COMPLICATIONS OF URINARY CATHETERS
Complications related to the use of urinary catheters are not infrequent and therefore the catheters should be used only when absolutely necessary. Silicone catheters are available for patients with latex allergies.
Catheter-Associated Urinary Tract Infection
Catheter-associated urinary tract infections (CA-UTIs) are a very common cause of nosocomial infections. Signs and symptoms of CA-UTI include fever, rigors, altered mental status, malaise, or lethargy, flank pain, costovertebral angle tenderness, acute hematuria, and pelvic discomfort. In those whose catheters have been removed, dysuria, urgent or frequent urination, or suprapubic pain or tenderness may indicate CA-UTI. Do not treat asymptomatic bacteriuria in a patient with a short-term catheterization, except in pregnancy or immediately posturologic procedure. CA-UTI in spinal cord injury patients may also present with increased spasticity, autonomic dysreflexia, and a sense of unease. Pyelonephritis is the most common complication of CA-UTI and should be suspected when fever is present. Other related infections include prostatitis, epididymitis, and scrotal abscess.
Diagnosis of CA-UTI in the ED is made clinically with urine microscopy. Send urine for culture. Add blood cultures if the patient is septic or immunocompromised. An ultrasound may be useful to identify urinary obstruction. Remember that pyuria is universal for patients with long-term (>1 month) indwelling catheters and in the absence of symptoms, pyuria should not be used in the diagnosis of infection. Hematuria is a better indicator of infection. Remove the urinary catheter if clinically feasible or replace the catheter if it is >7 days old. In patients with mild symptoms, empirically treat with ciprofloxacin 500 mg twice a day, levofloxacin 500 mg once a day, or cefpodoxime 200 mg twice a day. Tailor specific antibiotic choice to local bacterial sensitivities. Seven days is the recommended duration of antimicrobial treatment for patients with CA-UTI who have prompt resolution of symptoms, and 10 to 14 days of treatment is recommended for those with a delayed response. In patients with catheter-associated pyelonephritis, admission is frequently required. Check urine cultures and blood cultures if there is concern for sepsis.
Nondeflation of Foley Retention Balloon
Nondeflation of the Foley retention balloon prevents the removal of the catheter. Cut the plastic catheter valve just proximal to the inflation port and insert a flexible guide wire to expand the channel and deflate the balloon. If this is not successful, insert a 22-G central venous catheter (CVC) over the guide wire. Once the tip of the catheter enters the balloon, remove the guide wire and deflate the balloon. If the inflated balloon persists, instill 10cc of mineral oil through the CVC and wait 15 minutes to dissolve the balloon (this step may be repeated). If these methods fail, consult a urologist to remove the catheter.
COMPLICATIONS OF PERCUTANEOUS NEPHROSTOMY
Percutaneous nephrostomy is a urinary drainage procedure used for supravesical or ureteral ...