Intermittent catheterization
Excellent 1111
20180510013410unit_4__assignment___intermittent_catheterization1.pptxMN504: Scientific and Analytic Approaches to Advanced Evidence-Based Practice
Professor Rita Brennan
February 26, 2015
Intermittent Catheterization
Clinical Inquiry
Reason for Inquiry
Hospitals all over the United States are exploring new methods to lower the number of urinary tract infections related to the use of urinary catheters.
Based on evidence-based information, intermittent catheterization has been used as an intervention to lower such incidence.
Looking to further analyze the results of intermittent catherization in decreasing infection rates I posed the following PICOT question.
PICOT
How effective is it to reinsert urinary catheters for acute urinary retention versus intermittent catheterization on an ICU patient in decreasing the incidence of urinary tract infections within 90 days?
Clinical Inquiry
Data Bases Used
CINHAL Database
Cochrane Database
MEDLINE Database
Key Words Used For Search
Bladder Drainage
Intermittent Catheterization
Urinary Tract Infections and Hospitalizations
Urinary Catheter Infections
CAUTI
Cochrane Database
Using key words ‘urinary retention’ one relevant study was identified.
The study compared
Indwelling urethral catheterization versus suprapubic catheterization;
Indwelling urethral catheterization versus intermittent catheterization;
Suprapubic catheterization versus intermittent catheterization. (Niël-Weise., & van den Broek, 2005)
Review of Evidence
This study was a Level 1 study because it was a review of RCT and their own data that was collected.
This study was a randomized and quasi randomized study that was comparing alternatives to indwelling catheterization with short term catheterization in adults.
In this study there were three trials reviewed, that were all parallel randomized groups.
The data describing bacteriuria were available from two of the three eligible trials; in both, rates were higher in the urethral catheterization group (RR of the meta-analysis 2.90, 95% CI 1.44 to 5.84, Comparison 02.02.01; Dobbs 1997; van den Brand 2001).( Niël-Weise., & van den Broek, 2005)
(Niël-Weise., & van den Broek, 2005)
This chart represents the incidence of
6
RBIC (R) -
Review of Evidence
Although great attention was placed to the randomization of the study and review of literature, there was not sufficient clinical data that supported the idea of using intermittent catheterization as a direct method to decrease the incidence of infection.
The study was limited since only three patients were used, two of the patients were post operative hip replacements and one female post total hysterectomy.
A more diverse and larger group would have been beneficial in further identifying infection rates.
It was however identified that urinary catheters had the greatest incidence of infection but was not specific as to probable cause (time of use, comorbidity, or acute retention).
Medline Database Results
The MEDLINE database was used to search the key words, intermittent catheterization and indwelling urinary catheters.
The study reviewed was identified as a level 1 study where the objective of the study was to compare clean intermittent catheterization with transurethral indwelling catheterization for the treatment of abnormal post-void residual bladder volume in post surgical patients specifically post vaginal prolapse.
This study was used because it compared both interventions and had a notable sized number of participants.
Study Results
This study identified that a significantly lower risk of bacteriuria and UTI was found in the CIC (clean intermittent catheterization)group (14 versus 38%; P = 0.02).
The risk of UTI was also significantly lower in the CIC group (12 versus 33%; P = 0.03). (Hakvoort et al., 2011)
There was also a larger number of participants, 87 total, 45 patients were randomized in the CIC group and 42 patients were randomized in the TIC group.
Data Analysis
Table 2. Comparison of required duration of catheterization,
bacteriuria, number of catheterizations and hospitalization
CIC (n = 45) TIC (n = 42) P
Bacteriuria 6 (14) 15 (38) 0.02*
Urinary tract infection 5 (12) 13 (33) 0.03*
Duration of catheterization (hours) 18 (5–112) 72 (72–144) <0.001**
Number of catheter introductions 3 (1–18) 1 (1–2) <0.001**
Duration of hospitalization (days) 2 (1–2) 4 (1–7) <0.001**
Data are presented as median (range) or n (%).
*Mann–Whitney U-test.
**Fisher’s exact test.
(Hakvoort et al., 2011)
From this table we can identify that the incidence of bacteriuria with the use of clean intermittent catheterization was less half of those than the patient who had a transurethral indwelling catheter. (Hakvoort et al., 2011)
Review of Evidence
This study was not initially going to be chosen because of its specificity to a patient population but the data interpreted in the study could be applied to all patient populations.
The trials were randomized and patients were randomly selected to be intermittently catheterized or have indwelling catheters as part of their care for acute urinary retention.
Particular interest was given to incidence of infection with both methods which contributes to an understanding of which method may be the best practice to control infection rates.
Conclusion
The studies reviewed yielded a good amount of information to indicate that indwelling catheters yield a higher infection rate than intermittent catheterization.
Further review of data and research connecting the two interventions needs to be addressed to validate the PICOT question.
Most of the literature reviewed placed strong interest in removal of IUC per evidenced based protocols but did not identify their suitable alternatives as contributors of lower incidence of infection.
References
Hakvoort, R. A., Thijs, S. D., Bouwmeester, F. W., Broekman, A. M., Ruhe, I. M., Vernooij, M. M.,
& ... Roovers, J. P. (2011). Comparing clean intermittent catheterization and transurethral indwelling catheterization for incomplete voiding after vaginal prolapsed surgery: a multicentre randomized trial. BJOG: An International Journal Of Obstetrics And Gynecology, 118(9), 1055-1060. doi:10.1111/j.1471-0528.2011.02935.x
Niël-Weise, B.S., & van den Broek, P.J. 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 Johnson, X. Y.
URETHRAL CATHETERISATION VS INTERMITTENT
CATHETERISATION
Outcome or subgroup title
No. of
studies
No. of
participants Statistical method Effect size
1 Number of patients with no return of normal
bladder function 48 h after surgery 1
Risk Ratio (M-H,
Fixed, 95% CI)
Totals not
selected
2 Bacteriuria (symptomatic and asymptomatic) 2
Risk Ratio (M-H,
Fixed, 95% CI) Subtotals only
2.1 Overall
2 194
Risk Ratio (M-H,
Fixed, 95% CI)
2.90 [1.44,
5.84]
2.2 Male
1 27
Risk Ratio (M-H,
Fixed, 95% CI)
11.79 [0.72,
194.19]
2.3 Female
1 72
Risk Ratio (M-H,
Fixed, 95% CI)
2.36 [0.64,
8.73]
3 Urinary symptoms immediately after surgery 1
Risk Ratio (M-H,
Fixed, 95% CI)
Totals not
selected
4 Postoperative pyrexia 1
Risk Ratio (M-H,
Fixed, 95% CI)
Totals not
selected
5 Costs per patient for the first 48 hours after
surgery
Other data
No numeric
data
