Reasons for replacement of long-term urethral catheters: implications for randomized trials.

Abstract

On any given day more than 100,000 nursing home patients have indwelling urethral catheters in place. We prospectively followed 47 such patients for almost 18 patient-years and observed 249 catheter replacements. The mean number of replacements per 100 days of catheterization was 3.1 (71% of the catheters were replaced within 30 days of insertion). Nonprescribed removal by the patient or nursing staff was the most frequent cause of replacement (43%), followed by leakage (33%) and obstruction (24%). Catheter replacements followed patient-specific patterns, with each reason for replacement being associated significantly with the reason for the prior replacement (p less than 0.001). To minimize the effect of patient-specific replacement patterns, studies of complications of catheterization that may be affected by catheter obstruction or replacement should use cross-over designs.