moreover, it’s presence can lead to several catheter-related issues, with a significant burden on patients’ life. The current study aims to evaluate the feasibility of postoperative day (POD 2) catheter removal after RARP and to assess its impact on short- and long-term urinary continence (UC). METHODS: Patient characteristics and perioperative data were prospectively collected for 402 consecutive patients treated with RARP ± pelvic lymph node dissection (PLND) between January 2018 and July 2019. After exclusion, (locally advanced prostate cancer, missing follow-up data) final population consisted of 369 patients. Postoperative complications and UC were retrospectively analyzed. Ethical committee approval has been obtained. RESULTS: 255 (70%) patients underwent catheter removal on POD 2. 65 (25%) received PLND. 1 patient experienced a major postoperative complication [Clavien Dindo Classification (CDC) > IIIa]. 33 (12.9%) required re-catheterization due to acute urinary retention (AUR) after catheter removal (CDC I). 5 (2%) patients required re-catheterization due to AUR combined with anastomotic leakage. After a median follow-up of 18 months [Interquartile range (IQR) 13-24] 236 (93%) patients recovered UC. Early UC rate was 67% and median time to UC recovery was 1 month (IQR: 0-4). No anastomotic strictures were recorded. Age at surgery (p=0.1), prostate volume (p=0.6), and voiding LUTS (p=0.2) were not associated with the risk of retention after POD 2 catheter removal. CONCLUSIONS: Indwelling catheter removal on POD 2 after RARP is a safe option in patients with localized PCa, with acceptable rates of AUR and anastomotic leakage, and without impact on short- and long-term functional outcomes . Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e270-e270 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dries Develtere More articles by this author Giuseppe Rosiello More articles by this author Pietro Piazza More articles by this author Abhishek Pandey More articles by this author Camille Berquin More articles by this author Sinatti Celine More articles by this author Hannah Van Puyvelde More articles by this author Stefano Puliatti More articles by this author Marco Amato More articles by this author Rui Farhina More articles by this author Elisabeth Pauwels More articles by this author Ruben De Groote More articles by this author Peter Schatteman More articles by this author Geert De Naeyer More articles by this author Frederiek D'Hondt More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement Loading ...

Strategies for the removal of short-term indwelling urethral catheters in adults.

Strategies for the removal of short-term indwelling urethral catheters in adults.

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.

Early removal of indwelling urinary catheter after radical surgery for early-stage cervical cancer-A cohort study.

To evaluate the difference between early and delayed removal of indwelling urinary catheter after radical hysterectomy (RH) or radical trachelectomy (RT). An ambispective study was conducted in early-stage cervical cancer patients who underwent RH or RT. Delayed indwelling urinary catheter removal occurred on a postoperative day (POD) 7 in the retrospective group (January 2012-November 2013), and early removal occurred on POD 1 in the prospective group (May 2014-June 2017).The postvoid residual (PVR) test was performed after indwelling catheter removal in both groups. Our sample included 47 patients in the delayed group and 48 in the early one. There was no difference in age, body mass index, tumor size, histology, stage, surgical approach, and intraoperative and postoperative complications. Indwelling urinary catheter reinsertion was needed in 16 (34%) patients in the delayed group and 12 (25%) in the early group (P = .37), with no statistical difference between the median PVR volumes -82.5 and 45 mL (P = .06), respectively. Seven (14.9%) patients in the delayed group presented with 30-day urinary tract infection vs two (4.2%) in the early group (P = .09). Early indwelling urinary catheter removal, in regard to the rate of catheter reinsertion and PVR volume, does not differ from delayed removal.

