http://goo.gl/zfkdj2
When I was a resident, it was routine to place urine catheters (a catheter threaded up the urethra, into the bladder) in older patients when they landed in the hospital. For some diagnoses, we were even taught that the urine catheter was standard of care. For example, virtually any patient admitted with a diagnosis of congestive heart failure (CHF) had a urine catheter placed.
We needed to ask, "does the benefit of getting more information about urine output outweigh the risks of placing the catheter?" We now know that in the vast majority of cases, the answer to this question is a resounding NO. But unfortunately, while we are now more aware of the risks of urine catheters, they are still used far too frequently, and we often fail to balance the benefits of the catheter against the very substantial harms.
One of the key harms of the urine catheter is illustrated by a very instructive case vignette published in JAMA Internal Medicine as part of the wonderful Teachable Moments series. An 80 year old man with was admitted with fluid overload due to kidney disease. A urine catheter was placed to monitor his fluid status, and after several days he was discharged home in better condition.
Or so it seemed. Unfortunately, 5 days later he became seriously ill with an infection that started in his bladder (urinary tract infection) that then spread to his blood (sepsis). He required care in the intensive care unit. The value on his prior admission of precisely assessing how much urine he was producing was clearly not worth the risk of this disastrous and life threatening complication.
One of the key harms of the urine catheter is illustrated by a very instructive case vignette published in JAMA Internal Medicine as part of the wonderful Teachable Moments series. An 80 year old man with was admitted with fluid overload due to kidney disease. A urine catheter was placed to monitor his fluid status, and after several days he was discharged home in better condition.
Or so it seemed. Unfortunately, 5 days later he became seriously ill with an infection that started in his bladder (urinary tract infection) that then spread to his blood (sepsis). He required care in the intensive care unit. The value on his prior admission of precisely assessing how much urine he was producing was clearly not worth the risk of this disastrous and life threatening complication.