1
Running head: TYPES OF CATHETERIZATION
Types of Catheterization
2
Running head: TYPES OF CATHETERIZATION
Study: author,
Year
Study Design
Study Question
Subjects
Interventions/ Control
Groups
Outcome Measures
2 medical/surgical
inpatient nursing
units
Policy and product
improvements and unitspecific strategies focusing
on a review of current
evidence
CAUTI rates
N = 40 receiving an
indwelling catheter group
N = 40 receiving an
intermittent catheter group
Incidence of
symptomatic infection
rate with the use of
indwelling catheter
Oman, Makic, Fink,
Schraeder, Hulett,
Keech, Wald,
(2012)
Quality
improvement
process study
Level II-3
Nurse-directed
interventions to reduce
catheter-associated
urinary tract infections
Turi, Hanif, Fasih,
Shaikh, (2006)
Comparative
minimally
invasive
randomized
study
Level 1
Are there differences in
complication rates
between those
performing clean
intermittent
catheterization with
indwelling catheters
Trautner, (2010)
Review of
Literature of
RCTs
Level 1
Van deer Brand &
Castelein, (2001)
Randomized
Control Trial
Level 1
80 consecutive
patients selected
from outpatient
department during
evaluation for
symptoms of bladder
outlet obstruction or
post-operative cases
of stricture urethra
Review of literature to 9 RCTs were
provide evidence-based included in this study
research on indwelling
versus intermittent
urinary catheterization
Does an indwelling
catheter or intermittent
catheterization lead to
less postoperative
bacteriuria or an
urinary tract infection
99 post-op patients
Incidence of
symptomatic infection
rate with the use of
intermittent catheter
Risk of UTI with the
use of indwelling or
intermittent catheter
Significant Results
* include p values
The surgical unit
demonstrated a significant
decrease in catheter days (P
¼ .018) between phase 1
and 3 data periods between
400 days to 305
Symptomatic infections
occurred in both groups
E-coli was the most
frequently isolated
pathogen (54.5%)
Increased infection rate in
the indwelling catheter
N/A
“Based on available
evidence, indwelling urinar
y
catheterization with remov
al 24-48 h postoperatively
was superior
to intermittent
catheterization”
N = 46 patients assigned to Type of catheterization Indwelling catheter group
the indwelling catheter
had a bacteriuria rate of
group
Amount of
24% compared with 6% in
catheterizations
the intermittent
N = 53 patients assigned to
catheterization group (P=5
the intermittent catheter
Length of
.018)
group
catheterization
Average number of
Rate of a postop
catheterizations was 1.6 per
bacteriuria
patient
3
Running head: TYPES OF CATHETERIZATION
Nyman, Gustafsson, Randomized
Langius-Eklo,
Control Trial
Johansson, Norlin, Level 1
Hagberg, (2013).
Zhang, et al., (2015) Review of
Literature –
Meta-Analysis
of RCT’s
Level 1
Johansson, Athlin,
Randomized
Frykholm, Bolinder, control trial
Larsson, (2002)
Level 1
Differences between
intermittent and
indwelling urinary
catheterization in hip
surgery patients in
relation to nosocomial
UTIs
Intermittent urinary
catheterization could be
more effective than
indwelling
catheterization in
preventing UTI in
patients with post-op
urinary retention
(POUR)
Will the use of
intermittent
catheterization be
found to increase the
incidence of UTI, as
compared to the use of
indwelling catheters?
N = 170 post-op hip
patients
Most of these
patients n = 110,
were patients with
hip fractures and
n=60 were patients
with osteoarthritis
Nine studies, all
RCTs were included
in this article
N=85 patients were
randomized to the
intermittent catheterization
group
N = 85 to the indwelling
catheterization group
1771 patients included in
the studies in this review
Various inclusion
criteria
N=870 in the indwelling
catheterization group
N=901 in the intermittent
catheterization group
N=144
N/A
Orthopedic ward in
medium sized
hospital in Sweden
All patients admitted
with traumatic hip
fractures and
underwent surgeru
Incidence of CAUTIs
Rate of catheterization
between hip
replacement patients
and osteoarthritis
patients
Number of bladder
scans
Number of
catheterizations
Rate of developing
UTI based on type of
catheter
Incidence of CAUTI
dependent on type of
catheterization
Time until voiding
returns to normal
dependent on type of
catheterization
No patient needed straight
catheterization after
removal of the indwelling
catheter
The frequency of CAUTIs
was 8 (9.4%) in the
intermittent and 10 (11.8%)
in the indwelling
catheterization group, p =
0.618;
No significant difference
was detected between
indwelling catheterization
group and the intermittent
catheterization group
(N=1771; RR=1.23, 95%CI
[0.85, 1.76], P=0.268;
I2=44.1%, P= 0.074
The majority (61% of 18)
of the patients treated with
indwelling catheter
contracted UTI during their
hospital stay, compared
with 32% in the
group who were treated
with intermittent
catheterization
4
Running head: TYPES OF CATHETERIZATION
Tang, Kwok, Hui,
Woo, (2005)
Randomized
prospective
study
Level 1I-I
Knight & Pellegrini, Randomized
(1996)
control trial
Level 1
Hung & Lam,
(2004)
Prospective
Randomized
Trial
Level 1
Is using intermittent
catheterization along
with bladder scanning
an appropriate
alternative to
indwelling
catheterization in
prevention of CAUTI?