Multi-Pronged CAUTI Reduction Strategy

<h3>Background</h3> Catheter associated urinary tract infection (CAUTI) rates were identified as a concern at a large regional medical center (>500 beds). Inpatient chart audits were conducted revealing: nurse initiated indwelling catheter removal protocols inconsistently applied, catheters inserted for urinary retention without supporting documentation, catheters frequently inserted in the emergency department (ED), and inconsistent nursing care documentation. Based on our findings a multi-disciplinary, multi-pronged plan to improve the quality of care related to indwelling catheters and reduce CAUTI was deployed. <h3>Methods</h3> An interdisciplinary team was organized, gap and root-cause analyses were performed. The urinary retention assessment pathway (URAP) was developed to support the nurse initiated indwelling catheter removal protocol. A campaign, Foley Reduction in the ED, was established to reduce initial insertion of indwelling catheters. On the inpatient units, device rounds were implemented to reinforce appropriate nursing practice. An external catheter was made available for female patients. Standardized CAUTI prevention content was provided at orientation as well as annual education for all nursing staff. <h3>Results</h3> Improvements were observed after implementation of the URAP and inpatient device rounds; an emphasis on prevention of insertion of indwelling urinary catheters in the ED; and education regarding proper care and maintenance. A reduction in CAUTI Standardized Infection Ratio from 0.85 in 2018 to 0.662 and a slight decrease in the Standardized Utilization Ratio from 0.931 in 2018 to 0.856 was noted in 2019. <h3>Conclusions</h3> A comprehensive CAUTI prevention strategy for a large regional medical center focusing on clinical education, catheter insertion in the ED, and consistent catheter care and nurse initiated indwelling catheter removal in the inpatient units has led to a reduction of CAUTI and usage of indwelling catheters. While there have been marked improvements, continued monitoring and process improvement will be imperative.

Ideal timing of indwelling catheter removal after robot-assisted radical prostatectomy with a running barbed suture technique: a prospective analysis of 425 consecutive patients

ObjectiveTo compare prospectively early outcome and complications of catheter removal after robot-assisted radical prostatectomy (RARP) on the 4th or 7th day with a standardized running barbed suture technique.IntroductionThe time point of removing the indwelling catheter after RARP mainly depends on institute’s/surgeon’s preferences. Removal should be late enough to avoid urinary leakage and complications such as acute urinary retention (AUR) but early enough to avoid unnecessary catheter indwelling.Materials and methodsA consecutive single-institutional series of patients underwent RARP between July 2015 and August 2017 and were entered in a prospectively maintained data base. Between July 2015 and December 2016 a cystogram was performed on 7th postoperative day (group A), thereafter the cystogram was performed on 4th postoperative day (group B). Incidence of acute urinary retention (AUR), urinary tract infections (UTI) and adverse events between the two cohorts was compared.Results425 patients were analyzed (group A: n = 231; group B: n = 194). Both cohorts were comparable regarding demographic and oncological parameters. Watertight anastomosis was present in 84.8% in group A and in 82.5% in group B, respectively. AUR within 4 weeks after RARP occurred in 2.2% (n = 3) in A and 9.4% (n = 15) in B (p = 0.001). AUR within 72 h after catheter removal occurred in group A: 1% (n = 2) and in group B: 6.3% (n = 10) (p = 0.005). Symptomatic urinary tract infections occurred in 8.2% (n = 16) in group A and in 6.9% (n = 11) in group B. There were no differences in the rate of secondary anastomosis dehiscence. Age, BMI, prostate size, surgeon, or intraoperative bladder neck reconstruction were not correlated to the occurrence of AUR or UTI.ConclusionsThe removal of indwelling catheter on day 4 after a RARP with a running barbed suture shows similar anastomosis leakage rates as on the 7th postoperative day. However, AUR rates are higher for early removal. Patients scheduled for early removal should be carefully informed about the increased risk for AUR. Catheter indwelling time does not represent a risk factor for UTI.

