Urinary catheterization: Difference between revisions

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imported>Charles G. Hansen
m (→‎Removal of urinary catheters: Spelling -- changed "tow cycles" to "two cycles")
imported>Robert Badgett
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==Removal of urinary catheters==
==Removal of urinary catheters==
{{main|urinary retention}}
{{main|urinary retention}}
From the patient care standpoint, if the patient has had an indwelling catheter for a significant period of time, ''bladder retraining'' may be advisable before removal. This consists of two cycles of clamping the tube for two hours and  releasing it for five minutes, to help restore bladder muscle tone. Since the act of removal often stimulates a strong urge to void, the patient should be given a bedpan or urinal before starting to remove the catheter. <ref name=mCCP>{{citation
Retained volumes of more than 900 ml reduced chance of successful removal of the catheter.<ref name="pmid2641206">{{cite journal |author=Taube M, Gajraj H |title=Trial without catheter following acute retention of urine |journal=Br J Urol |volume=63 |issue=2 |pages=180–2 |year=1989 |month=February |pmid=2641206 |doi= |url= |issn=}}</ref>
| title = Manual of Critical Care Procedures
| publisher = Springhouse | author = Bass LS ''et al.'' | year = 1994
| isbn = 0-87434-691-6
}}, p. 425</ref>


A policy of using of intermittent catheterisation for postoperative patients was "associated with a lower risk of bacteriuria than indwelling urethral catheterisation, but might be more costly...limits catheterisation to those people who definitely need it."<ref name="pmid16034924">{{cite journal |author=Niël-Weise BS, van den Broek PJ |title=Urinary catheter policies for short-term bladder drainage in adults |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD004203 |year=2005 |pmid=16034924 |doi=10.1002/14651858.CD004203.pub2 |url=http://dx.doi.org/10.1002/14651858.CD004203.pub2 |issn=}}</ref>
{| class="wikitable" align="right"
|+ Selected [[randomized controlled trial]]s of [[adrenergic alpha-antagonist]]s prior to removal of a catheter for acute [[urinary retention]] in men.<ref name="pmid15679793">{{cite journal| author=Lucas MG, Stephenson TP, Nargund V| title=Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia. | journal=BJU Int | year= 2005 | volume= 95 | issue= 3 | pages= 354-7 | pmid=15679793
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15679793 | doi=10.1111/j.1464-410X.2005.05299.x }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid15667868">{{cite journal| author=McNeill SA, Hargreave TB, Roehrborn CG, Alfaur study group| title=Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind placebo-controlled study. | journal=Urology | year= 2005 | volume= 65 | issue= 1 | pages= 83-9; discussion 89-90 | pmid=15667868
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15667868 | doi=10.1016/j.urology.2004.07.042 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref><ref name="pmid12361896">{{cite journal| author=Shah T, Palit V, Biyani S, Elmasry Y, Puri R, Flannigan GM| title=Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention. | journal=Eur Urol | year= 2002 | volume= 42 | issue= 4 | pages= 329-32; discussion 332 | pmid=12361896
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12361896 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
! Trial!! [[Adrenergic alpha-antagonist]]!!Result
|-
| Lucas<ref name="pmid15679793"><br/>2002|| [[Tamsulosin]] 0.4 mg once daily for ≤ 8 days|| Benefit
|-
| Alfaur study<ref name="pmid15667868"/><br/>2005|| [[Alfuzosin]] 10 mg once daily for 3 days|| Benefit
|-
| Tibung (unpublished)<br/>2006||[[Alfuzosin]] 10 mg once daily for 2 days||Insignificant benefit
|-
| Shah<ref name="pmid12361896"/><br/>2005||[[Alfuzosin]] 5 mg twice daily for 36 hours and then again for 2 weeks<br/>([[Alfuzosin]] half life is 10 hours)||No benefit
|}


