Indwelling Urinary Catheters: A One-Point Restraint?

More than four decades ago, Dr. Paul Beeson persua-sively argued against routine use of indwelling uri-nary catheters in hospitalized patients, making the “case against the catheter ” (1). He urged, “The decision to use this instrument should be made with the knowledge that it involves risk of producing a serious disease ” (1). This ad-vice remains relevant today. Although these devices provide indispensable benefits, they are also the dominant risk fac-tor for hospital-acquired urinary tract infection, the most common nosocomial infection in the United States (2). Infections and other untoward effects associated with in-dwelling urinary catheters lead to increased health care costs, patient discomfort, morbidity, and even death (3–6). Regrettably, unjustified and excessively prolonged catheter use persists despite clear evidence of its detrimen-tal effects (7–9). Indwelling catheters have the practical effect of needlessly confining patients in what could be called a “one-point ” restraint, raising serious safety and ethical concerns analogous to those noted more than a decade ago with “four-point ” (limb) restraints. Lessons learned from efforts to curtail the use of physical restraints may help identify strategies for diminishing the use of in-dwelling urinary catheters