[Nurse questionnaire survey about the urethral catheterization and clinical analysis of iatrogenic urethral injury].
This study was aimed at determining the status of iatrogenic urethral injury associated with insertion of urethral catheters at our hospital. We studied the data of 32 patients with iatrogenic urethral injury at our hospital. We also carried out a questionnaire survey of 150 nurses who could be in charge of urethral catheter insertions, and conducted an analysis based on the answers obtained from 133 of the 150 nurses (response rate 88.7%). The 32 patients included 14 patients with reduced activity of daily living (ADL) who required assistance in daily life (44%), 4 patients with spinal cord injury (13%), and 4 patients under anesthesia or sedation (13%). Acute complications included sepsis in 5 patients (16%) and septic shock in 3 patients (9%). Long-term urethral catheterization was indicated in all the patients with sepsis. Examination of the responses to the questionnaire showed that while 86% of the nurses said "I inject water to fix the balloon after confirming urine outflow," 7% answered "I inject water into the balloon even if there is no urine outflow"; 46% said "I compress the lower abdomen when there is no urine outflow," 6% said "I perform urinary bladder irrigation," and 48% said "I neither compress the lower abdomen when there is no urinary flow nor perform urinary bladder irrigation". Nearly half of the patients with iatrogenic urethral injury at our hospital had reduced ADL. In the patients in whom long-term catheterization was indicated, urethral injury at the time of regular replacement of a catheter was associated with a high likelihood of sepsis occurring as a complication. Based on the results of the questionnaire, more than 80% of the nurses complied with the rule that water to fix the balloon must be injected only after confirming urinary outflow at the time of inserting a urethral catheter. However, when there was no urine outflow after insertion of the catheter, there were variations in the procedure to handle the situation. In the education of nurses, training on the appropriate actions that must be taken in this situation appears to be important.