Nollen Jeanne-Marie, Pijnappel Laury, Schoones Jan W, Peul Wilco C, Van Furth Wouter R, Brunsveld-Reinders Anja H
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands.
J Clin Nurs. 2023 May;32(9-10):2155-2177. doi: 10.1111/jocn.16393. Epub 2022 Jun 8.
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.
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.
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.
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.
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.
Nurses should focus on early IDUC removal while being aware of urinary retention.
留置导尿管（IDUCs）与并发症相关，因此尽早拔除至关重要。目前，尚不清楚特定拔除时间的影响以及该拔除时间会带来哪些后果。
概述现有证据，以确定术后三种IDUC拔除时间（若干小时后、一天中的特定时间以及灵活拔除时间）对医院内并发症发生情况的影响。
检索截至2021年6月6日的PubMed、Medline、Embase、Emcare和Cochrane对照试验中央注册库。纳入描述拔除时间与再次置管、尿路感染（UTIs）、下床活动时间、首次排尿时间和住院时间关系的研究。采用纽卡斯尔-渥太华量表和Cochrane有效实践与护理组织评估研究质量。进行叙述性描述分析。本综述报告遵循PRISMA指南。
纳入20项研究，其中18项比较了若干小时后的拔除情况，1项报告了特定拔除时间，1项报告了这两个主题。关于拔除时间越晚UTIs发生率越高这一假设，结果相互矛盾。尽早拔除不会导致更高的再次置管率，而立即拔除有利于缩短首次下床活动时间和缩短住院时间。报告特定拔除时间的研究未发现结果存在差异。没有研究涉及灵活拔除时间。
尽管如果IDUC拔除时间≥24小时UTIs发生率会增加，但尚无确凿证据表明尽早拔除会减少UTIs。立即或在1 - 2天后拔除不会导致更高的再次置管率，而立即拔除会使下床活动更早且住院时间更短。
护士应在关注尿潴留的同时，注重尽早拔除IDUC。
