Traumatic Catheter Removal- At-Risk Populations, Outcomes and Prevention: A Retrospective Medical Record Review

Traumatic catheter removal (TCR) occurs when a urinary catheter is removed with the balloon inflated, causing urethral injury. We aim to identify cases of TCR, determine at-risk populations and describe outcomes and interventions.

Retrospective medical record review.

EMERSE, a natural language processing tool, was used to identify cases of TCR in a large academic hospital (2014-2024). Charts were reviewed for demographics, causes and outcomes of TCR. Descriptive statistics and chi-square analyses were run for comparison of categorical variables.

Among 198 patients, average age was 68, and 86% (170) were male. Patients removed their own catheter in 75% of TCRs; staff removed the catheter incorrectly in 22% of cases. 65 patients experienced an escalation of care after TCR. 156 patients had gross haematuria, requiring manual irrigation (n = 31, 20%), continuous bladder irrigation (n = 12, 8%), or surgical clot evacuation (n = 3, 2%). 21 patients had a catheter-associated UTI after TCR. 31 patients had repeated TCRs. Patients with altered mental status were more likely to have repeat TCR. Prevention mechanisms included sedating medications (n = 50), patient sitters (n = 29), restraints (n = 28), hand mitts (n = 15) and decoy catheters (n = 12). Sedating medications were associated with less repeat TCR events, while restraints and patient sitters were not.

TCR has been historically difficult to characterize due to lack of diagnosis code and inconsistent reporting. In this study, a surprising number of TCR events occurred when hospital staff removed patients' catheters. These instances could be decreased with targeted education on the safe removal of catheters. Sedating medications were associated with fewer repeat TCR events. Restraints and patient supervision were not, indicating that they may not be effective prevention mechanisms. Further research is needed to identify optimal education and patient-centred interventions to prevent TCR.

STROBE guidelines.

None.