6 Perioperative Urinary Catheterisation in Hip Fracture Patients

There are currently no national guidelines, in the UK, advising when to catheterize hip fracture patients and when to trial without a catheter (TWOC). We audited the practice in a UK teaching hospital where there is a consultants’ consensus that all patients should be catheterized on the day of admission (or day of surgery; which is usually within 36 hours of admission) and TWOC as soon as possible within 72 hours postoperatively. We also correlated delays in TWOC with urinary tract infection (UTI) rates. Methods Audit of consecutive hip fracture patients who had undergone surgery. Patients who had long term indwelling urinary catheter were excluded. Data collected include: demographics and date and time of admission, catheterisation, operation and TWOC, also duration of catheter post operatively, reason if TWOC delayed and whether the patient had a UTI. Results 43 patients were included; 30 males and 13 females with a mean age of 82.9 and 83.9 years respectively. Urinary catheters were inserted in 100% of patients preoperatively. Overall 23% of patients had a UTI. There were more UTIs with prolonged catheterization. The results are summarised in the table. The reason for delaying a TWOC was not documented in any of patients’ notes. Discussion The low rate of TWOC within 72 hours can be attributed to:Lack of clear guidelinesReluctance to have a TWOC for older patients with poor postoperative mobility with concerns regarding inability to reach the toilet timely.Reluctance to have a TWOC for those who did not open their bowels postoperatively.Time and resources pressure. Conclusion and recommendations National guidelines for urinary catheterisation in hip fracture patients are needed meanwhile Orthopaedic Department guidelines will improve the care in these patients. Patients should have a urinary catheter “passport” documenting the date of insertion, expected date of TWOC and the reasons for delaying TWOC. It is important to educate the team about the importance of TWOC as early as possible and improve communication.