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Strategies for the removal of short-term indwelling urethral catheters in adults

  • Review
  • Intervention

Authors


Abstract

Background

Approximately 15% to 25% of all hospitalised patients have indwelling urethral catheters, mainly to assist clinicians to accurately monitor urine output during acute illness or following surgery, to treat urinary retention, and for investigative purposes.

Objectives

The objective of this review was to determine the best strategies for the removal of catheters from patients with a short-term indwelling urethral catheter. The main outcome of interest was the number of patients who required recatheterisation following removal of indwelling urethral catheter.

Search methods

We searched the Cochrane Incontinence Group Specialised Register (searched 7 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (January 1966 to 12 July 2006), EMBASE (January 1980 to 12 July 2006), CINAHL (January 1982 to 12 July 2006), Nursing Collection (January 1995 to January 2002) and reference lists of relevant articles and conference proceedings were searched. We also contacted manufacturers and researchers in the field. No language or other restrictions were applied.

Selection criteria

All randomised and quasi-randomised controlled trials (RCTs) that compared the effects of alternative strategies for removal of short-term indwelling urethral catheters on patient outcomes were considered for inclusion in the review.

Data collection and analysis

Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Relative risks (RR) for dichotomous data and a weighted mean difference (WMD) for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately.

Main results

Twenty six trials involving a total of 2933 participants were included in the review. One trial included three treatment groups.

In 11 RCTs amongst 1389 people, there was no significant difference in need for recatheterisation, although recatheterisation after removal at night was more likely to be during working hours. Pooled results demonstrated that, following urological surgery and procedures, patients whose indwelling urethral catheters were removed at midnight passed significantly larger volumes at their first void (Difference (fixed) 96 ml; 95% CI 62 to 130). Similar findings were reported for patients following TURP (Difference (fixed) 27; 95% CI 23 to 31). Removal at midnight was also associated with longer time to first void, and shorter lengths of hospitalisation (relative risk of not going home on day of removal = 0.71, 95% CI 0.64 to 0.79).

Results in 13 trials amongst 1422 participants having early rather than delayed catheter removal were consistent with a higher risk of voiding problems and a lower risk of infection, with shorter hospitalisation.

In three trials involving 234 participants the data were too few to assess differential effects of catheter clamping compared with free drainage prior to withdrawal. No eligible trials compared flexible with fixed duration of catheterisation, or assessed prophylactic alpha sympathetic blocker drugs prior to catheter removal.

Authors' conclusions

There is suggestive but inconclusive evidence of a benefit from midnight removal of the indwelling urethral catheter. There are resource implications but the magnitude of these is not clear from the trials. The evidence also suggests shorter hospital stay after early rather than delayed catheter removal but the effects on other outcomes are unclear. There is little evidence on which to judge other aspects of management, such as catheter clamping.

摘要

背景

移除成人身上短期導尿管的策略

大約有15%∼25%的住院病人有被置放導尿管,主要是為了在急性病程中或手術後來監測病人的排尿量、處理病人尿液滯留的問題以及為了臨床研究調查的理由。

目標

這篇回顧文章的目的在於判定移除短期尿管最好的方式。我們最關切的結果是在移除短期尿管後有多少病人會需要再次放置導尿管。

搜尋策略

搜尋了以下:Cochrane Incontinence Group Specialised Register(2005/12/7)、Cochrane Central Register of Controlled Trials (Cochrane Library 2006, Issue 2), MEDLINE (January 1966 to 12 July 2006), EMBASE (January 1980 to 12 July 2006), CINAHL (January 1982 to 12 July 2006), Nursing Collection (January 1995 to January 2002)以及其參考資料與相關文獻。我們也有與投身與此領域的學者做接觸。過程中並沒有語言或是一些其他方面的限制。