Retained volumes of more than 900 ml reduced chance of successful removal of the catheter.<ref name="pmid2641206">{{cite journal |author=Taube M, Gajraj H |title=Trial without catheter following acute retention of urine |journal=Br J Urol |volume=63 |issue=2 |pages=180–2 |year=1989 |month=February |pmid=2641206 |doi= |url= |issn=}}</ref>
[[Adrenergic alpha-antagonist]]s might be effective (residual volume of <200 ml after removeal of catheter) according to a [[systematic review]] by the [[Cochrane Collaboration]].<ref name="pmid19821385">{{cite journal| author=Zeif HJ, Subramonian K| title=Alpha blockers prior to removal of a catheter for acute urinary retention in adult men. | journal=Cochrane Database Syst Rev | year= 2009 | volume=  | issue= 4 | pages= CD006744 | pmid=19821385
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19821385 | doi=10.1002/14651858.CD006744.pub2 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> This review found four trials of [[alfuzosin]] (10 mg once daily or 5 mg twice daily)<ref name="pmid15667868">{{cite journal| author=McNeill SA, Hargreave TB, Roehrborn CG, Alfaur study group| title=Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind placebo-controlled study. | journal=Urology | year= 2005 | volume= 65 | issue= 1 | pages= 83-9; discussion 89-90 | pmid=15667868
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15667868 | doi=10.1016/j.urology.2004.07.042 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> and one of [[tamsulosin]] (0.4 mg once daily)<ref name="pmid15679793">{{cite journal| author=Lucas MG, Stephenson TP, Nargund V| title=Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia. | journal=BJU Int | year= 2005 | volume= 95 | issue= 3 | pages= 354-7 | pmid=15679793
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15679793 | doi=10.1111/j.1464-410X.2005.05299.x }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>. The [[adrenergic alpha-antagonist]]s were started 24 to 72 hours before trial without a catheter (TWOC) in 4 trials and 8 days prior in one trial.


Regarding how long to wait until a voiding without catheter trial, "a tendency for later removal to be associated with fewer short-term voiding problems, but increasing risk of urinary tract infection, more dissatisfaction and longer hospital stay" according to a [[systematic review]] by the [[Cochrane Collaboration]].<ref name="pmid17443536">{{cite journal |author=Griffiths R, Fernandez R |title=Strategies for the removal of short-term indwelling urethral catheters in adults |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD004011 |year=2007 |pmid=17443536 |doi=10.1002/14651858.CD004011.pub3 |url=http://dx.doi.org/10.1002/14651858.CD004011.pub3 |issn=}}</ref>
Removing the catheter at midnight might be the most effective determinant according to a [[systematic review]] by the [[Cochrane Collaboration]].<ref name="pmid17443536">{{cite journal |author=Griffiths R, Fernandez R |title=Strategies for the removal of short-term indwelling urethral catheters in adults |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD004011 |year=2007 |pmid=17443536 |doi=10.1002/14651858.CD004011.pub3 |url=http://dx.doi.org/10.1002/14651858.CD004011.pub3 |issn=}}</ref>


Removing the catheter at midnight might be the most effective determinant according to a [[systematic review]] by the [[Cochrane Collaboration]].<ref name="pmid17443536">{{cite journal |author=Griffiths R, Fernandez R |title=Strategies for the removal of short-term indwelling urethral catheters in adults |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD004011 |year=2007 |pmid=17443536 |doi=10.1002/14651858.CD004011.pub3 |url=http://dx.doi.org/10.1002/14651858.CD004011.pub3 |issn=}}</ref>
Using intermittent catheterisation for postoperative patients was "associated with a lower risk of bacteriuria than indwelling urethral catheterisation, but might be more costly...limits catheterisation to those people who definitely need it."<ref name="pmid16034924">{{cite journal |author=Niël-Weise BS, van den Broek PJ |title=Urinary catheter policies for short-term bladder drainage in adults |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD004203 |year=2005 |pmid=16034924 |doi=10.1002/14651858.CD004203.pub2 |url=http://dx.doi.org/10.1002/14651858.CD004203.pub2 |issn=}}</ref>


