115TRIAL WITHOUT CATHETER: THE ROLE OF BLADDER FILLING PRIOR TO REMOVAL OF URETHRAL CATHETERS. A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS

Abstract

Scope: Urinary catheters are commonly used with hospital prevalence highest in patients over 70. In acute care, the risk of catheter-associated urinary tract infections significantly rises after two days with associated risks of sepsis, death, and estimated NHS costs of 1700/episode.[1] New initiatives are needed to minimise catheter-related harm including delirium and functional decline in older adults. Bladder filling with fluid prior to catheter removal presents a possible technique to facilitate early removal. However the clinical effectiveness of this procedure remains unclear. Search Method(s): A systematic review of four databases (MEDLINE, EMBASE, CINAHL and The Cochrane Central Register) was conducted in February 2018 for RCTs of bladder filling procedures prior to catheter removal in adults, compared to standard care. Risk of bias was estimated using Cochrane guidelines and quality of evidence was assessed using the GRADE criteria. Result(s): 5893 studies were identified, four met eligibility criteria. All studies were small, indications for catheterisation were exclusively peri-operative or acute urinary retention. The majority of included patients were male. Age was documented in two studies, one reported a range of 45-87, the other a median of 70.5. We found some evidence to suggest that bladder filling procedures reduced the time to decision of TWOC outcome. There was inconsistent evidence regarding re-catheterisation rates and time to discharge. All studies had a high risk of bias with reported outcomes assessed to be of very low quality. Conclusion(s): There is no definitive evidence that bladder filling is superior to standard catheter removal procedures. Given the number of patients requiring this procedure, many of whom are older, defining the optimal protocol is important for quality, safety and cost. Further randomised controlled trials in relevant hospital and community populations are required.