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A randomised controlled trial on the effect of clamping the indwelling urinary catheter in patients with hip fracture
Department of Orthopaedics, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-0460-3864
Department of Urology, Örebro University Hospital,Örebro, Sweden; Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences. Centre for Assessment of Medical Technology, Örebro County Council, Örebro, Sweden.ORCID iD: 0000-0002-8658-3360
2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, p. 405-413Article in journal (Refereed) Published
Abstract [en]

Aim. To investigate the effect of clamping the urinary catheter before its removal in patients with hip fracture. Background. Difficulties to return to normal bladder function after removal of the urinary catheter are frequent in patients with hip fracture. Clamping the urinary catheter before removal is proposed to shorten the amount of time required to return to normal bladder function. Design. A randomised controlled trial was conducted at the orthopaedic clinic at a Swedish university hospital. Methods. Patients with hip fracture aged >= 50 without a urinary catheter, without cognitive impairment or additional severe physical problems at the time of admission (n = 113) were included. They were randomly assigned either to have their urinary catheter clamped before removal or to have their catheter removed with free drainage. Blinding was not possible because of the nature of the study. The primary outcome was the amount of time required to return to normal bladder function. Secondary outcomes were need for re-catheterisation and length of hospital stay. All patients were analysed in accordance with the intention-to-treat principle. Results. The median time required to return to normal bladder function was six (Q(1) 4-Q(3) 8) hours in the clamped catheter group and four (Q(1) 3-Q(3) 7.25) hours in the free drainage group. There were no significant differences between the groups regarding the time required to regain normal bladder function (p = 0.156), the number of patients requiring re-catheterisation (p = 0.904) and the mean time in hospital (p = 0.777). Conclusion. This randomised trial did not show any advantage or disadvantage with clamping the urinary catheter before removal. Relevance to clinica practice. Clamping is an additional task for the nursing staff in the removal of the indwelling urinary catheter. Therefore, when considering the present results, it seems that clamping the indwelling urinary catheters in patients with hip fracture is not indicated.

Place, publisher, year, edition, pages
2010. Vol. 19, no 3-4, p. 405-413
Keyword [en]
clamping, hip fractures, nursing, randomised controlled trial, urinary catheterisation
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
URN: urn:nbn:se:oru:diva-13035DOI: 10.1111/j.1365-2702.2009.03050.xISI: 000273599200013PubMedID: 20500280Scopus ID: 2-s2.0-74549155751OAI: oai:DiVA.org:oru-13035DiVA: diva2:382736
Note

Funding Agencies:

Department of Orthopaedics Orebro University Hospital  Centre for Assessment of Medical Technology, Orebro County Council  

Available from: 2011-01-03 Created: 2011-01-03 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Urinary catheter policies for short-term bladder drainage in hip surgery patients
Open this publication in new window or tab >>Urinary catheter policies for short-term bladder drainage in hip surgery patients
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.

In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.

In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 75
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 38
Keyword
Urinary catheterisation, nosocomial urinary tract infection, hip fracture, hip arthroplasty, nursing, patient experiences, clamping
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-22505 (URN)978-91-7668-870-0 (ISBN)
Public defence
2012-06-01, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-04-12 Created: 2012-04-12 Last updated: 2017-10-17Bibliographically approved

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Hälleberg-Nyman, MariaJohansson, Jan-ErikGustafsson, Margareta

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