Urinary Catheterizations and Lack of Informed Consent
A urinary catheter is a hollow flexible tube
inserted into the bladder to drain urine. This catheter drains
urine from your bladder into a bag outside your body. Common
reasons for a urinary catheter include staff convenience, urine
leakage (incontinence), urinary retention, certain surgeries
such as prostatectomy, and surgery lasting more than three hours.
Staff convenience is a very common reason for the use of indwelling
catheters, and one which is recommended against by many universities
and government organization. There is the perception that it
is more convenient for nurses to place a catheter rather than
take the patient out of the bed several times a day to change
bed sheets and clothing, to help him/her to use a bed pan or
walk to the bathroom, and to change diapers. Nurses should never
use those reasons to catheterize patients. Foley catheters
are not appropriate as a treatment for incontinence.
Many people feel that urinary catheterizations
are an invasion of their bodily privacy even if they are done
by a nurse or doctor of the same gender especially when they
are not really necessary. Patient modesty is not the only concern
with urinary catheters. You easily get infections or injuries
from urinary catheters. Urinary catheters are the number
one cause of hospital-acquired infections. About 80%
of hospital-acquired urinary tract infections are related to
urinary catheters. About 10% to 30% of male urinary catheterizations
result in urethral injury. Check out complications
that can occur from urinary catheters.
While it is true that some hospitals and medical facilities
have worked to decrease the number of urinary catheterizations
on patients due to concerns about infections, many medical facilities
in the United States continue to do many unnecessary urinary
catheterizations. Outpatient Surgery clinics typically do less
urinary catheterizations than hospitals.
Urinary catheter is standard for many surgeries that
do not really require them at some medical facilities.
One man who had a simple neck surgery in a Georgia hospital
was very upset and embarrassed when he woke up and discovered
that he had a urinary catheter. He was not even asked for consent
to have the urinary catheter inserted. Urinary catheter is not
necessary for a simple neck surgery. When his daughter asked
the nurse why he had a Foley catheter, the nurse replied by
saying he needed one because he could not walk. A patient’s
inability to walk is not a reason for a urinary catheter. Unfortunately,
what happened to this man is pretty common.
Some patients have urinary catheters inserted
when they go under anesthesia and then removed before they wake
up so they are unaware that they had a catheter unless they
find out from their records or had difficulty urinating or felt
burning sensation as they urinated after they woke up from surgery.
This is very unethical.
Some medical facilities allow nursing students to practice inserting
urinary catheters on patients under anesthesia without their
consent. This is very unethical. This unethical practice violates
a patient’s wishes for modesty and could cause complications
such as blood infection, Urinary Tract Infection, urethral injury,
etc. Because nursing students have limited experience, they
are more likely to injure patients they catheterize. While it
is true that nursing students need practice with urinary catheterizations
before they graduate from nursing schools, nursing school students
should only do urinary catheterizations that are absolutely
necessary under supervision of an experienced nurse and with
a patient’s consent. Nursing schools should have their
students do urinary catheters on mannequins as much as possible.
Every nursing school should have a urinary catheter simulator
such as a
male catheterization simulator.
When is urinary catheter medically
Neurogenic bladder, acute urinary retention that cannot be
resolved, acute bladder outlet obstruction, end of life comfort
care of a terminal patient, certain surgeries such as prostatectomy
and hysterectomy, prolonged surgical procedure
(not a few hours) with general or spinal anesthesia. Most surgeries
are less than 3 hours long so most surgery patients should not
be catheterized at all.
Different types of anesthesia and effects
on bladder functions:
Local Anesthesia – This type of anesthesia
has no effect on bladder function at all so there is no need
for a urinary catheter if you have local anesthesia. You should
strive to have surgeries such as hand, wrist, etc. with local
anesthesia if possible. Even knee surgeries can be done with
local anesthesia now.
General Anesthesia – In short surgeries
that are not longer than 3 hours, there is usually no effect
on the bladder. The bladder will become distended in longer
cases and the patient could become incontinent over time.
