Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/25097
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dc.contributor.authorShepherd, Ashleyen_UK
dc.contributor.authorMackay, William Gen_UK
dc.contributor.authorHagen, Suzanneen_UK
dc.date.accessioned2018-05-04T22:33:56Z-
dc.date.available2018-05-04T22:33:56Z-
dc.date.issued2017-03-06en_UK
dc.identifier.otherCD004012en_UK
dc.identifier.urihttp://hdl.handle.net/1893/25097-
dc.description.abstractBackground  People requiring long-term bladder draining with an indwelling catheter can experience catheter blockage. Regimens involving different solutions can be used to wash out catheters with the aim of preventing blockage. This is an update of a review published in 2010.  Objectives  To determine if certain washout regimens are better than others in terms of effectiveness, acceptability, complications, quality of life and critically appraise and summarise economic evidence for the management of long-term indwelling urinary catheterisation in adults.  Search methods  We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings to 23 May 2016. We also examined all reference lists of identified trials and contacted manufacturers and researchers in the field.  Selection criteria  All randomised and quasi-randomised trials comparing catheter washout policies (e.g. washout versus no washout, different washout solutions, frequency, duration, volume, concentration, method of administration) in 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.  Data collection and analysis  Two review authors independently extracted data. Disagreements were resolved by discussion. Data were assessed and analysed as described in theCochrane Handbook. If data in trials were not fully reported, clarification was sought from the study authors. For categorical outcomes, the numbers reporting an outcome were related to the numbers at risk in each group to derive a risk ratio (RR). For continuous outcomes, means and standard deviations were used to derive mean differences (MD).  Main results  We included seven trials involving a total of 349 participants, 217 of whom completed the studies. Three were cross-over and four were parallel-group randomised controlled trials (RCTs). Of these, two trials were added for this update (one parallel-group RCT with 40 participants and one cross-over RCT with 67 participants). Analyses of three cross-over trials yielded suboptimal results because they were based on between-group differences rather than individual participants' differences for sequential interventions. Two parallel-group trials had limited clinical value: one combined results for suprapubic and urethral catheters and the other provided data for only four participants. Only one trial was free of significant methodological limitations, but there were difficulties with recruitment and maintaining participants in this study.  The included studies reported data on six of the nine primary and secondary outcome measures. None of the trials addressed: number of catheters used, washout acceptability measures (including patient satisfaction, patient discomfort, pain and ease of use), or health status/measures of psychological health; very limited data were collected for health economic outcomes. Trials assessed only three of the eight intervention comparisons identified. Two trials reported in more than one comparison group.  Four trials compared washout (either saline or acidic solution) with no washout. We are uncertain if washout solutions (saline or acidic), compared to no washout solutions, has an important effect on the rate of symptomatic urinary tract infection or length of time each catheter was in situ because the results are imprecise.  Four trials compared different types of washout solution; saline versus acidic solutions (2 trials); saline versus acidic solution versus antibiotic solution (1 trial); saline versus antimicrobial solution (1 trial). We are uncertain if type of washout solution has an important effect on the rate of symptomatic urinary tract infection or length of time each catheter was in situ because the results are imprecise.  One trial compared different compositions of acidic solution (stronger versus weaker solution). We are uncertain if different compositions of acidic solutions has an important effect on the rate of symptomatic urinary tract infection or length of time each catheter was in situ because only 14 participants (of 25 who were recruited) completed this 12 week, three arm trial.  Four studies reported on possible harmful effects of washout use, such as blood in the washout solution, changes in blood pressure and bladder spasms.  There were very few small trials that met the review inclusion criteria. The high risk of bias of the included studies resulted in the evidence being graded as low or very low quality.  Authors' conclusions  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.en_UK
dc.language.isoenen_UK
dc.publisherWiley-Blackwell for the Cochrane Collaborationen_UK
dc.relationShepherd A, Mackay WG & Hagen S (2017) Washout policies in long-term indwelling urinary catheterisation in adults. Cochrane Database of Systematic Reviews, 2017 (3), Art. No.: CD004012. https://doi.org/10.1002/14651858.CD004012.pub5en_UK
dc.rightsThis item has been embargoed for a period. During the embargo please use the Request a Copy feature at the foot of the Repository record to request a copy directly from the author. You can only request a copy if you wish to use this work for your own research or private study. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD004012. DOI: 10.1002/14651858.CD004012.pub5, Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review. This is the reference to the original version of this review: Mooney J, Hagen S, Niel-Weise B. Washout policies for management of long-term voiding problems in catheterised adults (Protocol). The Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD004012. DOI: 10.1002/14651858.CD004012.en_UK
dc.titleWashout policies in long-term indwelling urinary catheterisation in adultsen_UK
dc.typeJournal Articleen_UK
dc.rights.embargodate2018-03-07en_UK
dc.rights.embargoreason[Shepherd_et_al-2017-The_Cochrane_Library.pdf] Publisher requires embargo of 12 months after formal publication.en_UK
dc.identifier.doi10.1002/14651858.CD004012.pub5en_UK
dc.identifier.pmid28262925en_UK
dc.citation.jtitleCochrane Database of Systematic Reviewsen_UK
dc.citation.issn1469-493Xen_UK
dc.citation.volume2017en_UK
dc.citation.issue3en_UK
dc.citation.publicationstatusPublisheden_UK
dc.citation.peerreviewedRefereeden_UK
dc.type.statusVoR - Version of Recorden_UK
dc.author.emailashley.shepherd@stir.ac.uken_UK
dc.citation.date06/03/2017en_UK
dc.contributor.affiliationHealth Sciences Stirlingen_UK
dc.contributor.affiliationUniversity of the West of Scotlanden_UK
dc.contributor.affiliationGlasgow Caledonian Universityen_UK
dc.identifier.isiWOS:000400761200011en_UK
dc.identifier.scopusid2-s2.0-85014530323en_UK
dc.identifier.wtid884224en_UK
dc.contributor.orcid0000-0002-7687-4586en_UK
dc.date.accepted2017-03-06en_UK
dcterms.dateAccepted2017-03-06en_UK
dc.date.filedepositdate2017-03-07en_UK
rioxxterms.apcnot requireden_UK
rioxxterms.typeJournal Article/Reviewen_UK
rioxxterms.versionVoRen_UK
local.rioxx.authorShepherd, Ashley|0000-0002-7687-4586en_UK
local.rioxx.authorMackay, William G|en_UK
local.rioxx.authorHagen, Suzanne|en_UK
local.rioxx.projectInternal Project|University of Stirling|https://isni.org/isni/0000000122484331en_UK
local.rioxx.freetoreaddate2018-03-07en_UK
local.rioxx.licencehttp://www.rioxx.net/licenses/under-embargo-all-rights-reserved||2018-03-06en_UK
local.rioxx.licencehttp://www.rioxx.net/licenses/all-rights-reserved|2018-03-07|en_UK
local.rioxx.filenameShepherd_et_al-2017-The_Cochrane_Library.pdfen_UK
local.rioxx.filecount1en_UK
Appears in Collections:Faculty of Health Sciences and Sport Systematic Reviews

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