PD05-02 POTENTIAL BENEFITS OF A DEDICATED DIFFICULT URINARY CATHETER(DUC) TEAM: THE 4-YEAR EXPERIENCE AT A SINGLE INSTITUTION

Abstract

INTRODUCTION AND OBJECTIVE: Difficult access with urinary catheter remains a common issue with practicing urologists and other members of the hospital team. A combination of anatomic and iatrogenic factors can contribute to issues with foley placement in both male and female patients. In teaching hospitals, residency programs allow for triage of catheter issues and generally communication of problems of insertion prompt physician contact from nursing staff. According to CDC 2018, 12-18% of adults admitted to hospital will have an indwelling catheter inserted some time during inpatient stay. Of all urology consultations, an estimated six percent are directly related to complications related to failed catheter attempts. This study reviews a single institution's 4-year experience with a hospital team dedicated to difficult urinary catheter (DUC) placement., METHODS: A retrospective review was performed over a period from May 2013 to May 2017. In October 2012, 34 nurses in 3 high volume inpatient units and the emergency department were trained as part of the team. An algorithm was formulated and the DUC team was consulted in cases of history of DUC placement, radical prostatectomy or prostate procedure, urethral stenosis, pelvic radiation, hypospadias, or difficult visibility of the meatus. No more than 2 attempts at foley placement were performed prior to calling the DUC team. For placement, 10 cc of 2% lidocaine was infused 2-5 minutes prior and 18 french coude was selected in cases of BPH or 12 french silastic in urethral stenosis. All cases of consultation were recorded along with type of catheter, number of attempts, duration of attempt, time of day, and success of placement., RESULTS: Over this four-year period, a total of 529 patients underwent evaluation by the DUC team at our institution. The average number of attempts was 2.4 for catheter placement with an average duration of 35 minutes. Of these attempts, 88.6% were successful by the team without physician consultation. Timing of difficult catheter placement was during the day (6 A.M. to 6 P.M.) in 65% of cases. The most common catheter used in successful placement in men was an 18 french coude (35%) and in women a standard 16 french foley (31%)., CONCLUSIONS: The review of our DUC team date demonstrates the potential role and success of this program in the hospital. The algorithm and teaching provide and inexpensive method to reduce unnecessary consultation and potential iatrogenic injury leading to surgery. A reduction of 408 consultations over this period emphasizes this benefit. The DUC team continues to serve as an invaluable resource and could be adopted by other institutions in the future., Source of Funding: None, (C) 2020 by the American Urological Association, Inc.