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Urinary catheter policies for short-term bladder drainage in hip surgery patients
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0003-0460-3864
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. , 75 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 38
Keyword [en]
Urinary catheterisation, nosocomial urinary tract infection, hip fracture, hip arthroplasty, nursing, patient experiences, clamping
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-22505ISBN: 978-91-7668-870-0 (print)OAI: oai:DiVA.org:oru-22505DiVA: diva2:515236
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
List of papers
1. A prospective study of nosocomial urinary tract infection in hip fracture patients
Open this publication in new window or tab >>A prospective study of nosocomial urinary tract infection in hip fracture patients
2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, 2531-2539 p.Article in journal (Refereed) Published
Abstract [en]

Aim.  To investigate risk factors and consequences of nosocomial urinary tract infection in hip fracture patients. Background.  Nosocomial urinary tract infection is a well-known problem in hip fracture patients. There are several risk factors for nosocomial urinary tract infection described in the literature.

Design.  Prospective observational study with a descriptive and comparative design.

Methods.  Hip fracture patients were included consecutively between April 2006-March 2007. Excluded were those under 50, having an indwelling urinary catheter, signs of cognitive impairment or additional severe physical problems at the time of admission. To verify nosocomial urinary tract infection, a urine specimen was taken at admission and discharge. Patients with and without nosocomial urinary tract infection were compared.

Results.  The study included 86 hip fracture patients, of whom 45 (52·3%) contracted nosocomial urinary tract infection in hospital. Earlier reported risk factors for nosocomial urinary tract infection were not confirmed in this study, with one exception: diabetes. All diabetic patients in the study contracted urinary tract infections. Patients receiving cloxacillin as antibiotic prophylaxis for wound infection contracted UTI less often than other patients. There were no statistical differences between groups with regard to urinary tract infection frequency four months after fracture or with regard to mortality after one year.

Conclusion.  Diabetes was the only previously known risk factor for nosocomial urinary tract infection confirmed among hip fracture patients in this study. Cloxacillin as antibiotic prophylaxis for surgery seemed to offer a certain protection against nosocomial urinary tract infection. Relevance to clinical practice.  Nurses in clinical practice should be aware of the risk of urinary tract infections in hip fracture patients and especially in hip fracture patients with diabetes. Patients given cloxacillin as antibiotic prophylaxis seem less likely to contract nosocomial urinary tract infection.

Keyword
hip fracture, nosocomial urinary tract infection, nurses, nursing, risk factors, urinary catheterisation
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-16578 (URN)10.1111/j.1365-2702.2011.03769.x (DOI)000293748900015 ()21733026 (PubMedID)2-s2.0-80051575875 (Scopus ID)
Available from: 2011-08-15 Created: 2011-08-15 Last updated: 2017-12-08Bibliographically approved
2. A randomised controlled trial on the effect of clamping the indwelling urinary catheter in patients with hip fracture
Open this publication in new window or tab >>A randomised controlled trial on the effect of clamping the indwelling urinary catheter in patients with hip fracture
2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, 405-413 p.Article 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.

Keyword
clamping, hip fractures, nursing, randomised controlled trial, urinary catheterisation
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-13035 (URN)10.1111/j.1365-2702.2009.03050.x (DOI)000273599200013 ()20500280 (PubMedID)2-s2.0-74549155751 (Scopus ID)
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
3. Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis
Open this publication in new window or tab >>Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis
Show others...
(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.

Keyword
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:nbn:se:oru:diva-22507 (URN)
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
4. An issue but of varying impact: a descriptive study of hip surgery patients’ experiences of bladder emptying and urinary catheterisation
Open this publication in new window or tab >>An issue but of varying impact: a descriptive study of hip surgery patients’ experiences of bladder emptying and urinary catheterisation
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterisation is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterisation and urination have not been studied before.

Objectives: The aim of the study was to describe patients' experiences of bladder emptying and urinary catheterisation in connection with hip surgery.

Design: A qualitative study with descriptive design was conducted among hip surgery patients.

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

Participants: Purposive sample of 30 hip surgery patients, 17 with fractures and 13 with osteoarthritis.

Method: Face-to-face interviews were conducted and analysed with inductive qualitative content analysis.

Results: The main category "An issue but of varying impact" illustrated the patients' experiences of bladder emptying and urinary catheterisation. The findings are reported under five generic categories: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion upon dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterised, bladder emptying was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterisation was experienced as convenient. Some patients did not want to be catheterised, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time.

Conclusions: The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterisation are described in positive as well as negative terms.

Keyword
Bladder emptying, Hip arthroplasty, Hip fractures, Nursing, Patient experiences, Qualitative research, Urinary catheterization
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-22509 (URN)
Available from: 2012-04-12 Created: 2012-04-12 Last updated: 2017-10-17Bibliographically approved

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