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Washout of long-term indwelling urinary catheter

One of the main complications of catheterization is the onset of encrustations, frequently resulting in obstruction of the catheter. The catheterization duration is the most important risk factor for bacteriuria, essential for the process of encrustation to start off. Regimens involving different solutions can be used to wash out catheters with the aim of preventing blockage. Common solutions for washout are sterile saline or citric acid solutions. This question comes from a home care unit where the washout policy is about to be changed to tap water.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut201928 Registration no: SBU 2019/604

Question

Are there any studies on the benefits and harms of using tap water as a washout solution?

Identified literature

Table 1. Systematic review with low/medium risk of bias.
Included studies Population/Intervention Outcome
Shepherd et al (2017) [1]
We included seven trials involving a total of 349 participants, 217 of whom completed the studies. adults (aged 16 years and above) in any setting (i.e. hospital, nursing/residential home, community) with an indwelling urethral or suprapubic catheter for more than 28 days. effectiveness, acceptability, complications, quality of life and economic evidence
Authors' conclusion:
“Data from seven trials that compared different washout policies were limited, and generally, of poor methodological quality or were poorly reported. The evidence was not adequate to conclude if washouts were beneficial or harmful. Further rigorous, high quality trials that are adequately powered to detect benefits from washout being performed as opposed to no washout are needed. Trials comparing different washout solutions, washout volumes, and frequencies or timings are also needed.”

References

  1. Shepherd AJ, Mackay WG, Hagen S. Washout policies in long-term indwelling urinary catheterisation in adults. Cochrane Database of Systematic Reviews, 3, 2017. CD004012.

Literature search

Medline via OVID 2019-09-30 
Bladder Washout with tap water
The search result, usually found at the end of the documentation, forms the list of abstracts. [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation
  Search terms Items found
Population:
1. Exp Catheters, Indwelling/ 18,265
2. Exp Urinary Catheterization/ 14,097
3.  ((Urine or Urinary or suprapubic or bladder or indwelling or long-term or longterm) adj3 catheter*).ab,ti. 17,156
4. 1 OR 2 OR 3 41,413
5 Catheterization, Central Venous/ 14,675
6. Vascular Patency/ 13,748
7. Postoperative Care/ 58,334
8. 5 OR 6 OR 7 86,357
Intervention:
9. Exp Therapeutic Irrigation/ 49,739
10. Bladder washout*.mp 107
11. (bladder adj3 (irrigat* OR lavage OR wash* OR instillation)).ab,ti 1,689
12. Catheter maintenanc*.mp 120
13. (catheter* adj3 (blockage* OR wash* OR instillation OR irrigat*)).ab,ti 1,267
14. encrustation$.mp. 796
15. Crystallization/ 50,461
16. 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 52,786
Control:
17. (Water OR Fluid* OR Solution*).mp 2,002,219
18. (Saline OR acidic OR antibioti* OR antimicro* OR Citric OR NaCl OR Sodium OR H2O OR dihydrogen monoxide OR aqua).mp 1,318,975
19. 17 OR 18 3,040,855
Combined sets:
20. 4 AND 16 1,164
21. 20 NOT 8 1,067
Final 21 AND 19 433

 

Cochrane Library via Wiley 2019-09-30
Bladder washout with tap water
The search result, usually found at the end of the documentation, forms the list of abstracts. au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”; CRM = Method Studies; DARE = Database Abstracts of Reviews of Effects, “other reviews”; EED = Economic Evaluations; HTA = Health Technology Assessments
  Search terms Items found
Population:
1. [mh "Catheters, Indwelling"] 994
2. [mh "Urinary Catheterization"] 694
3. ((Urine or Urinary or suprapubic or bladder or indwelling or long-term or longterm) NEAR/3 catheter*):ab,ti. 2,514
4. 1 OR 2 OR 3 3,570
5. [mh “Catheterization, Central Venous”] 792
6. [mh “Vascular Patency”] 899
7. [mh “Postoperative Care”] 4,346
8. 5 OR 6 OR 7 6,013
Intervention:
9. [mh “Therapeutic Irrigation”] 2,249
10. “Bladder washout”*:ab,ti,kw 7
11. (bladder NEAR/3 (irrigat* OR lavage OR wash* OR instillation)):ab,ti 272
12. “Catheter maintenance*”:ab,ti,kw 24
13. (catheter* NEAR/3 (blockage* OR wash* OR instillation OR irrigat*)):ab,ti 332
14. Encrustation*:ab,ti,kw 42
15. [mh “Crystallization”] 95
16. 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 2,897
Control:
17. (Water OR Fluid* OR Solution*):ab,ti,kw 92,255
18. (Saline OR acidic OR antibioti* OR antimicro* OR Citric OR NaCl OR Sodium OR H2O OR ’dihydrogen monoxide’ OR aqua):ab,ti,kw 99,274
19. 17 OR 18 171,592
Combined sets:
20. 4 AND 16 162
21. 20 NOT 8 146
Final 21 AND 19 82

