Impact of early postoperative indwelling urinary catheter removal: A systematic review

Abstract

Background Indwelling urinary catheters (IDUCs) are associated with complications and early removal is therefore essential. Currently, it is unknown what the effect of a specific removal time is and what the consequences of this removal time are. Research question To present an overview of the available evidence to determine the effects of three postoperative IDUC removal times (after a certain number of hours, at a specific time of day and flexible removal time) on the development of complications in hospital. Methods PubMed, Medline, Embase, Emcare and Cochrane Central Register of Controlled Trials were searched till 6 June, 2021. Studies were included that described the effect of the removal time in relation to re‐catheterisation, urinary tract infections (UTIs), ambulation time, time of first voiding and hospital stay. The quality of the studies was assessed with the Newcastle‐Ottawa Scale and the Cochrane Effective Practice and Organisation of Care. A narrative descriptive analysis was performed. PRISMA guidelines were followed in reporting this review. Results Twenty studies were included from which 18 compared removal after a number of hours, 1 reported on a specific removal time and 1 reported on both topics. The results were contradicting regarding the hypothesis that later removal increases the incidence of UTIs. Earlier removal does not lead to a higher re‐catheterisation rate while immediate removal is beneficial for reducing the time to first ambulation and shortening the hospital stay. Studies reporting on specific removal times did not find differences in outcomes. No study addressed flexible removal time. Conclusions There is inconclusive evidence that earlier removal results in less UTIs, despite the incidence of UTIs increasing if the IDUC is removed ≥24 h. Immediate or after 1–2 day(s) removal does not lead to higher re‐catheterisation rates while immediate removal results in earlier ambulation and shorter length of hospital stay. Implications of key findings Nurses should focus on early IDUC removal while being aware of urinary retention.

Patient perspectives on indwelling urinary catheters and fluid balances after transsphenoidal pituitary surgery: a qualitative study

“…Mobility challenges related to the IDUC, including prolonged time to ambulation (walking without the support of a nurse), immobility and discomfort, overlap with previous findings 36. In this study, patients reported feeling dependent on nurses’ directives which could have delayed the moment of mobilisation and thereby have a negative influence on the discharge date 37 38…”

Impact of a Rounding Checklist Implementation in the Trauma Intensive Care Unit on Clinical Outcomes

“…However, the risk of infection associated with these catheters is a critical concern. Therefore, numerous studies, including recent systematic reviews, have highlighted the importance of promptly removing unnecessary central venous and urinary catheters in order to prevent catheter-associated infections [39][40][41][42]. In our study, there were significantly decreased indwelling periods of the central and urinary catheters in the after-FD group.…”

Feasibility and safety of a non-indwelling urinary catheter after flexible ureteroscopy with intelligent control of renal pelvis pressure: A retrospective study

“…With the advancement of minimally invasive technology and the promotion of the ERAS concept, increasing evidence supports the expedient removal of catheters and the absence of urinary indentations after surgery [13,14]. Due to problems such as high renal pelvic pressure and low lithotripsy e ciency, traditional ureteroscopy is prone to postoperative complications such as infection and bleeding.…”

“…Furthermore, the longer the catheter retention time, especially > 2 days, the greater the probability of patients developing catheter-associated UTIs [17,18]. Early removal of unnecessary urinary catheters, either immediately or after 1-2 days, does not result in higher recatheterization rates, whereas immediate removal leads to earlier activity and a shorter hospital stay [13,19,20].…”