Initiative Curbs ED Urinary Catheterization in Febrile Kids

By David Douglas

June 03, 2016

NEW YORK (Reuters Health) - Screening of urine bag specimens for urinary tract infections (UTIs) can obviate catheterization in many very young febrile emergency department (ED) patients, according to Pennsylvania-based researchers.

As Dr. Jane M. Lavelle told Reuters Health by email, "It is important to consider UTI as a source of fever in some febrile babies and toddlers. However, a two-step process using urine specimens obtained via a bag can spare many the more painful process of urethral catheterization."

"If the urine obtained via bag does not show evidence of possible infection," she added, "a urine culture, which must be obtained by urethral catheterization in children who are not toilet trained, is no longer needed."

In a June 2 online paper in Pediatrics, Dr. Lavelle, of Children's Hospital of Philadelphia, and colleagues note that before the intervention on average 63% of children 6 to 24 months old underwent catheterization. None was screened by urine bag, however. Cultures were positive in only 4.3%.

Children of this age group, the investigators point out, make up about 20% of the more than 90,000 patients attending the pediatric ED annually and about 22% of them present with a chief complaint of fever.

After preliminary studies, monitoring, education, and other preparation, the process was put in place. Parents were instructed to encourage oral fluid intake and bags were used for urine collection and subsequent screening.

During the six-month intervention, 69% of 828 children were screened for UTI. However, most had a urine bag as the first step. Only 16% had catheterization as the first step. A further 14% went on to catheterization, generally because of positive bag screening results.

Thus, overall, say the investigators, urethral catheterization rates were reduced by more than half, from 63% to less than 30% -- sparing more than 350 patients the painful catheterization procedure.

The screening process, they add, "can be instituted in a high-volume ED without increasing length of stay or missing cases of UTI."

"The next phase of this initiative," the researchers conclude, will help determine how best to approach managing younger children, who currently are still screened via urinary catheterization."

Commenting on the findings by email, Dr. Sanjay Saint told Reuters Health, "The authors do a nice job of describing a quality improvement intervention that may improve the safety of children."

Dr. Saint, who is director of the Ann Arbor VA Medical Center/University of Michigan Patient Safety Enhancement Program, concluded, "Avoiding the use of an indwelling catheter has the potential to reduce both infectious and non-infectious complications of catheterization."

The authors reported no funding or disclosures.


Pediatrics 2016.