Removing indwelling catheters: trial without catheter in the community

Indwelling urinary catheters are inserted to drain the bladder for a variety of reasons, but are an intervention of last resort. Unless contraindicated, patients with an indwelling catheter should therefore have at least one trial without catheter to assess if they can pass urine without having a catheter in situ. The commonest method in undertaking trial without catheter is to remove a indwelling urethral catheter and monitor urinary output over a period of time. Another method is when the catheter is not removed in patients who have a suprapubic catheter. Instead the catheter is clamped, and urethral urine output monitored. This is followed by immediately measuring any residue of urine drained via the supra-pubic catheter. This article looks at undertaking a 'trial without catheter' using both methods and examines the arguments concerning when to remove catheters, midnight or early in the morning.