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Objective:
Assessment of adult urinary catheter (UC) guidelines applied to children (<18yo) with postoperative epidural catheters.
Design:
Prospective case series
Setting:
Tertiary referral center
Patients:
All general pediatric surgery patients with concomitant epidural analgesia from October 1st, 2010 to April 1st, 2011
Interventions:
None
Main Outcome Measures:
Determination of the rate of UC use, the duration of indwelling UCs, the rate of postoperative UC re/insertions, and the rate of catheter-associated urinary tract infections (CAUTIs)
Results:
Results: Of 77 children undergoing general surgical procedures with epidural analgesia, 28 did not have a UC placed, 49 did. When the surgeon did not place a UC intraoperatively, 4 patients (14%) required postoperative insertion. When the surgeon placed a UC but removed it within 24h, 1 patient (4.5% of 22) required a subsequent UC. When the surgeon placed a UC and deemed it necessary to remain longer than 24h, 4 patients (15% of 27) required reinsertion. One patient overall (1.3%) developed a urinary tract infection; this patient had no intraoperative UC, but did require multiple postoperative UCs and had a past history of difficulty voiding.
Conclusions:
These results preliminarily support the application of adult UC removal guidelines to children with epidural catheters. Furthermore, our surgeons were able to estimate which patients did not need catheters 86% of the time, and removed them in appropriate patients at 24h with 95% success. These data also indicate that removing UCs present for longer duration may incur risk of subsequent retention and recatheterization. Additionally, UCs placed outside of the sterile operating theater may incur more risk of CAUTI.