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

Venous injury caused by peripheral intravenous indwelling catheter and recovery

Objective To observe the correlation factors of venous injury caused by peripheral intravenous indwelling catheter, so as to guide the rational use of clinical intravenous indwelling catheter, so as to avoid venous injury and promote vascular recovery. Methods This study was carried out in five Class Ⅲ Grade A hospitals. In each hospital, we randomly selected one of the departments: Digestive Internal Medicine, Nephrology, Hepatobiliary Surgery, Extraglandular Surgery and Respiratory Medicine as the research departments. The inpatients admitted from March to June 2018 were selected and included in the study as a whole with the consent of the patients. In this study, 81 qualified patients were successfully injected with the peripheral intravenous indwelling catheter infusion and observed. According to the prescription of the doctors and hospital department policies, peripheral intravenous indwelling catheter was used for infusion. Specialists were arranged to record the patients' infused solution, evaluate the puncture site of the indwelling catheter before puncture and the results of venous blood vessel evaluation before puncture. Observe and record the reasons for the removal of indwelling catheter, the patency during the removal, the indwelling time, the marking of indwelling vein, evaluate and record the condition of the puncture site of indwelling catheter and the grade of phlebitis. The elasticity and filling degree of venous vessels were evaluated and recorded on the 14th day after catheter removal. Results (1) The severity of local phlebitis was positively correlated with the severity of vascular injury when removing intravenous indwelling catheter; the incidence of moderate and severe vascular injury was 9.09% when local symptoms were grade Ⅰ phlebitis; the incidence of moderate and severe vascular injury was 95.83% when local symptoms were grade Ⅱ and Ⅲ phlebitis when removing intravenous indwelling catheter; and there was statistical difference in the incidence of moderate and severe vascular injury between the two groups (P 0.05) . Conclusions Phlebitis after peripheral intravenous indwelling catheter infusion is the main cause of vascular injury and hinders venous recovery. Preventive measures should be taken in clinical puncture and use of venous indwelling needles; the removal of indwelling catheters should not be based only on indwelling time; the symptoms of puncture sites and patients' reactions should be evaluated in accordance with the regulations to avoid phlebitis above grade Ⅱ; in order to avoid vascular injury caused by infusion of peripheral intravenous indwelling catheters, asymptomatic removal of intravenous indwelling catheter is recommended. Key words: Phlebitis; Peripheral intravenous indwelling catheters; Blood vessel recovery; Vascular injury; Indwelling time; Indicators for removal of catheter

Would early removal of indwelling catheter effectively prevent urinary retention after hip fracture surgery in elderly patients?

BackgroundThis study aimed to investigate the incidence and risk factors of postoperative urinary retention (POUR) among elderly patients who underwent hip fracture surgery and to evaluate the effect of indwelling catheterization on the occurrence of POUR.Materials and methodsFrom January 2012 to January 2015, consecutive patients aged over 70 years who underwent hip fracture surgery were enrolled in this study. All patients underwent indwelling catheterization due to voiding difficulty upon admission. Demographic data, perioperative variables, and postoperative duration of patient-controlled analgesia and indwelling catheterization, postoperative complications, and mortality were collected. The incidence of POUR was investigated, and the risk factors related to POUR were analyzed using a logistic regression analysis. The cutoff value for the timing of catheter removal was determined using receiver operating characteristic (ROC) curve analysis.ResultsPOUR developed in 68 patients (31.8%) of the 214 patients. Of these, 24 (35.3%) were male. The indwelling catheter was left in place for an average of 3.4 days (range, 0–7 days) postoperatively. A significant difference was noted in gender and duration of indwelling catheterization between patients with POUR and without. The cutoff value for the timing of catheter removal as determined by ROC curve analysis was 3.5 postoperative day with 51.4% sensitivity and 71.5% specificity. Multiple logistic regression revealed that the duration of the indwelling catheter [odds ratios (OR), 0.31; p = 0.016)] and male gender (OR, 2.22; p = 0.014) were independent risk factors related to the occurrence of POUR.ConclusionsThe significant risk factors of POUR among elderly patients undergoing hip fracture surgery were early indwelling catheter removal and male gender. Therefore, early removal of indwelling catheter in elderly patients following hip fracture surgery may increase the risk of POUR, especially in male patients.

Early versus delayed removal of indwelling catheters in patients after elective cesarean section: a prospective randomized trial

Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12 h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time.Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2 h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12 h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time.Results: Urinary frequency (p = .04), microscopic hematuria incidence (p = .04), postoperative mobilization time (p = .01), and length of hospital stay (p = .009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time.Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.