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Indwelling Urinary Catheters: A One-Point Restraint?
- Sanjay Saint, MD, MPH;
- Benjamin A. Lipsky, MD; and
- Susan Dorr Goold, MD, MHSA, MA
More than four decades ago, Dr. Paul Beeson persuasively argued against routine use of indwelling urinary catheters in hospitalized patients, making the “case against the catheter” (1). He urged, “The decision to use this instrument should be made with the knowledge that it involves risk of producing a serious disease” (1). This advice remains relevant today. Although these devices provide indispensable benefits, they are also the dominant risk factor for hospital-acquired urinary tract infection, the most common nosocomial infection in the United States (2). Infections and other untoward effects associated with indwelling urinary catheters lead to increased health care costs, patient discomfort, morbidity, and even death (3-6).
Regrettably, unjustified and excessively prolonged catheter use persists despite clear evidence of its detrimental effects (7-9). Indwelling catheters have the practical effect of needlessly confining patients in what could be called a “one-point” restraint, raising serious safety and ethical concerns analogous to those noted more than a decade ago with “four-point” (limb) restraints. Lessons learned from efforts to curtail the use of physical restraints may help identify strategies for diminishing the use of indwelling urinary catheters.
Indwelling Urinary Catheters Are Widely—and Often Inappropriately—Used
Each year, almost 25% of the approximately 96 million urinary catheters sold worldwide are sold in the United States, where between 16% and 25% of hospitalized patients have an indwelling urinary catheter (9, 10). In a substantial proportion of these patients, the catheter is used inappropriately (7, 8). Two decades ago, a study of hospitalized patients found that catheter use was unjustifiable for more than one third of the hospital days they were in use (8). More recently, Jain and colleagues (7) reported that initial insertion was unjustified in 21% of hospitalized patients with a urinary catheter and that continued catheter use was unwarranted for almost half of the …
