Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri.
Department of Anesthesiology, The Children's Mercy Hospital, Kansas City, Missouri.
J Surg Res. 2019 Jan;233:100-103. doi: 10.1016/j.jss.2018.07.060. Epub 2018 Aug 17.
In some institutions, urinary catheters (UCs) have been placed in all patients receiving opioid patient-controlled analgesia (PCA) because of the increased incidence of urinary retention. Our institutional data demonstrated no UC replacements in 48 children who had PCA for perforated appendicitis who had their catheters removed before discontinuation of the PCA. As part of a quality improvement initiative, we discontinued the practice of requiring UC with PCA for perforated appendicitis.
A prospective list of patients with perforated appendicitis was maintained. Data were gathered regarding 60 consecutive patients. UC placement was allowed for specific indications including urinary retention and surgeon discretion.
Sixteen patients (27%) received a UC with 14 of these being placed in the operating room (OR). Two UCs were placed outside the OR for urinary retention. Patients who underwent UC placement in the OR weighed significantly more than those who did not (33 versus 42 kg, P = 0.05). No patients required replacement of the catheter once removed. There were no postoperative urinary tract infections. Median PCA duration was 68 h (50, 98) for patients with UC placed in the OR compared with 60 h (47, 78) (P = 0.42). Median postoperative length of stay for patients with UC placed in the OR was 95 h (76, 140) compared with 90 h (70, 113) (P = 0.09).
UC can be withheld from patients with perforated appendicitis who are placed on PCA with a very low placement rate. UC placement at time of operation did not lengthen time receiving PCA or length of stay.
在一些机构，由于尿潴留发生率增加，所有接受阿片类药物患者自控镇痛（PCA）的患者都被放置了导尿管（UC）。我们的机构数据显示，48 例接受 PCA 治疗穿孔性阑尾炎的患儿在停止 PCA 前拔除了导尿管，没有更换 UC。作为质量改进计划的一部分，我们停止了在穿孔性阑尾炎患者中使用 PCA 时常规放置 UC 的做法。
建立了穿孔性阑尾炎患者的前瞻性名单。收集了 60 例连续患者的数据。允许根据特定指征放置 UC，包括尿潴留和外科医生的决定。
16 例患者（27%）接受了 UC，其中 14 例在手术室（OR）放置。2 例 UC 因尿潴留而在 OR 之外放置。在 OR 放置 UC 的患者体重明显重于未放置 UC 的患者（33 公斤与 42 公斤，P=0.05）。一旦拔除导尿管，没有患者需要更换。没有术后尿路感染。在 OR 放置 UC 的患者中，PCA 持续时间中位数为 68 小时（50，98），而未放置 UC 的患者为 60 小时（47，78）（P=0.42）。在 OR 放置 UC 的患者中，术后住院时间中位数为 95 小时（76，140），而未放置 UC 的患者为 90 小时（70，113）（P=0.09）。
在接受 PCA 治疗的穿孔性阑尾炎患者中，可以不放置 UC，且放置率非常低。在手术时放置 UC 并不会延长 PCA 或住院时间。
