Kamdar Ami, Yahya Abdus, Thangaraj Latha
Hemel Hempstead General Hospital, Hemel Hempstead, UK.
Geriatr Gerontol Int. 2009 Jun;9(2):131-4. doi: 10.1111/j.1447-0594.2008.00490.x.
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.
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.
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.
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.
综合医院收治的患者中，15% - 25%在住院期间曾短期留置导尿管（IDC）。关于老年股骨颈骨折患者短期导尿的具体发生率及并发症的数据较少。
回顾性收集2007年8月31日以来赫默尔亨普斯特德综合医院50例股骨颈骨折患者的病历资料。从患者病历中整理出关于患者人口统计学特征、病前状况、尿道插管记录及原因、插管部位、拔除IDC前后庆大霉素覆盖情况、残余尿量、导尿管插入持续时间、拔除IDC前夹闭导尿管情况、导尿管相关尿路感染、拔除IDC后新发尿失禁/尿潴留等具体信息。既往有长期导尿史的患者被排除在研究之外。
78%的患者进行了IDC插入（95%置信区间，64 - 88.4%）。大多数导尿管在病房插入（75%），其余大多在手术室和恢复室插入。在插入IDC的样本中，只有约三分之一的患者病历记录了残余尿量。在这些患者中，大多数残余尿量超过300 mL。插入IDC的主要原因是尿潴留（50%）、尿失禁（30.8%）和液体监测（11.5%）。31.4%的患者因插入IDC记录有尿路感染。
本研究显示，与综合医院15% - 25%的收治率相比，老年股骨颈骨折患者短期插入IDC的发生率较高（约75%）。在患者病历中更有效地记录尿道IDC插入背后的原因以及提高临床警惕性以防止不必要导尿方面具有重要意义。
