Adopting a New Standard of Care for Bladder Catheterization
An Evidence-Based Transition to Short-Term Suprapubic Bladder Catheterization
Historical Perspective of Bladder Management:
For more than 3,500 years, urinary catheters have been used to drain the bladder for treatment of urinary incontinence and retention. The urethral “Foley” flexible catheter has been in use since its introduction nearly 80 years ago, despite the fact this catheter can cause serious infections resulting in death, bladder stones, damage to kidneys and serious injuries to the urethra and lower urinary tract.
In the U.S., over $65 billion is spent annually to treat Hospital Acquired Infections (HAI) with the single largest source of HAI (40%) attributed to urinary tract infections (UTI). Catheter Associated Urinary Tract Infections (CAUTI) represent 80% of all UTI, accounting for one-third of all HAI and associated with a 10% mortality rate, considered a “Never Event”. CAUTI develops into Urosepsis at a 12% incidence rate, with a mortality rate, based on severity, ranging from 5.6% in sepsis without organ dysfunction to 34.3% in septic shock patients.
Over 17 million urethral catheters are placed in U.S. hospitals every year, with 8.6 million placed in Emergency Care and 4.7 million placed in Critical Care. Up to 25% of all inpatients and over 66% of all critical care patients receive a urethral catheter prior to discharge.
For the past several decades clinical studies have documented the clinical benefits of suprapubic catheters, which have significantly lower infection rates and eliminate common severe injuries due to urethral catheterization. Additionally, patients prefer suprapubic catheters by 89% due to lower pain and greatly improved quality of life.
It is time to consider a change in the “Standard of Care” for bladder catheterization in select patient populations. It is no longer acceptable to treat urethral catheter infections with antibiotics that are becoming less effective and treating urethral injuries that can be prevented. Evidence-based clinical research has identified patient selection criteria based upon expected catheter indwelling time. Patients that are expected to require bladder management for a duration of greater than 4 days can benefit from suprapubic catheterization, with significantly lower infections rates and readmissions, and elimination of common serious injuries due to urethral catheterization. In particular, Critical Care patient populations can benefit most from this change, with significant improvement of clinical outcomes at lower treatment costs resulting in shorter Length of Stay.
In the past, procedures for placing a suprapubic catheter resulted in high mortality and morbidity. Percutaneous Trocar Punch has a documented 4.4% mortality rate and a 45.5% complication rate. Open Cystostomy, relegated for the obese and neurologic injury and disease patient populations, has a 2.4% mortality rate, with a 22.9% complication rate.
With the introduction of T-SPeC (Transurethral Supra-Pubic endo Cystostomy), a 5 minute, minimally invasive procedure, a new paradigm for suprapubic catheter placement has been established, with zero mortality and a complication rate of 1.8%. T-SPeC has become the enabling technology to propel this transformation of how select patient populations are catheterized, enabling healthcare to effectively address historical high rates of infection (CAUTI and Urosepsis) and non-infectious complications associated with urethral catheterization.
The following list of clinical references represent only a few of more than 400 cited evidence-based studies documenting the benefits of suprapubic catheterization versus urethral catheterization. For access to the entire clinical reference library cited, register here.
