SESSION TYPE: Thoracic Surgery Posters I
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: In response to an identified association of prolonged urinary catheterization with urinary tract infections (UTI’s), the Centers of Disease Control established a 1b recommendation guiding postoperative removal of urinary catheters within 24 hours unless otherwise indicated. In general thoracic surgical patients receiving thoracic epidural analgesia, current practice dictates maintaining urinary catheterization for the duration of the epidural to prevent urinary retention. The purpose of this study was to evaluate urinary retention rates when urinary catheters were discontinued within the first 24 hours post-op during uninterrupted epidural analgesia.
METHODS: All general thoracic surgery patients with thoracic epidural analgesia were considered for inclusion in a prospective, observational study during a seven-month period. Exclusion occurred if patients were <18, male >65, had a history of urologic procedures or urinary retention, known benign prostatic hypertrophy, or admitted to ICU. Informed consent was obtained. Data points collected included location of epidural; time and amount of spontaneous void; urinary bladder scanning results; time of epidural discontinuation and presence of UTI defined by CDC guidelines. Urinary catheter discontinuation was scheduled for midnight on the operative day. Urinary retention was identified at >400cc determined by bladder scan. The study was Institutional Review Board approved.
RESULTS: 69 general thoracic surgery patients with thoracic epidurals were considered for study over a seven-month time period. Of those, 46 qualified. The urinary catheters of 39 patients were removed within 24 hours post-op. Seven patients did not receive a urinary catheter. SPSS was utilized for analysis. Of the 46 patients, 2% had urinary retention.
CONCLUSIONS: Urinary catheter removal within 24 hours post-op in carefully selected general thoracic surgery patients receiving uninterrupted thoracic epidural analgesia resulted in a low incidence of urinary retention.
CLINICAL IMPLICATIONS: In select populations of general thoracic surgery patients with thoracic epidurals, removal of urinary catheters is safe and complies with the CDC recommendations.
DISCLOSURE: The following authors have nothing to disclose: Laurel Rhyne, Tiffany Potter, J. Robert Headrick
No Product/Research Disclosure InformationMemorial Health Care System, Chattanooga, TN