Iatrogenic bladder injury and prevention of catheter-related bacteriuria

Literature review conducted and presented by Dr. Clara Farley

EUA guidelines on iatrogenic bladder trauma:

  • Repair in two layers with absorbable sutures
  • Postop bladder drainage is required for 7-14 days
  • Cystoscopy is advised

Bacteriuria in patients with indwelling catheters occurs at a rate of approx. 3-10% per day of catheterization:

  • Of those with bacteriuria, approx. 10-25% develop UTI (GU or systemic symptoms)
  • 4% of less develop catheter related bacteremia

Association between the rate of UTI and duration of catheterization:

  • 15% at 3 days
  • 68% at 8 days

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Foley or no Foley? Criteria for perioperative Foley placement

One discussion this week included the use of Foley catheters.


Reference: Meddings J, et al. Michigan Appropriate Periopeartive (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA Appropriateness Method. BMJ Quality & Safety. 2019 Jan;28(1):56-66. doi:10.1136/bmjqs-2018-008025

Summary: Indwelling urinary catheters are commonly used for patients undergoing general and orthopaedic surgery. Despite infectious and non-infectious harms of urinary catheters, there is limited guidance available to surgery teams regarding appropriate perioperative catheter use.

Meddings et al (2019) used the RAND Corporation/University of California Los Angeles (RAND/UCLA) Appropriateness Method 21 to formally rate the appropriateness of urinary catheter placement and timing for removal across routine general and
orthopaedic surgical procedures in adults, as rated by clinicians in different clinical settings across the US and informed by the available literature involving perioperative urinary catheter use.

foley

(Meddings et al, 2019, p.61)