A panel of physicians and nurses has defined three scenarios for appropriate use of indwelling catheters with a goal of minimizing their use and reducing the risk of catheter-associated urinary tract infections (CAUTI), according to a study published August 12, 2018, by BMJ Quality & Safety. Use of the catheters in patients undergoing general and orthopedic surgery is common, but exactly how healthcare providers use the devices may vary regionally, the authors say. The devices have also been increasingly recognized as carrying the potential to harm patients, causing either infectious or physical complications ranging from urinary tract infections to urethral trauma, the study says. Using a standardized, multiround rating process, two panels (consisting of 13 surgeons and nurses for general surgery and 11 for orthopedic surgery) rated 127 clinical scenarios for catheter placement and duration of use, weighing the benefits and disadvantages in each. Appropriateness ratings categorized each scenario into one of three groups: first, the surgery should be performed without the catheter; second, the catheter should be used during surgery and ideally removed before the patient leaves the operating room; and third, the catheter should be used during surgery and kept in use until the appropriate time during postoperative days 1 through 4, with further specific recommendations given for different scenarios. For many of the scenarios in which the panel suggested the third rating, the authors note that the first voiding trial for catheter removal may occur on postoperative day 1. The study also notes that these recommendations are intended only to provide guidance regarding patients who do not have another reason for catheter use, such as a critical illness for which urine output must be measured to guide other care the patient is receiving.

HRC Recommends: Since the Centers for Medicare and Medicaid Service identified catheter-associated urinary tract infection (CAUTI) as a preventable hospital-acquired condition for which treatment will not be reimbursed, many studies have been conducted to determine ways to reduce its occurrence. Protocols and best practices to reduce CAUTI have been identified and implemented, yet the problem of CAUTI persists. Because catheters are often used or continued without a valid indication, the guidelines for appropriate catheter use provided in this study add to the body of literature connecting lower rates of CAUTIs with a reduction in use of indwelling urinary catheters.