Urinary catheterization

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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

For more information, see: Urinary tract infection.

Preventing cross infection (nosocomial infection) of the urinary tract is a national priority in the United States.[2][3] Regarding short-term catheterization:

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.[9]
  • It is not clear what methods of intermittent catheterization are best according to at systematic review by the Cochrane Collaboration.[10]

Removal of urinary catheters

For more information, see: urinary retention.

Retained volumes of more than 900 ml indicated reduced chance of successful removal of the catheter.[11] One protocol only inserts a urinary catherter for post-operative retention if the bladder is estimated to contain 500 ml or more of urine estimated by bladder scanning.[12]

Selected randomized controlled trials of adrenergic alpha-antagonists prior to removal of a catheter for acute urinary retention in men.[13][14][15]
Trial Adrenergic alpha-antagonist Result
Lucas[13]
2002		 Tamsulosin 0.4 mg once daily for ≤ 8 days Benefit
Alfaur study[14]
2005		 Alfuzosin 10 mg once daily for 3 days Benefit
Tibung (unpublished)
2006		 Alfuzosin 10 mg once daily for 2 days Insignificant benefit
Shah[15]
2005		 Alfuzosin 5 mg twice daily for 36 hours and then again for 2 weeks
(Alfuzosin half life is 10 hours)		 No benefit

Adrenergic alpha-antagonists might be effective (residual volume of <200 ml after removal of catheter) according to a systematic review by the Cochrane Collaboration.[16] This review found four trials of alfuzosin (10 mg once daily or 5 mg twice daily)[14] and one of tamsulosin (0.4 mg once daily)[13]. 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 of 11 randomized controlled trials, including one of nonsurgical patients[17], by the Cochrane Collaboration.[18]

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."[8]

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 of thirteen randomized controlled trials, including one trial of non-surgical patients[11], by the Cochrane Collaboration.[18]

Intermittent clamping of catheters is of uncertain benefit.[19][18] 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. [20]

References

  1. ↑ Anonymous (2024), Urinary catheterization (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Anonymous (2009). HHS Action Plan to Prevent Healthcare-Associated Infections: Executive Summary. U.S. Department of Health & Human Services. Retrieved on 2009-01-07.
  3. ↑ Anonymous (2009). HHS Action Plan to Prevent Healthcare-Associated Infections: Prevention – Prioritized Recommendations. U.S. Department of Health & Human Services. Retrieved on 2009-01-07.
  4. ↑ 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.
  5. ↑ Schumm K, Lam TB (2008). "Types of urethral catheters for management of short-term voiding problems in hospitalised adults.". Cochrane Database Syst Rev (2): CD004013. DOI:10.1002/14651858.CD004013.pub3. PMID 18425896. Research Blogging.
  6. ↑ Niël-Weise BS, van den Broek PJ (2005). "Antibiotic policies for short-term catheter bladder drainage in adults.". Cochrane Database Syst Rev (3): CD005428. DOI:10.1002/14651858.CD005428. PMID 16034973. Research Blogging.
  7. ↑ 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.
  8. ↑ 8.0 8.1 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 11.0 11.1 Taube M, Gajraj H (February 1989). "Trial without catheter following acute retention of urine". Br J Urol 63 (2): 180–2. PMID 2641206. [e] Cite error: Invalid <ref> tag; name "pmid2641206" defined multiple times with different content
  12. ↑ Lau H, Lam B (2004). "Management of postoperative urinary retention: a randomized trial of in-out versus overnight catheterization.". ANZ J Surg 74 (8): 658-61. DOI:10.1111/j.1445-1433.2004.03116.x. PMID 15315566. Research Blogging.
  13. ↑ 13.0 13.1 13.2 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.
  14. ↑ 14.0 14.1 14.2 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.
  15. ↑ 15.0 15.1 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.
  16. ↑ Zeif HJ, Subramonian K (2009). "Alpha blockers prior to removal of a catheter for acute urinary retention in adult men.". Cochrane Database Syst Rev (4): CD006744. DOI:10.1002/14651858.CD006744.pub2. PMID 19821385. Research Blogging.
  17. ↑ Webster J, Osborne S, Woollett K, Shearer J, Courtney M, Anderson D (2006 Mar-Apr). "Does evening removal of urinary catheters shorten hospital stay among general hospital patients? A randomized controlled trial.". J Wound Ostomy Continence Nurs 33 (2): 156-63. PMID 16572016.
  18. ↑ 18.0 18.1 18.2 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. Cite error: Invalid <ref> tag; name "pmid17443536" defined multiple times with different content
  19. ↑ 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]
  20. ↑ Bass LS et al. (1994), Manual of Critical Care Procedures, Springhouse, ISBN 0-87434-691-6, p. 425
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