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Abdel-fattah M, Johnson D, Constable L, Thomas R, Cotton S, Tripathee S, Cooper D, Boran S, Dimitropoulos K, Evans S, Granitsiotis P, Hashim H, Kilonzo M, Larcombe J, Little P, MacLennan S, Murchie P, Myint PK, N’Dow J, Norrie J, Omar MI, Paterson C, Scotland G, Thiruchelvam N, MacLennan G. Randomised controlled trial comparing the clinical and cost-effectiveness of various washout policies versus no washout policy in preventing catheter associated complications in adults living with long-term catheters: study protocol for the CATHETER II study. Trials 2022; 23:630. [PMID: 35927733 PMCID: PMC9351274 DOI: 10.1186/s13063-022-06577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Various washout policies are widely used in adults living with long-term catheters (LTC). There is currently insufficient evidence on the benefits and potential harms of prophylactic LTC washout policies in the prevention of blockages and other LTC-related adverse events, such as urinary tract infections. CATHETER II tests the hypothesis that weekly prophylactic LTC washouts (normal saline or citric acid) in addition to standard LTC care reduce the incidence of catheter blockage requiring intervention compared to standard LTC care only in adults living with LTC. METHODS CATHETER II is a pragmatic three-arm open multi-centre superiority randomised controlled trial with an internal pilot, economic analysis, and embedded qualitative study. Eligible participants are adults aged ≥ 18 years, who have had a LTC in use for ≥ 28 days, have no plans to discontinue the use of the catheter, are able to undertake the catheter washouts, and complete trial documentation or have a carer able to help them. Participants are identified from general practitioner practices, secondary/tertiary care, community healthcare, care homes, and via public advertising strategies. Participants are randomised 1:1:1 to receive a weekly saline (0.9%) washout in addition to standard LTC care, a weekly citric acid (3.23%) washout in addition to standard LTC care or standard LTC care only. Participants and/or carers will receive training to administer the washouts. Patient-reported outcomes are collected at baseline and for 24 months post-randomisation. The primary clinical outcome is catheter blockage requiring intervention up to 24 months post-randomisation expressed per 1000 catheter days. Secondary outcomes include symptomatic catheter-associated urinary tract infection requiring antibiotics, catheter change, adverse events, NHS/ healthcare use, and impact on quality of life. DISCUSSION This study will guide treatment decision-making and clinical practice guidelines regarding the effectiveness of various prophylactic catheter washout policies in men and women living with LTC. This research has received ethical approval from Wales Research Ethics Committee 6 (19/WA/0015). TRIAL REGISTRATION ISRCTN ISRCTN17116445 . Registered prospectively on 06 November 2019.
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Affiliation(s)
- Mohamed Abdel-fattah
- grid.7107.10000 0004 1936 7291Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, UK
| | - Diana Johnson
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Lynda Constable
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Ruth Thomas
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Seonaidh Cotton
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Sheela Tripathee
- grid.7107.10000 0004 1936 7291Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- grid.7107.10000 0004 1936 7291Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sue Boran
- The Queen’s Nursing Institute, London, UK
| | | | | | | | - Hashim Hashim
- grid.418484.50000 0004 0380 7221North Bristol NHS Trust, Bristol, UK
| | - Mary Kilonzo
- grid.7107.10000 0004 1936 7291Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Paul Little
- grid.5491.90000 0004 1936 9297Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Sara MacLennan
- grid.7107.10000 0004 1936 7291Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- grid.7107.10000 0004 1936 7291Academic Primary Care Research Group, University of Aberdeen, Aberdeen, UK
| | - Phyo Kyaw Myint
- grid.7107.10000 0004 1936 7291Ageing Clinical & Experimental Research Team, University of Aberdeen, Aberdeen, UK
| | - James N’Dow
- grid.7107.10000 0004 1936 7291Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Muhammad Imran Omar
- grid.7107.10000 0004 1936 7291Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Catherine Paterson
- grid.1039.b0000 0004 0385 7472School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, Australia
| | - Graham Scotland
- grid.7107.10000 0004 1936 7291Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nikesh Thiruchelvam
- grid.24029.3d0000 0004 0383 8386Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graeme MacLennan
- grid.7107.10000 0004 1936 7291Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