[[Alfuzosin]] 10 mg per day may help<ref name="pmid15126812">{{cite journal |author=McNeill SA, Hargreave TB |title=Alfuzosin once daily facilitates return to voiding in patients in acute urinary retention |journal=J. Urol. |volume=171 |issue=6 Pt 1 |pages=2316–20 |year=2004 |month=June |pmid=15126812 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/00005392-200406000-00048 |issn=}}</ref><ref name="pmid15667868">{{cite journal |author=McNeill SA, Hargreave TB, Roehrborn CG |title=Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind placebo-controlled study |journal=Urology |volume=65 |issue=1 |pages=83–9; discussion 89–90 |year=2005 |month=January |pmid=15667868 |doi=10.1016/j.urology.2004.07.042 |url=http://linkinghub.elsevier.com/retrieve/pii/S0090-4295(04)01071-4 |issn=}}</ref><ref name="pmid10510105">{{cite journal |author=McNeill SA, Daruwala PD, Mitchell ID, Shearer MG, Hargreave TB |title=Sustained-release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo-controlled |journal=BJU Int. |volume=84 |issue=6 |pages=622–7 |year=1999 |month=October |pmid=10510105 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1464-4096&date=1999&volume=84&issue=6&spage=622 |issn=}}</ref> whereas [[alfuzosin]] SR 5mg once daily did not help.<ref name="pmid12361896">{{cite journal |author=Shah T, Palit V, Biyani S, Elmasry Y, Puri R, Flannigan GM |title=Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention |journal=Eur. Urol. |volume=42 |issue=4 |pages=329–32; discussion 332 |year=2002 |month=October |pmid=12361896 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0302283802003196 |issn=}}</ref> [[Tamsulosin]], though less well studied, might have less effect on blood pressure.<ref name="pmid9352699">{{cite journal |author=Buzelin JM, Fonteyne E, Kontturi M, Witjes WP, Khan A |title=Comparison of tamsulosin with alfuzosin in the treatment of patients with lower urinary tract symptoms suggestive of bladder outlet obstruction (symptomatic benign prostatic hyperplasia). The European Tamsulosin Study Group |journal=Br J Urol |volume=80 |issue=4 |pages=597–605 |year=1997 |month=October |pmid=9352699 |doi= |url= |issn=}}</ref>
Regarding how long to wait until a voiding without catheter trial, "a tendency for later removal to be associated with fewer short-term voiding problems, but increasing risk of urinary tract infection, more dissatisfaction and longer hospital stay" according to a [[systematic review]] by the [[Cochrane Collaboration]].<ref name="pmid17443536">{{cite journal |author=Griffiths R, Fernandez R |title=Strategies for the removal of short-term indwelling urethral catheters in adults |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD004011 |year=2007 |pmid=17443536 |doi=10.1002/14651858.CD004011.pub3 |url=http://dx.doi.org/10.1002/14651858.CD004011.pub3 |issn=}}</ref>


Intermittent clamping of catheters is of uncertain benefit.<ref name="pmid16234728">{{cite journal |author=Fernandez RS, Griffiths RD |title=Clamping short-term indwelling catheters: a systematic review of the evidence |journal=J Wound Ostomy Continence Nurs |volume=32 |issue=5 |pages=329–36 |year=2005 |pmid=16234728 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1071-5754&volume=32&issue=5&spage=329 |issn=}}</ref>
Intermittent clamping of catheters is of uncertain benefit.<ref name="pmid16234728">{{cite journal |author=Fernandez RS, Griffiths RD |title=Clamping short-term indwelling catheters: a systematic review of the evidence |journal=J Wound Ostomy Continence Nurs |volume=32 |issue=5 |pages=329–36 |year=2005 |pmid=16234728 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1071-5754&volume=32&issue=5&spage=329 |issn=}}</ref> This consists of two cycles of clamping the tube for two hours and  releasing it for five minutes, to help restore bladder muscle tone. Since the act of removal often stimulates a strong urge to void, the patient should be given a bedpan or urinal before starting to remove the catheter. <ref name=mCCP>{{citation | title = Manual of Critical Care Procedures
| publisher = Springhouse | author = Bass LS ''et al.'' | year = 1994 | isbn = 0-87434-691-6 }}, p. 425</ref>


==References==
==References==
<references/>
<references/>

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In medicine, urinary catheterization is "employment or passage of a catheter into the urinary bladder (urethral catheterization) or kidney (ureteral catheterization) for therapeutic or diagnostic purposes.[1]

Complications

Urinary tract infection

Regarding short-term catheterization:

  • Antiseptic impregnated catheters reduce urinary tract infections according to a systematic review by the Cochrane Collaboration.[2]
  • "Condom catheters is less likely to lead to bacteriuria, symptomatic UTI, or death than the use of indwelling catheters. This protection is especially apparent in men without dementia" according to a randomized controlled trial.[3]
  • Suprapubic catheters "have advantages over indwelling catheters in respect of bacteriuria, recatheterisation and discomfort."[4]

Regarding long-term catheterization and prevention of urinary tract infections:

  • It is not clear what type of catheterization is best according to at systematic review by the Cochrane Collaboration.[5]
  • It is not clear what methods of intermittent catheterization are best according to at systematic review by the Cochrane Collaboration.[6]

Removal of urinary catheters

For more information, see: urinary retention.

Retained volumes of more than 900 ml reduced chance of successful removal of the catheter.[7]

Selected randomized controlled trials of adrenergic alpha-antagonists prior to removal of a catheter for acute urinary retention in men.[8][9][10]
Trial Adrenergic alpha-antagonist Result
LucasCite error: Closing </ref> missing for <ref> tag This review found four trials of alfuzosin (10 mg once daily or 5 mg twice daily)[9] and one of tamsulosin (0.4 mg once daily)[8]. The adrenergic alpha-antagonists were started 24 to 72 hours before trial without a catheter (TWOC) in 4 trials and 8 days prior in one trial.

