Original ArticlesEarly Removal of Urinary Catheter After Surgery Requiring Thoracic Epidural: A Prospective Trial
Section snippets
Methods
Data were collected while an early urinary catheter removal protocol was implemented within the University of Virginia’s division of thoracic surgery. As a quality-improvement measure, this study was considered exempt from full review by the institutional review board. Adult patients who underwent surgery through a thoracotomy incision and who required a thoracic epidural for postoperative pain control were included. Exclusion criteria were postoperative hemodynamic instability (mean arterial
Results
Between July 2011 and May 2012, 106 consecutive patients were enrolled into the prospective study. Five patients were excluded due to incomplete auditing records. The historic control group included 218 consecutive patients who underwent surgery between May 2010 and July 2011. Of these, 8 were excluded due to hemodynamic instability, prolonged intubation, or presence of end-stage renal disease. Demographic characteristics for the 101 early-removal patients and the 210 control patients are shown
Discussion
The benefits of epidural analgesia after thoracotomy are numerous, including augmentation of respiratory function and decreases in incidences of arrhythmias, renal failure, and respiratory infections.20 However, incidence of POUR historically has been high in the presence of thoracic epidurals. High-dose epidurals using bupivacaine, 0.25%, have been associated with POUR rates as high as 33%,21 while rates of less than 5% have been reported with lower doses.22 Although the potentially harmful
Conclusion
A protocol endorsing indwelling catheter removal within 48 hours postoperatively among patients receiving thoracic surgery with epidural analgesia is associated with a significantly higher rate of POUR. However, an early-removal protocol may contribute to a multifaceted approach to reducing the rate of CAUTI. When implementing such a protocol, providers must first consider the need for diligent and frequent monitoring for urinary retention.
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