Suprapubic Catheter Change Methods: A Crossover Comparison Cohort Trial.

Abstract

The purpose of this study was to compare 2 methods of suprapubic catheter (SPC) change, instillation and observation. The instillation method requires instillation of saline to the bladder prior to SPC removal; the observation method is completed taking note of the angle and length at which the indwelling SPC is withdrawn and observation of urine from the newer catheter when inserted. Nonrandomized crossover trial. Fifty-nine community-dwelling adults who were long-term SPC users participated in the study. There were 38 males and 21 females, with a mean age of 68.5 years. Most had chronic, progressive, or complex comorbidity. The mean duration of SPC use was 3.5 years. Participants underwent 4 SPC changes using the instillation method, followed by 4 changes using the observation method. Data were collected using a 3-part survey document; it queried demographic and catheter-related clinical information, the number of symptomatic catheter-associated urinary tract infections (CAUTIs) requiring antibiotic treatment, the number of catheter blockages that occurred during data collection, and nurses' experiences during catheter changes (including narrative feedback-related problems, concerns, or comments in relation to each catheter change). The comparative CAUTI and blockage outcomes were analyzed using McNemar's test for 2 paired samples. Narrative data were analyzed using thematic analysis. There were 231 SPC changes using the observation method. No episodes of catheter displacement occurred. Analysis of nurses' narrative revealed concerns regarding "slowness" of urine drainage from the newly inserted catheter. This concern was addressed by promotion of adequate hydration prior to catheter change. There were 120 paired useable surveys included in the CAUTI and blockage incidence comparison; no statistically significant differences in CAUTI occurrences were found based on catheter change method (11 vs 11, P = .7728). No differences in the catheter blockage episodes were found based on catheter change method (8 vs 6, P = .7237). The observation method of SPC change was as effective as the instillation method.