Category Archives: CAUTIs

What has been written on early removal of urinary catheters in surgical patients during the last five years?

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Murphy, Miles, et al. “Postoperative management and restrictions for female pelvic surgery: a systematic review.” International urogynecology journal and pelvic floor dysfunction 24.2 (2013):185-193.

Zaouter, C, et al. “Early removal of urinary catheter leads to greater post-void residuals in patients with thoracic epidural.” Acta anaesthesiologica Scandinavica 56.8 (2012):1020-1025.

Chai, Joyce, and Ting-ChungPun. “A prospective randomized trial to compare immediate and 24-hour delayed catheter removal following total abdominal hysterectomy.” Acta obstetricia et gynecologica Scandinavica 90.5 (2011):478-482.

Mentler, Ellie, et al. “High incidence of acute urinary retention associated with immediate catheter removal after laparoscopic Nissen fundoplication.” Surgical endoscopy 25.5 (2011):1611-1616.

Huang, Chih C, et al. “Optimal duration of urinary catheterization after anterior colporrhaphy.” International urogynecology journal and pelvic floor dysfunction 22.4 (2011):485-491.

Das Bhagia S, et al. “Is it necessary to remove foleys catheter late after transurethral prostatectomy in patients who presented with acute urinary retention secondary to benign prostatic hyperplasia?” JPMA. The journal of the Pakistan Medical Association 60.9 (2010):739-741.

Kamilya, Gourisankar, et al. “A randomized controlled trial comparing short versus long-term catheterization after uncomplicated vaginal prolapse surgery.” Journal of obstetrics and gynaecology research 36.1 (2010):154-158.

Chia, Yuan-Yi, et al. “Optimal duration of urinary catheterization after thoracotomy in patients under postoperative patient-controlled epidural analgesia. Acta anaesthesiologica Taiwanica 47.4 (2009):173-179.

Zaouter, Cedrick, PepaKaneva, and FrancoCarli. “Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia.” Regional anesthesia and pain Medicine 34.6 (2009):542-548.

de Moya, Marc A, et al. “Colovesical fistula repair: is early Foley catheter removal safe?” The Journal of surgical research 156.2 (2009):274-277.

Ozu, Choichiro, et al. “Radical retropubic prostatectomy with running vesicourethral anastomosis and early catheter removal: our experience.” International journal of urology 16.5 (2009):487-492.

Sekhavat, Leila, TahminahFarajkhoda, and RobabDavar. “The effect of early removal of indwelling urinary catheter on postoperative urinary complications in anterior colporrhaphy surgery.” The Australian and New Zealand journal of obstetrics and gynaecology 48.3 (2008):348-352.

Overview of peripherally inserted central catheters and central venous catheters

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Abeloff: Abeloff’s Clinical Oncology, 4th ed. Copyright © 2008 Churchill Livingstone, An Imprint of Elsevier
CHOOSING THE RIGHT DEVICE

Go to Joanna Briggs and cut and paste the following phrases into the search box:
peripherally inserted central catheter
central venous catheter

Egan GM ; Siskin GP ; Weinmann R 4th ; Galloway MM. A Prospective Postmarket Study to Evaluate the Safety and Efficacy of a New Peripherally Inserted Central Catheter Stabilization System. Journal of Infusion Nursing, 2013 May-Jun; 36 (3): 181-8

Beghetto MG ; Victorino J ; Teixeira L ; de Azevedo MJ Parenteral nutrition as a risk factor for central venous catheter-related infection.
JPEN Journal of Parenteral & Enteral Nutrition, 2005 Sep-Oct; 29 (5): 367-73.

Baiocco, Graziella Gasparotto ; da Silva, Jefferson Luis Braga The Use of the Peripherally Inserted Central Catheter (Pice) in the Hospital Environment. Revista Latino-Americana de Enfermagem (RLAE) (REV LAT AM ENFERMAGEM), 2010 Nov-Dec; 18 (6): 1131-7.

Databases searched: Joanna Briggs, CINAHL, MDConsult. Keywords: peripherally inserted central catheter, central venous catheter, indications

Indwelling urinary catheter removal protocols for reducing CAUTI rates

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A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections. Moola Sandeep Konno R.

Removal of short term indwelling urethral catheters. [Best practice information sheets]

Urethral Catheter: Removal. [Evidence Summaries]

Clinical practical procedures. Urinary catheters: part 4 — removing an indwelling urinary catheter. Nursing Times 2008 vol:104 iss:42 pg:26

Fink, Regina; Gilmartin, Heather; Richard, Angela; Capezuti, Elizabeth; Boltz, Marie; Wald, Heidi; Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Health system Elders hospitals. Detail American Journal of Infection Control, 2012 Oct; 40 (8): 715-20

Prevention of catheter-associated urinary tract infections in patients with hip fractures through education of nurses to specific catheter protocols. Orthopedic Nursing. 2012 vol:31 iss:1 pg:12

Dailly, Sue; Prevention of indwelling catheter-associated urinary tract infections. Nursing Older People, 2011 Mar; 23 (2): 14-9

Reviewed JKN 4/14

Are there systematic reviews of the evidence about the effect of chlorhexidine on rate of catheter associated urinary tract infections?

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Joanna Briggs Institute’s JBI+COnNECT, an evidence summary source, has published this evidence summary:  Urethral Catheter (Indwelling Short-Term):  Urinary Tract Infection Prevention

The Clinical Bottom Line section summarizes evidence on various care regimens, including daily cleaning.  Two relevant statements:
“Daily cleansing of the urethral meatus using soap and water or perineal cleanser has been shown to be effective to reduce CAUTI.3 (Level II)”
“The following interventions are not deemed effective for reducing CAUTI incidence: sterile technique for catheter insertion, use of antiseptic solutions or ointment during routine meatal care, 2-chambered urinary drainage bags, antiseptic filters incorporated into the drainage bag, bladder or catheter irrigation, frequent urinary drainage bag changes and placing an antiseptic solution into the urinary drainage bag.3 (Level I)”

References to other systematic reviews are available through this PubMed search: chlorhexidine AND urinary tract infection AND catheter AND (systematic review OR meta-analysis)

Does perineal cleaning with chlorhexidine prior to inserting a urinary catheter reduce the rate of catheter-acquired urinary tract infections (CAUTI)?

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Bottom line:  There is no evidence that cleaning the perineal area with chlorhexidine prior to catheter insertion reduces the rate of CAUTI.

Summary:  Identified documents using JBI+COnNECT (Joanna Briggs Institute)

Review of results led to CDC CAUTI guidelines, 2009.
Page 43 references two studies that found no difference between cleaning with chlorhexidine v. water prior to catheter insertion.  There are also studies referenced in that section that address intermittent care.

A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections
Page 702 – describes 1 RCT of 436 patients admitted to obstetrical unit who were randomized to periurethral cleaning with water v. chlorhexidine prior to insertion of catheter.  No significant difference in rates of CAUTI between the groups.

The RCT of 436 patients is also referenced in this best practice summary: Management of short-term indwelling urethral catheters to prevent urinary tract infections

Communicating about evidence-based practice in patient care

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Welcome. This blog facilitates communication on issues of evidence-based practice by Emory Healthcare Nursing Quality Initiatives teams. Questions posed by the teams and information to address those questions will be documented in these posts.