Removing the catheter at midnight might be the most effective determinant according to a systematic review by the Cochrane Collaboration.[11]

Using intermittent catheterisation for postoperative patients was "associated with a lower risk of bacteriuria than indwelling urethral catheterisation, but might be more costly...limits catheterisation to those people who definitely need it."[4]

Regarding how long to wait until a voiding without catheter trial, "a tendency for later removal to be associated with fewer short-term voiding problems, but increasing risk of urinary tract infection, more dissatisfaction and longer hospital stay" according to a systematic review by the Cochrane Collaboration.[11]

Intermittent clamping of catheters is of uncertain benefit.[12] This consists of two cycles of clamping the tube for two hours and releasing it for five minutes, to help restore bladder muscle tone. Since the act of removal often stimulates a strong urge to void, the patient should be given a bedpan or urinal before starting to remove the catheter. [13]

References

  1. ↑ Anonymous (2024), Urinary catheterization (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Schumm K, Lam TB (2008). "Types of urethral catheters for management of short-term voiding problems in hospitalized adults: a short version Cochrane review". Neurourology and urodynamics 27 (8): 738–46; discussion 747–8. DOI:10.1002/nau.20645. PMID 18951451. Research Blogging.
  3. ↑ Saint S, Kaufman SR, Rogers MA, Baker PD, Ossenkop K, Lipsky BA (July 2006). "Condom versus indwelling urinary catheters: a randomized trial". Journal of the American Geriatrics Society 54 (7): 1055–61. DOI:10.1111/j.1532-5415.2006.00785.x. PMID 16866675. Research Blogging.
  4. ↑ 4.0 4.1 Niël-Weise BS, van den Broek PJ (2005). "Urinary catheter policies for short-term bladder drainage in adults". Cochrane Database Syst Rev (3): CD004203. DOI:10.1002/14651858.CD004203.pub2. PMID 16034924. Research Blogging.
  5. ↑ Jahn P, Preuss M, Kernig A, Seifert-Hühmer A, Langer G (2007). "Types of indwelling urinary catheters for long-term bladder drainage in adults". Cochrane database of systematic reviews (Online) (3): CD004997. DOI:10.1002/14651858.CD004997.pub2. PMID 17636782. Research Blogging.
  6. ↑ Moore KN, Fader M, Getliffe K (2007). "Long-term bladder management by intermittent catheterisation in adults and children". Cochrane database of systematic reviews (Online) (4): CD006008. DOI:10.1002/14651858.CD006008.pub2. PMID 17943874. Research Blogging.
  7. ↑ Taube M, Gajraj H (February 1989). "Trial without catheter following acute retention of urine". Br J Urol 63 (2): 180–2. PMID 2641206. [e]
  8. ↑ 8.0 8.1 Lucas MG, Stephenson TP, Nargund V (2005). "Tamsulosin in the management of patients in acute urinary retention from benign prostatic hyperplasia.". BJU Int 95 (3): 354-7. DOI:10.1111/j.1464-410X.2005.05299.x. PMID 15679793. Research Blogging.
  9. ↑ 9.0 9.1 McNeill SA, Hargreave TB, Roehrborn CG, Alfaur study group (2005). "Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind placebo-controlled study.". Urology 65 (1): 83-9; discussion 89-90. DOI:10.1016/j.urology.2004.07.042. PMID 15667868. Research Blogging.
  10. ↑ Shah T, Palit V, Biyani S, Elmasry Y, Puri R, Flannigan GM (2002). "Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention.". Eur Urol 42 (4): 329-32; discussion 332. PMID 12361896.
  11. ↑ 11.0 11.1 Griffiths R, Fernandez R (2007). "Strategies for the removal of short-term indwelling urethral catheters in adults". Cochrane Database Syst Rev (2): CD004011. DOI:10.1002/14651858.CD004011.pub3. PMID 17443536. Research Blogging.
  12. ↑ Fernandez RS, Griffiths RD (2005). "Clamping short-term indwelling catheters: a systematic review of the evidence". J Wound Ostomy Continence Nurs 32 (5): 329–36. PMID 16234728. [e]
  13. ↑ Bass LS et al. (1994), Manual of Critical Care Procedures, Springhouse, ISBN 0-87434-691-6, p. 425
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