Will the use of an
indwelling catheter
after surgery increase
the incidence of UTI
What are the best
practice guidelines for
the management of
postoperative urinary
retention?
Number of intermittent “No statistically significant
catheterizations
difference between
Elderly patients with
indwelling urinary
urinary retention
Number of days until
catheterization and a more
N=45 in indwelling
patient was catheter
conservative
From rehab wards in catheterization (IDC) group free
approach using intermittent
Shatin Hospital
catheterization”
Development of bacteriuria after day 14
N=119
N=57 the IMC group
Incidence of CAUTI
The IDC group had an 8%
depending on type of
(5 of 62 patients) infection
Receiving either total N=62 in the IDC group
catheterization
rate compared with 12% (7
hip arthroscopy or
of 57, P = 0.45) in the IMC
+
total knee
Number of days until
group
arthroscopy
return of normal
bladder function
Excluded if patients
had a chronic history
Cost between two
of UTI
types of catheterization
N=81
N=60
All patients who
developed urinary
retention post-op
during specific time
frame of study
N=36 in intermittent
catheterization (IMC)
group
Amount of direct
nursing care time spent
N=31 - Patients with odd
Incidence of urinary
The findings
number hospital
retention after surgery of the present prospective
roomsintermittent
randomized trial proved
catheterization group
Incidence of UTI based that
on type of
indwelling catheterization
N = 29 - Patients with even catheterization
left overnight conferred no
hospital room
benefits,
numbersindwelling
compared to the policy of
catheterization
in–out catheterization.
5
Running head: TYPES OF CATHETERIZATION
References
Hung, L., & Lam, B. (2004). Management of postoperative urinary retention: a randomized trial
of in−out versus overnight catheterization. ANZ Journal Of Surgery, 74(8), 658-661.
Johansson, I., Athlin, E., Frykholm, L., Bolinder, H., & Larsson, G. (2002). Intermittent versus
indwelling catheters for older patients with hip fractures. Journal Of Clinical Nursing,
11(5), 651-656.
Knight, R., Pellegrini V. Jr. (1996), Bladder management after total joint arthroplasty. Journal of
Arthroplasty; 11:882–888.
Nyman, M. H., Gustafsson, M., Langius-Eklöf, A., Johansson, J., Norlin, R., & Hagberg, L.
(2013). Intermittent versus indwelling urinary catheterisation in hip surgery patients: A
randomised controlled trial with cost-effectiveness analysis. International Journal Of
Nursing Studies, 50(12), 1589-1598.
Oman, K. S., Makic, M. F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012).
Nurse-directed interventions to reduce catheter-associated urinary tract infections.
American Journal Of Infection Control, 40(6), 548-553.
Schumm, K., & Lam, T. (2014). Types of indwelling urethral catheters for short-term
catheterisation in hospitalised adults. Cochrane Database Of Systematic Reviews, (9),
N.PAG.
Tang, M. W., Kwok, T. C., Hui, E., & Woo, J. (2006). Intermittent versus indwelling urinary
catheterization in older female patients. Maturitas, 53(3), 274-281.
Trautner, B. (2010). Management of catheter-associated urinary tract infection. Current Opinion
In Infectious Diseases, 23(1), 76-82.
Turi, M., Hanif, S., Fasih, Q., Shaikh M., (2006), Proportion of complications in patients
practicing clean intermittent self-catheterization (CISC) vs indwelling catheter. J Pak
Med Assoc, 56(9) 401-404
U.S. Preventive Services Task Force (1996). Guide to clinical preventive services (2nd ed.).
Van den Brand, I. C. J. B., & Castelein, R. M. (2001). Total joint arthroplasty and incidence of
postoperative bacteriuria with an indwelling catheter or intermittent catheterization with
one-dose antibiotic prophylaxis: a prospective randomized trial. The Journal of
arthroplasty, 16(7), 850-855
.
Zhang, W., Liu, A., Hu, D., Xue, D., Li, C., Zhang, K., . . . Pan, Z. (2015). Indwelling versus
intermittent urinary catheterization following total joint arthroplasty: A systematic review
and meta-analysis. PLoS One, 10(7)
6
Running head: TYPES OF CATHETERIZATION
Appendix A: U.S. Preventive Services Task Force, Levels of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial or metaanalysis of randomized, controlled trials
II-1: Evidence obtained from well-designed controlled trials without randomization
II-2: Evidence obtained from II well-designed cohort or case-control analytic studies, preferably
from more than one center or research group
II-3: Evidence from multiple time series with or without the interventions
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or
reports of expert committees
U.S. Preventive Services Task Force (1996). Guide to clinical preventive services (2nd ed.).
Baltimore: Williams and Wilkins.