選擇標準

所有根據病人移除短期尿管後的結果來比較不同移除短期導尿管方式優缺的隨機化/半隨機化臨床試驗(RCTs)都被囊括在這篇回顧文章中。

資料收集與分析

由兩位專家分別去評估所收納的文章的合格性、各個試驗的細節與試驗所使用的方法。二元資料的相對危險性與連續性資料的加總平均差都被要求在95%信賴區間中。

主要結論

這篇文章回顧了26個臨床試驗,囊括了2933名受試者。在收納了1389位受試者的11個試驗中,雖然大部分的人會比較偏好在白天拔除,但資料顯示在白天與在夜晚移除導尿管並沒有明顯的差異。橫斷面的時間序列資料顯示在泌尿科的手術或介入後放置導尿管的病人,若是在午夜移除導尿管,能夠在移除尿管後之後的第一次排尿有明顯較大量的尿量(差異數:96ml,95%信賴區間:62∼130ml)。在接受過TURP的病人身上也有類似的發現(差異數:27ml,95%信賴區間:23∼31ml)。在午夜移除導尿管的病人被發現與較短的住院天數(在白天移除導尿管後住院天數的RR值:0.71,95%信賴區間:0.64∼0.79)。在另外收編了1422名受試者的13個試驗中則顯示:較早移除導尿管與較多的排尿問題、較低的感染機率和較短的住院天數有密切關係。 在其中收納了234位受試者的3個試驗,資料則是不足以評估在移除導尿管前將尿管箝緊來訓練膀胱是否真有其效果。並沒有符合我們收納文獻標準的試驗能夠比較單次導尿與放置導尿管的優缺,也不足以評估在移除導尿前給予alphablocker是否真有其益。

作者結論

在午夜移除導尿管為較建議但仍具討論空間的方式。也有一些證據顯示較早移除導尿管與較短的住院時間有其相關,但之於其他的相關結果則並不清楚其相關性。並沒有證據顯示其他的處置例如移除導尿管前的箝制訓練是否真有其益。

翻譯人

本摘要由中國醫藥大學附設醫院蔡宛真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於住院病人移除短期導尿管的方式: 住院病人常因其急性病程或是接受手術之後而需要放置導尿管來幫助膀胱中尿液的排空。放置導尿管潛在的可能併發症有感染、組織的傷害與病人的不適。這篇回顧文章收集了26個希望能找出最佳移除短期導尿管方式的臨床試驗。其中有11個研究比較了在夜晚或早晨移除導尿管的結果,指出在午夜移除導尿管的病人比較能夠在較長時間後自解出較大量的尿量,但結果還是會因人而異。若以移除之後會因為尿液滯留而需要再次置放導尿管的病人數目來比較,在夜晚或是早晨移除導尿管並沒有明顯的差異。然而在午夜移除導尿管的病人卻顯著地較早晨移除尿管的病人能夠較早出院。在其中13個臨床試驗中發現,較短的放置導尿管時間與較短的住院天數和較低的受感染風險息息相關。在其中3個試驗的資料則是不足以評估在移除前的箝制尿管、誘導膀胱尿液體積填充對病人的結果真有其幫助。

Plain language summary

Strategies for removing catheters used in the short term to drain urine from the bladder in hospitalised patients

Patients in hospital with a brief severe illness or following surgery may have a tube placed into the passage from the bladder (an in-dwelling urethral catheter). Potential complications are infection, tissue damage and patient discomfort. This review identified 26 controlled trials looking at the best strategies for removal of catheters. In 11 studies comparing late night versus early morning removal, removal at midnight resulted in a longer time to first void and patients passing significantly larger volumes, although these findings varied widely. There was no apparent effect on the number of patients who required recatheterisation because of subsequent urinary retention, but patients with catheters removed at midnight were discharged from hospital significantly earlier than those with morning removal. Based on findings from 13 trials, limiting how long a catheter was left in place was linked to a shorter stay in hospital and less risk of infection. The information available from three trials was too limited to assess whether clamping prior to removal, to simulate normal filling of the bladder, improved outcomes.

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