Incidence, Contributing Factors, and Morbidity Associated with Catheter Related Urethral Injuries

Thursday, 15 July 2010: 9:10 AM

Susan Blackmer Tocco, MSN, RN, CNS, CNRN, CCNS1
Sarah Frewin, MSN, RN, CNS, PCCN, CCNS1
Mary Lou Sole, PhD, RN, CCNS, FAAN, FCCM2
1Advanced Practice Nursing and Research, Orlando Regional Medical Center, Orlando, FL
2College of Nursing, University of Central Florida, Olando, FL

Learning Objective 1: identify factors associated with catheter related urethral injuries.

Learning Objective 2: describe measures to reduce the incidence of catheter related urethral injuries.

Purpose: Catheter related urethral injury (CRUI) is an iatrogenic hazard associated with the use of urinary catheters, yet there is scant evidence regarding this phenomenon to guide nursing practice. The purpose of the study was to examine the incidence, contributing factors, and morbidity associated with CRUI.

Methods: A retrospective study of consecutive adult inpatients assigned a diagnosis code of urethral injury between 2005 and 2008 was conducted through review of medical records. Cases with urethral injury resulting from non-catheter causes were excluded. Demographics (age and gender), etiology of injury (insertion vs. non-insertion causes), clinical manifestations of injury, and associated treatments were examined.

Results: CRUI occurred in 125 of 177,583 consecutive adult admissions over this three year period. The majority (n=111; 88.8%) of cases occurred in men (p=.006) and the average patient age was 68 years. Patient self-removal of the catheter was the most common cause of CRUI in men (n=54, 48.6%). Catheter-related hematuria of underdetermined cause was the leading cause of injury in women (n=9, 64.3%). Insertion-related CRUI occurred exclusively in men, and accounted for 36 (32.4%) of male injuries (p < .001). CRUI requiring blood transfusion occurred in 17 (13.6%) of the total cases (14.4% men vs. 7.1% women, p > .05). Four men required the placement of a suprapubic catheter and eight men were taken to the operating room for replacement of the urinary catheter. CRUI requiring a urologist to replace the catheter was more prevalent in insertion-related cases (61.1% insertion vs. 29.4% non-insertion, p < .001).

Conclusion: CRUI is significantly more prevalent in men and is associated with considerable morbidity. Minimizing catheter utilization and improving the practice of catheter insertion are needed to reduce the incidence of this preventable injury. Further investigation is needed to determine the role of catheter stabilization in CRUI’s of undetermined cause.