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Less Is More
February 2015

A Urinary Catheter Left in Place for Slightly Too Long: A Teachable Moment

Author Affiliations
  • 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2015;175(2):163. doi:10.1001/jamainternmed.2014.6583

A man in his 80s with a history of mild cognitive impairment and benign prostatic hypertrophy presented to our hospital in septic shock, presumed secondary to pyelonephritis. His medical history included nonvalvular atrial fibrillation, for which he took warfarin. He was initially febrile (temperature, 38.4°C), tachycardic (pulse rate, 111/minute), and hypotensive (systolic blood pressure <90 mm Hg). His international normalized ratio was 3.37, so warfarin was held. He was initially resuscitated with intravenous fluids and prescribed piperacillin-tazobactam empirically.