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Do Catheter Washouts Extend Patency Time in Long-term Indwelling Urethral Catheters?: A Randomized Controlled Trial of Acidic Washout Solution, Normal Saline Washout, or Standard Care

Moore, Katherine N.; Hunter, Kathleen F.; McGinnis, Rosemary; Bacsu, Chasta; Fader, Mandy; Gray, Mikel; Getliffe, Kathy; Chobanuk, Janice; Puttagunta, Lakshmi; Voaklander, Donald C.

Journal of Wound, Ostomy and Continence Nursing: January-February 2009 - Volume 36 - Issue 1 - p 82–90
doi: 10.1097/01.WON.0000345181.37656.de
CONTINENCE CARE
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PURPOSE Blockage of long-term indwelling catheters with mineral deposit is an ongoing management issue, but evidence on optimal management is lacking. Our purpose was to examine whether catheter washouts prevent or reduce catheter blockage.

DESIGN A multisite randomized controlled trial.

SUBJECTS AND SETTING Adults with long-term indwelling catheters that required changing every 3 weeks or less, living in the community, and requiring supportive or continuing care were recruited. Participants were randomly assigned to 1 of 3 groups: control (usual care, no washout), saline washout, or commercially available acidic washout solution (Contisol Maelor Pharmaceuticals Ltd, Wrexham, UK).

METHODS At baseline visit, the catheter was changed and participants were followed weekly for 8 weeks, with checks for catheter patency and urine pH. Participants randomized to saline or commercial solution had a weekly washout with the appropriate solution. Endpoints were 8 weeks (completion data), 3 or more catheter changes in the 8-week period, or symptomatic urinary tract infection (UTI) requiring antibiotics. The study hypothesis was that catheter life would be extended by 25% in the commercial solution group. It was not possible to blind participants or research nurses to washout versus no intervention, but participants in the saline and washout solution groups were blinded to solution type.

RESULTS One hundred twelve potential participants were screened; 73 were enrolled, randomized, and included in the final analysis. Of these, 53 completed the full 8 weeks of data collection; 16 terminated early because of 3 catheter changes or self-reported ‘UTI’. Other reasons for termination were hematuria, latex sensitivity, deceased/severe illness, or personal choice. Analysis of variance was used to analyze mean differences on demographic variables and mean number of weeks in study. Kaplan-Meier survival curve analysis showed no statistical difference between the groups in time to first catheter change.

CONCLUSION At this time, the evidence is insufficient to state whether catheter washout with saline or Contisol is more effective than usual care with no washout in preventing blocking. No increased risk of UTI was associated with washout regimes.

Katherine N. Moore, PhD, RN, CCCN, Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Kathleen F. Hunter, PhD, RN, NP, Assistant Professor, University of Alberta, Edmonton, Alberta, Canada.

Rosemary McGinnis, MSc, RN, Calgary Health Region Home Care.

Chasta Bacsu, MD, Urology Resident, University of Alberta, Edmonton, Alberta, Canada.

Mandy Fader, PhD, RN, Reader, University College London, London, United Kingdom.

Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Nurse Practitioner and Professor, Department of Urology and School of Nursing, University of Virginia, Charlottesville.

Kathy Getliffe, PhD, RGN, NDN, Professor, University of Southampton, Southampton, United Kingdom.

Janice Chobanuk, MN, RN, East Central Health Area, Alberta, Edmonton, Alberta, Canada.

Lakshmi Puttagunta, MD, FRSC, Pathologist, University of Alberta, Edmonton, Alberta, Canada.

Donald C. Voaklander, PhD, Professor, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.

Corresponding author: Katherine N. Moore, PhD, RN, CCCN, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada T6G 2G3 (Katherine.moore@ualberta.ca).

Copyright © 2009 by the Wound, Ostomy and Continence Nurses Society