Authors' objectives: Identify evidence-based criteria for indwelling urinary catheterization in critically-ill, continuously-sedated hospital inpatients.

Authors' results and conclusions: EVIDENCE SUMMARY ▪ Multisociety guidelines for the prevention of catheter-associated urinary tract infections (CAUTI) recommend insertion of indwelling urinary catheters (IUC) to collect patients’ urine only when necessary and to remove them as soon as they are no longer needed. Other methods for urine collection such as intermittent catheterization, condom catheters and other external devices, and absorbent pads, should be considered before an IUC is inserted. ▪ Many guidelines cite appropriateness criteria included in 2009 guidelines from the Healthcare Infection Control Practices Advisory Committee (HICPAC), a program of the CDC. Acute urinary retention and prolonged immobilization are among the indications considered appropriate; sedation is not on the list. ▪ Criteria from the Ann Arbor consensus panel are also widely cited. If strict prolonged immobilization is required and non-catheter means cannot be used to collect urine, indwelling urinary catheterization, an external urinary catheter, or intermittent catheterization are appropriate. If patients are unconscious due to sedation, catheterization is appropriate only if urinary retention can be anticipated. In scenarios where a patient is rendered completely unable to move (chemical paralysis), an indwelling catheter is appropriate. ▪ There are no clinical studies comparing indwelling bladder catheterization and other means of managing urine in sedated patients, nor are there studies reporting on the association between sedation and CAUTI. One study of critically ill patients whose catheters had been removed found that hypnotics such as continuous propofol or midazolam were strongly associated with urinary retention. Catecholamines were also associated with urinary retention. ©

Project Status: Completed

Year Published: 2024

URL for published report: https://www.med.upenn.edu/CEP/external-request-form.html

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: United States

Organisation Name: Penn Medicine Center for Evidence-based Practice

Contact Address: Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, 3600 Civic Center Blvd, 3rd Floor West, Philadelphia PA 19104

Contact Name: Nikhil Mull

Contact Email: cep@pennmedicine.upenn.edu

Copyright: <p>Center for Evidence-based Practice (CEP)</p>