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Editorials |16 July 2002

Indwelling Urinary Catheters: A One-Point Restraint?

Sanjay Saint, MD, MPH; Benjamin A. Lipsky, MD; Susan Dorr Goold, MD, MHSA, MA

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information

  • Disclaimer: Dr. Saint has received an honorarium from C.R. Bard, Inc., and serves as a consultant to UroSolutions, Inc.

    Grant Support: Dr. Saint is supported by a Career Development Award from the Veterans Affairs Health Services Research & Development Program. Dr. Goold is supported by a Robert Wood Johnson Generalist Physician Faculty Award.

    Request for Single Reprints: Sanjay Saint, MD, MPH, Patient Safety Enhancement Program, University of Michigan Health System, Room 7E08, 300 NIB–Campus Box 0429, Ann Arbor, MI 48109-0429; e-mail, saint@umich.edu.

    Current Author Addresses: Dr. Saint: University of Michigan Health System, Division of General Medicine, Room 7E08, 300 NIB, Campus Box 0429, Ann Arbor, MI 48109-0429.

    Dr. Lipsky: VA Puget Sound Healthcare System, General Internal Medicine Clinic (S-111-GIMC), 1660 South Columbian Way, Seattle, WA 98108.

    Dr. Goold: University of Michigan Health System, Division of General Medicine, Room 7B19, 300 NIB, Campus Box 0429, Ann Arbor, MI 48109-0429.

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FULL TEXT
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.
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...
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Saint S, Lipsky BA, Goold SD. Indwelling Urinary Catheters: A One-Point Restraint?. Ann Intern Med. 2002;137:125–127. doi: https://doi.org/10.7326/0003-4819-137-2-200207160-00012

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Published: Ann Intern Med. 2002;137(2):125-127.

DOI: 10.7326/0003-4819-137-2-200207160-00012

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2002 American College of Physicians
114 Citations

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