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Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0003-0460-3864
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0002-8658-3360
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, sweden.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background:  Hip surgery is associated with a risk for postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). Presently, there is limited knowledge whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery.

Objectives: The aim of the study was to investigate differences between intermittent and indwelling urinary catheterisation in hip surgery patients in relation to nosocomial UTI and cost-effectiveness.

Design: Randomised controlled trial with cost-effectiveness analysis.

Setting: The study was carried out at an orthopaedic department at a Swedish university hospital.

Method: One hundred seventy hip surgery patients (patients with fractures or with osteoarthritis) were randomly allocated to either intermittent or indwelling urinary catheterisation. Data collection took place at four time points: during stay in hospital, at discharge and at 4 weeks and 4 months after discharge.

Results: Eighteen patients contracted nosocomial UTIs, 8 in the intermittent catheterisation group and 10 in the indwelling catheterisation group (p = 0.618).  The patients in the intermittent catheterisation group were more often catheterised (p <0.001) and required more bladder scans (p <0.001) but regained normal bladder function sooner than the patients in the indwelling catheterisation group (p <0.001). Fourteen percent of the patients in the intermittent group did not need any catheterisation. Cost-effectiveness was similar between the indwelling and intermittent urinary catheterisation methods.

Conclusions: In the perspective of cost-effectiveness both indwelling and intermittent methods could be appropriate in clinical praxis. Both methods have advantages and disadvantages but by not using indwelling catheterisation routinely in this patient group unnecessary catheterisations might be avoided.

Keywords [en]
Cost-effectiveness, hip arthroplasty, hip fractures, intermittent catheterisation, indwelling catheterisation, nursing, randomised controlled trial, urinary tract infection
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-22507OAI: oai:DiVA.org:oru-22507DiVA, id: diva2:515288
Note

Note: This manuscript is published as an article: DOI 10.1016/j.ijnurstu.2013.05.007

In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 12, 1589-1598

Available from: 2012-04-12 Created: 2012-04-12 Last updated: 2017-10-17Bibliographically 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
Keywords
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, MariaGustafsson, MargaretaLangius-Eklöf, AnnJohansson, Jan-ErikNorlin, Rolf

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Hälleberg-Nyman, MariaGustafsson, MargaretaLangius-Eklöf, AnnJohansson, Jan-ErikNorlin, Rolf
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