 

Embase via embase. 2019-09-30
Bladder washout with tap water
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
  Search terms Items found
Population:
1. 'indwelling catheter'/exp 15,329
2. 'urinary catheter'/exp< 14,214
3. 'bladder catheterization'/exp 8,561
4. 'suprapubic catheter'/exp 1,075
5. ((urine OR urinary OR suprapubic OR bladder OR indwelling OR 'long term' OR longterm) NEXT/3 catheter*):ab,ti 22,047
6. 1 OR 2 OR 3 OR 4 OR 5 41,519
7. 'central venous catheterization'/exp 8,920
8. 'vascular patency'/exp 10,153
9. 'postoperative care'/exp 91,572
10. 8 OR 9 OR 10 110,310
Intervention:
11. 'bladder irrigation'/exp 2,119
12. ‘Bladder washout*':ti,ab,kw 151
13. (bladder NEXT/3 (irrigat* OR lavage OR wash* OR instillation)):ab,ti 2,192
14. ‘Catheter maintenanc*’:ti,ab,kw 196
15. (catheter* NEXT/3 (blockage* OR wash* OR instillation OR irrigat*)):ab,ti 942
16. 'encrustation'/exp OR 'catheter occlusion'/exp 1,839
17. 'crystallization'/exp 218,652
18. 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 224,632
Control:
19. (Water OR Fluid* OR Solution*):ab,ti,kw 2,053,161
20. (Saline OR acidic OR antibioti* OR antimicro* OR Citric OR NaCl OR Sodium OR H2O OR ’dihydrogen monoxide’ OR aqua):ab,ti,kw 1,396,392
21. 19 OR 20 3,179,314
Combined sets:
22. 6 AND 18 1,165
23. 22 NOT 10 1,104
Final 23 AND 21 407

 

CINAHL via ebsco.com 2019-09-30
Bladder washout with tap water
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields.; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
  Search terms Items found
Population:
1. (MH "Catheters, Urinary+") 1,900
2. (MH "Urinary Catheterization+") 2,944
3. (AB (urine OR urinary OR suprapubic OR bladder OR indwelling OR 'long term' OR longterm) N3 catheter*) OR (TI (urine OR urinary OR suprapubic OR bladder OR indwelling OR 'long term' OR longterm) N3 catheter*) 4,821
4. 1 OR 2 OR 3 7,204
5. (MH "Catheterization, Central Venous+") 4,564
6. (MH "Vascular Patency") 1,620
7. (MH "Postoperative Care+") 16,771
8. 5 OR 6 OR 7 22,868
Intervention:
9. (MH "Therapeutic Irrigation+") 5,576
10. AB Bladder washout* OR TI Bladder washout* 24
11. (AB bladder N3 (irrigat* OR lavage OR wash* OR instillation)) OR (TI bladder N3 (irrigat* OR lavage OR wash* OR instillation)) 176
12. AB Catheter maintenanc* OR TI Catheter maintenanc* 278
13. (AB catheter* N3 (blockage* OR wash* OR instillation OR irrigat*)) OR (TI catheter* N3 (blockage* OR wash* OR instillation OR irrigat*)) 519
14. AB Encrustation* OR TI Encrustation* 94
15. (MH "Crystallization") 320
16. 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 6,725
Control:
17. Water OR Fluid* OR Solution* 159,025
18. Saline OR acidic OR antibioti* OR antimicro* OR Citric OR NaCl OR Sodium OR H2O OR ’dihydrogen monoxide’ OR aqua 133,438
19. 17 OR 18 271,652
Combined sets:
20. 4 AND 16 272
21. 20 NOT 8 262
Final 21 AND 19 111
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