Intervention Review

Urinary catheter policies for short-term bladder drainage in adults

  1. Barbara S Niël-Weise1,*,
  2. Peterhans J van den Broek2

Editorial Group: Cochrane Incontinence Group

Published Online: 20 JUL 2005

Assessed as up-to-date: 28 MAY 2006

DOI: 10.1002/14651858.CD004203.pub2


How to Cite

Niël-Weise BS, van den Broek PJ. Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004203. DOI: 10.1002/14651858.CD004203.pub2.

Author Information

  1. 1

    Leiden University, Medical Centre, Leiden, Netherlands

  2. 2

    Leiden University Medical Center, Department of Infectious Diseases, 2300 RC Leiden, Netherlands

*Barbara S Niël-Weise, Medical Centre, Leiden University, C9-43 Box 9600, 2300 RC , Leiden, 0031, Netherlands. B.S.Niel-Weise@lumc.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JUL 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Indwelling urinary catheters are often used for bladder drainage during hospital care. Urinary tract infection is a common complication. Other issues that should be considered when choosing an approach to catheterisation are patients' comfort, other complications/adverse effects, and costs.

Objectives

To determine the advantages and disadvantages of alternative approaches to catheterisation for short-term bladder drainage in adults.

Search methods

We searched the Cochrane Incontinence Group Specialised Register (searched 29 May 2006). Additionally, we examined all reference lists of identified trials.

Selection criteria

All randomised and quasi-randomised trials comparing catheter route of insertion for adults catheterised for up to 14 days.

Data collection and analysis

Data were extracted by both reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the data in trials had not been fully reported, clarification was sought directly from the authors.

Main results

Seventeen parallel-group randomised controlled trials met the inclusion criteria.

Fourteen trials compared indwelling urethral catheterisation with suprapubic catheterisation. Groups managed with an indwelling catheter had more cases of bacteriuria (RR 2.60; 95%CI 2.12 to 3.18), more frequent recatheterisation (RR 4.12; 95%CI 2.94 to 7.56), and more people with discomfort (RR 2.98; 95%CI 2.31 to 3.85). There were no reports of complications during insertion, although not all trials stated this explicitly.

Three trials compared indwelling urethral catheterisation with intermittent catheterisation. In the two trials with data, there were fewer cases of bacteriuria in the intermittent catheterisation group (RR 2.90; 95%CI 1.44 to 5.84). Costs analyses reported in two trials favoured the indwelling group.

Authors' conclusions

There was evidence that suprapubic catheters have advantages over indwelling catheters in respect of bacteriuria, recatheterisation and discomfort. The clinical significance of bacteriuria was uncertain, however, and there was no information about possible complications or adverse effects during catheter insertion.

There was more limited evidence that the use of intermittent catheterisation was also associated with a lower risk of bacteriuria than indwelling urethral catheterisation, but might be more costly. Using intermittent catheterisation postoperatively limits catheterisation to those people who definitely need it.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Urinary catheter policies for short-term bladder drainage in adults

The most common catheterisation technique for bladder drainage during hospital care is indwelling urethral catheterisation, i.e. putting the catheter through the urethra into the bladder and leaving it there for a few days. Alternatives are suprapubic and intermittent urethral catheterisation. Urinary tract infection is a common complication, which prolong hospital stay, cause unpleasant symptoms such as fever and chills, and sometimes may threaten life by causing septic shock. The review found that inserting the catheter through the abdomen 'suprapubically,' or not leaving a urethral catheter in the bladder but using a catheter intermittently, both reduced the chances of infection. In making a choice, these advantages should be set against possible disadvantages such as injury caused during suprapubic catheter insertion. There was no information about possible complications or adverse effects during catheter insertion. A limitation of the trials was the uncertainty of the clinical significance of bacteriuria.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

成人短程膀胱尿液引流的尿管放置策略

尿管放置是對住院患者常用來幫助尿液引流的方法,而尿道感染是常見的併發症。此篇著重於不同的導尿方法對於患者舒適度併發症及花費的影響。

目標

討論不同導尿方法對於短期尿液引流患者的優缺點。

搜尋策略

搜尋的資料庫包括Cochrane Incontinence Group Specialised Register(至2006年5月29日),同時也搜尋了納入的參考列表。

選擇標準

所有討論需要放置導尿管(最多14天)的患者其相關的隨機/準隨機研究。

資料收集與分析

資料被兩位學者獨立的收集及分析,意見不同處藉由討論而獲得共識,而資料均被顯示在Cochrane Handbook。

主要結論

共有17個隨機平行研究被納入。14個研究比較了尿道及恥骨上的尿管放置。經尿道放置有較多的菌尿症,較高的重新放置機率及較多的不適感。而放置過程導致的併發症則無討論。3個研究討論了放置尿管及間歇導尿,其中2個顯示了間歇導尿有較少的菌尿症,但尿管放置的花費則較少。

作者結論

在減少菌尿症重覆置於及病人不適上恥骨上尿管放置較有優勢,但對於有臨床症狀的菌尿症或是插管造成的併發症則無討論。而間歇導尿相較尿管放置則有較少造成菌尿的機會,但花費較高,間歇導尿對於術後需要短期導尿病人可減少尿管放置的需要。

翻譯人

本摘要由中國醫藥大學附設醫院施欣如翻譯。

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

總結

尿管放置是住院病人最常使用的尿液引流方式(經由尿道使尿管置入膀胱且置留一段時間),其他方法則包括恥骨上尿管及間歇單次導尿。而泌尿道感染是常見的併發症,可能造成住院天數的增加。感染症狀如發燒、發抖,甚至是危及生命的敗血性休克。此篇討論結論出恥骨上尿管及間歇導尿可減少菌尿的產生,但在臨床決策上,置入恥骨上尿管而造成的併發症及臨床上感染導致症狀也需列入考慮,這是搜尋的資料中較少有證據佐証的。