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Alex J, Maneze D, Ramjan LM, Ferguson C, Montayre J, Salamonson Y. Effectiveness of nurse-targeted education interventions on clinical outcomes for patients with indwelling urinary catheters: A systematic review. NURSE EDUCATION TODAY 2022; 112:105319. [PMID: 35298974 DOI: 10.1016/j.nedt.2022.105319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To identify subject matter, pedagogical approaches and assess outcomes of interventions implemented to educate nurses in urinary catheterisation care and management. DESIGN A systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. DATA SOURCES Databases (CINAHL; MEDLINE; ProQuest; ERIC; Scopus; Cochrane; and APA PsycINFO) were searched using key concepts: education interventions, indwelling urinary catheter and nurses, from inception to July 2021. REVIEW METHODS Two researchers searched the databases, whereupon data were extracted using a standardised proforma and were analysed applying an abductive approach. The Joanna Briggs Institute Critical Appraisal tool was used to assess the quality of the included studies. Findings were analysed and reported using narrative synthesis. RESULTS Out of 1159 studies screened, nine educational intervention studies related to upskilling nurses in catheter management were identified. Subject matter addressed included pathophysiology of the urinary system, clinical indications and management of indwelling catheter and associated complications. Although the subject matter and pedagogical approaches varied, all identified studies reported positive effects in improving participants' knowledge. CONCLUSIONS Upskilling nurses and increasing their confidence to deliver patient-centred catheter care practices is an important intervention to improve outcomes for patients with long-term indwelling urinary catheters. However, actively engaging nurses who provide direct patient care is essential, in planning and implementing targeted educational interventions specific to learning needs. This review has identified a gap in the educational interventions for nurses, in better supporting the psychosocial needs of patients living with indwelling catheter. Codesigning educational interventions with nurses that are tailored to their contextual learning needs is likely to enhance behaviour change and improve current practice.
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Affiliation(s)
- Joby Alex
- Integrated & Community Health, Western Sydney Local Health District, Australia; School of Nursing and Midwifery, Western Sydney University, Mt Druitt Community Health Centre, Cnr Buran & Kelly Cl, Mount Druitt, NSW 2770, Australia.
| | - Della Maneze
- South Western Sydney Local Health District, Australia; Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Lucie M Ramjan
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia; COHORT, Ingham Institute for Applied Medical Research, Australia.
| | - Caleb Ferguson
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Locked Bag 8813, Wollongong, NSW 2522, Australia.
| | - Jed Montayre
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia; COHORT, Ingham Institute for Applied Medical Research, Australia.
| | - Yenna Salamonson
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia; COHORT, Ingham Institute for Applied Medical Research, Australia.
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Reid S, Brocksom J, Hamid R, Ali A, Thiruchelvam N, Sahai A, Harding C, Biers S, Belal M, Barrett R, Taylor J, Parkinson R. British Association of Urological Surgeons (BAUS) and Nurses (BAUN) consensus document: management of the complications of long-term indwelling catheters. BJU Int 2021; 128:667-677. [PMID: 33811741 DOI: 10.1111/bju.15406] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To look at best evidence and expert opinion to provide advice in the form of a consensus statement lead by Female, Neurological and Urodynamic Urology (FNUU) section of the British Association of Urological Surgeons (BAUS) in conjunction with the British Association of Urological Nurses (BAUN). METHODS Initially a literature search was performed with incorporation of aspects of the existing guidance and further informed by UK best practice by core members of the group. The document then underwent reviews by the FNUU Executive Committee members, the BAUN executive committee, a separate experienced urologist and presented at the BAUS annual meeting 2020 to ensure wider feedback was incorporated in the document. RESULTS Complications of long-term indwelling catheters include catheter-associated urinary tract infections (CAUTI), purple urine bag syndrome, catheter blockages, bladder spasms (causing pain and urinary leakage), loss of bladder capacity, urethral erosion ("catheter hypospadias")/dilatation of bladder outlet and chronic inflammation (metaplasia and cancer risk). CONCLUSIONS We have provided a list of recommendations and a troubleshooting table to help with the management of the complications of long term catheters.
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Affiliation(s)
- Sheilagh Reid
- Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield, UK
| | | | - Rizwan Hamid
- University College London Hospitals and London Spinal Injuries Unit, Stanmore, UK
| | - Ased Ali
- Pinderfields Hospital, Wakefield, UK
| | | | - Arun Sahai
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Chris Harding
- Newcastle upon Tyne Hospitals - NHS Foundation Trust, Newcastle, UK
| | | | - Mo Belal
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - Julia Taylor
- Clinical Governance Lead, Salford Royal Hospital, Manchester, UK
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