Spinal Anesthesia - Spinal anesthetics block
activity along the nerve fibers that travel between the nerve
centers of the brain and the bladder. Patients lose the sensation
to void about 1 minute after being injected with spinal anesthesia,
but will continue to feel dull pressure as the bladder reaches
full capacity. In addition, the ability to contract the detrusor
muscle is lost 2 to 5 minutes following the injection of local
anesthetics and still persists even after bladder sensation
is fully recovered. Spinal anesthesia with long-acting local
anesthetic therefore contributes more to POUR (Post Operative
Urinary Retention) than spinal anesthesia with short-acting
local anesthetic, since the inhibitory effect of spinal blockade
on bladder function lasts longer. Patients receiving spinal
anesthesia with short-acting local anesthetic are often able
to void shortly after outpatient surgery and are ready to leave
the PACU quickly. (Source: What
Do You Know About Post-Op Urinary Retention? - Outpatient Surgery)
If you have spinal anesthesia, you should request spinal anesthesia
with short-acting local anesthesia to reduce your chances of
Any bladder issues after surgery are most likely due to narcotics
used for pain control.
Every patient should use the bathroom before surgery takes
place. Most surgery patients are asked to not drink anything
for at least 6 hours before surgery so their bladders are empty.
Patients who might become incontinent should be given the option
of wearing disposable waterproof underwear or boxer shorts.
You can buy them before you come to the hospital.
Why is there no informed consent for
No informed consent is required for urinary catheterization.
Despite the common use of urinary catheters and the well-known
risks of complications
associated with urinary catheters, patients are not asked to
sign a written consent that discloses the advantages and disadvantages
of urinary catheters. Rarely are patients informed verbally
of the risks
of urinary catheters. Another concern is that many patients
care deeply about their modesty and would not want a urinary
catheter to be inserted by an opposite sex medical provider.
John Fisher, a medical malpractice lawyer in New York shares
in his article (Why
Consent For Urinary Catheters Should Be Mandatory) that
in evaluating hospital care throughout New York, he has not
seen a single consent form for urinary catheters. Since patients
with urinary catheters have a much higher chance of getting
a urinary tract infection than those who do not have a catheter,
the question must be posed: why is there no informed
consent for urinary catheters?
Do patients really
give “implied consent” to urinary catheterization?
Physicians and nurses will explain the patients give “implied
consent” to urinary catheterization based on the theory
that urinary catheterization is a common and routine part of
hospital treatment. However, informed consent is important for
urinary catheters for the following reasons.
- Urinary catheter complications
pose such a common and significant risk to patients.
- Urinary catheterization is an invasive procedure and embarrassing
for many patients who value their modesty. Every patient should
be given the option of having a same gender nurse or doctor
for the catheter insertion if it is absolutely necessary.
Check out how male
urinary catheterization and female
urinary catheterization are done.
Once given information about the risks and benefits
of urinary catheterization, the patient can make a fully informed
decision whether they wish to accept the risk and if they want
a same gender nurse or doctor to insert the catheter.
What is the downside of consent for urinary catheterizations?
A little more paperwork and time for hospital nurses, but isn’t
a fully informed patient worth this minor sacrifice? Patients
should be informed that urinary catheter insertion involves
the risk of complications, facts about how invasive the procedure
is & their option for same gender nurse, and a specific
consent relating to the pros and cons of a urinary catheter
should be signed by the patient.
If the patient is incapable of making decision about urinary
catheter, a family member should be asked for consent. Check
How A Patient Has a Right To Refuse a Urinary Catheter &
How to Refuse a Urinary
Because there is no informed consent for urinary catheters and
urinary catheter is standard for many surgeries and sick patients
who cannot move, patients and their families must speak up and
take steps to ensure that a urinary catheter is not inserted.
Again, the inability to walk is not a reason to insert a urinary
1.) Request that no urinary catheter be inserted
in writing. Write all over your surgical consent form that you
do not consent to urinary catheter and that your underwear may
not be removed at all for surgeries that do not involve the
genitals. Try to get the consent form the day before surgery
2.) Talk to the surgeon, nurses, and everyone
that will be involved in your care about how you do not permit
a urinary catheter to be inserted and that your underwear must
3.) It would be prudent to have someone that
is not employed by the medical facility such as your spouse
present for your surgery to make sure that they do not give
you any drugs especially Versed against your wishes to make
you become unable to speak up
4.) Type up a document saying that you do not consent to a
urinary catheter and make several copies to give to everyone
involved in your care.
Why Consent For Urinary
Catheters Should Be Mandatory By John Fisher
Do You Know About Post-Op Urinary Retention? - Outpatient Surgery
Catheter Conundrum: Reducing Unnecessary Placement
for indwelling urinary catheter use
patrols: a unique way to reduce the use of convenience urinary
A Patient Has a Right To Refuse a Urinary Catheter & Legal