Urinary catheters are commonly used in the operating room (OR) to facilitate urine drainage, maintain bladder decompression, and ensure accurate monitoring of urine output during surgical procedures. Their use is particularly important during prolonged surgery and procedures involving significant fluid shifts, as patients are unable to void naturally when under anesthesia. Accurate measurement of urine output is critical in assessing a patient’s fluid status and renal perfusion, thereby guiding intraoperative management and postoperative care.

There are several types of urinary catheters commonly used in the OR, each designed to meet specific clinical needs. The most commonly used type is the Foley catheter, which is an indwelling catheter made of flexible materials such as latex or silicone. It is inserted into the bladder and held in place by inflating a balloon at its distal end. Foley catheters are designed to provide continuous drainage for extended periods of time, making them ideal for major surgery. Intermittent catheters, also known as straight catheters, are used for one-time drainage and are removed immediately after the bladder is emptied. They are preferred in scenarios where prolonged catheterization is unnecessary. Suprapubic catheters are inserted through the abdominal wall directly into the bladder and are used when urethral catheterization is contraindicated, such as in patients with urethral trauma or strictures. Another type is the external or condom catheter, which is less invasive and is used primarily for male patients who have incontinence but do not require an indwelling catheter (1).

Determining when to use urinary catheters in the OR requires adherence to strict criteria to avoid unnecessary catheterization and reduce associated risks. The Ann Arbor criteria provide a structured approach to assessing the appropriateness of catheter use in hospitalized patients, including those undergoing surgery (1). These criteria suggest catheter use in cases where continuous bladder drainage is essential, such as prolonged surgery, perioperative fluid management, and when patients have severe postoperative mobility limitations. Preoperative evaluation should consider factors such as the patient’s history of urinary retention, duration of surgery, and likelihood of intraoperative fluid overload. In addition, the urgency and type of surgery will influence the choice of catheter and duration of use.

Despite their benefits, urinary catheters carry significant risks, most notably catheter-associated urinary tract infections. Catheter-associated urinary tract infections are the most common healthcare-associated infections and can lead to serious complications such as sepsis, prolonged hospitalization, and increased healthcare costs (2). Mechanical complications such as urethral trauma, bladder spasm, and catheter obstruction are also common. A multicenter study found that many patients experience discomfort and report both infectious and non-infectious complications following catheterization (3). Postoperative complications are of particular concern because indwelling catheters, if not removed promptly, can increase the risk of infection. Studies have shown that prolonged postoperative catheterization is associated with an increased incidence of catheter-associated urinary tract infections and other complications (4).

Effective strategies to minimize catheter-associated complications include maintaining aseptic technique during insertion, ensuring proper catheter maintenance, and following evidence-based protocols for timely removal. Educating healthcare professionals about appropriate catheter indications and maintenance protocols is critical. For example, the use of catheter indication sheets in emergency departments has been shown to improve the appropriateness of catheter use and reduce the incidence of unnecessary catheterizations (5). Regular assessment of the need for urinary catheters in the OR and prompt removal when clinically appropriate are essential practices. In addition, using smaller catheter sizes and ensuring adequate lubrication during insertion can reduce mechanical complications and patient discomfort.

References

1. Meddings J, Saint S, Fowler KE, et al. The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results Obtained by Using the RAND/UCLA Appropriateness Method. Ann Intern Med. 2015;162(9 Suppl):S1-S34. doi:10.7326/M14-1304
2. Apisarnthanarak A, Rutjanawech S, Wichansawakun S, et al. Initial inappropriate urinary catheters use in a tertiary-care center: incidence, risk factors, and outcomes. Am J Infect Control. 2007;35(9):594-599. doi:10.1016/j.ajic.2006.11.007
3. Saint S, Trautner BW, Fowler KE, et al. A Multicenter Study of Patient-Reported Infectious and Noninfectious Complications Associated With Indwelling Urethral Catheters. JAMA Intern Med. 2018;178(8):1078-1085. doi:10.1001/jamainternmed.2018.2417
4. Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg. 2008;143(6):551-557. doi:10.1001/archsurg.143.6.551
5. Gokula RM, Smith MA, Hickner J. Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters. Am J Infect Control. 2007;35(9):589-593. doi:10.1016/j.ajic.2006.12.004

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