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Urinary Catheterization in Infants: When It's Knot so Simple
David C Sheridan1,2, Beech Burns1,2, Megan Mickley1,2
1Oregon Health & Science University, Department of Emergency Medicine, Portland, Oregon.
Insights
A rare complication of pediatric urinary catheterization occurred when a catheter became knotted in a young girl's bladder. Prompt recognition and removal prevented further complications or transfers to specialized facilities.
Area of Science:
- Pediatric Emergency Medicine
- Urology
- Medical Device Complications
Background:
- Pediatric fever is a common emergency department (ED) presentation, often viral but potentially indicating serious bacterial infection like pyelonephritis in young children.
- Urinary catheterization is frequently performed in EDs to obtain sterile urine samples when no focal infection source is identified in febrile children.
- Straight catheterization is a standard, generally safe procedure for obtaining urine specimens in young children unable to void voluntarily.
Observation:
- A case report details a young girl who developed a retained, knotted urinary catheter within her bladder after a standard straight catheterization procedure.
- The retained catheter presented a rare but significant complication of an otherwise routine diagnostic intervention in the emergency setting.
Findings:
- The case highlights a rare complication of pediatric urinary catheterization: a retained and knotted catheter in the bladder.
- Successful management involved a specific technique for catheter removal, avoiding the need for pediatric subspecialty consultation or transfer.
Implications:
- This case underscores the importance of vigilance for rare complications associated with common pediatric procedures.
- Understanding and recognizing such rare events can improve emergency department management, potentially preventing patient transfers and specialized consultations.
- Awareness of this complication can enhance training for healthcare providers performing urinary catheterizations in pediatric populations.
Abstract:
Pediatric fever is one of the most common presenting complaints to emergency departments (ED). While often due to a viral illness, in young children without a source the most common bacterial infection is pyelonephritis. For this reason, when no focal source can be identified a urinary specimen is recommended. In young children who are unable to urinate on demand, a straight catheter is required to obtain a sterile specimen. This is generally a benign procedure and is performed frequently in EDs. We report a case of a young girl who underwent straight bladder catheterization and was subsequently found to have a retained catheter that had become knotted in the bladder. This case report highlights a rare complication of this common procedure and describes the technique required to remove the catheter. An understanding of these issues may avoid the need for transfer to a pediatric facility or for subspecialty consultation.