Retrospective observational study of the incidence of short-term indwelling urinary catheters in elderly patients with neck of femur fractures.

BACKGROUND

15-25% of general hospital admissions tend to involve patients that have had a short-term indwelling urinary catheter (IDC) inserted some time during their stay. There is little data on the specific incidence and complications of short-term urinary catheterization in elderly patients with neck of femur fractures.

METHODS

Data was collected from the notes of 50 patients at Hemel Hempstead General Hospital with neck of femur fractures retrospectively from 31 August 2007. Specific information on patient demographics, premorbid status, record and reason for urethral catheterization, place of insertion, gentamicin cover pre- and post-removal of IDC, residual volumes, duration of catheter insertion, catheter clamping prior to removal of IDC, urinary tract infection with IDC, post-IDC removal newly incontinent/in retention were collated from patient notes. Patients with prior chronic catheterization were excluded from the study.

RESULTS

78% of the patients had an IDC insertion (95% confidence interval, 64-88.4%). Most of the catheters were inserted on the ward (75%) with the rest being inserted mostly in theatre and recovery. Only approximately one-third of the sample that had IDC inserted had residual volume documented in the notes. Of these patients, the majority had residual volume above 300 mL. The main reasons for IDC insertion were urinary retention (50%), incontinence (30.8%) and fluid monitoring (11.5%). Of the patients, 31.4% had documented urinary tract infection as a result of IDC insertion.

CONCLUSION

This study revealed a higher incidence of short-term IDC insertion ( approximately 75%) in elderly patients with neck of femur fractures in comparison to general hospital admissions of 15-25%. There is a role for more effective documentation in patient notes on the reasons behind urinary IDC insertion and increased clinical vigilance in preventing unnecessary catheterizations.