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Indications for urinary catheterization in hospitalized children: An integrative review
Anita C de Jong1, Marjorie de Neef2, Job B M van Woensel1
1Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
Insights
Appropriate urinary catheterization indications in children are unclear, mirroring adult practices. This review identifies key factors influencing catheter use and suggests interventions like daily checklists to reduce inappropriate usage and prevent complications.
Area of Science:
- Pediatric Healthcare
- Medical Device Utilization
- Clinical Practice Guidelines
Background:
- Current guidelines lack specificity for pediatric urinary catheterization indications.
- Catheter-associated complications are a significant concern in hospitalized children.
- This review addresses the need for clearer indications in pediatric populations.
Purpose of the Study:
- To evaluate reported indications for urethral catheterization in hospitalized children (<18 years).
- To identify factors influencing urinary catheter insertion and removal.
- To review interventions for reducing inappropriate urinary catheter use.
Main Methods:
- An integrative review methodology was employed.
- Searches were conducted in major databases (Medline, Embase, Cochrane, CINAHL, Web of Science) in January 2024.
- Two reviewers independently selected studies, extracted data, and categorized findings.
Main Results:
- 49 studies were included, detailing indications such as acute urinary retention, monitoring, surgery, and end-of-life care.
- Ambiguous policies exist regarding routine catheterization for acute urinary retention.
- Factors influencing use include re-catheterization risk, patient distress, staff factors, and local practices.
Conclusions:
- Pediatric urinary catheterization indications largely align with adult practices, with notable ambiguity in routine use for acute urinary retention.
- Local preferences significantly shape current practices.
- Interventions like daily checklists show promise in reducing inappropriate catheter use.
Introduction:
Appropriate indications for urinary catheterization are crucial to prevent catheter-associated complications, but current guidelines lack specificity for hospitalized children. This review aimed to evaluate reported indications for urethral catheterization in hospitalized children aged <18 years. Secondary, we aimed to identify factors influencing catheter insertion and removal, and to review the effectiveness of interventions to reduce inappropriate catheter usage.
Methods:
For this integrative review, a search was conducted in January 2024 in Medline, Embase, Cochrane library, CINAHL, and Web of Science, and additional sources for guidelines and grey literature. Two reviewers independently selected the studies and executed structured data extraction and categorization.
Results:
Of 15,910 search results, 49 studies were included. The main reported indications for urinary catheterization in hospitalized children include managing acute urinary retention, urine output monitoring, specific surgeries, lumbar epidural analgesia, perineal wounds, and end-of-life care. Ambiguous policies were reported regarding routine catheterization to prevent acute urinary retention. The main factors influencing catheter insertion and removal were the risk of re-catheterization, patient distress, staff capacity and skills, awareness of catheter presence, variation of local practice, usage of protocols, and established criteria for urinary retention. Studies that described a sustained effect on reducing inappropriate urinary catheter use included a daily checklist, with or without a designated expert focusing on reducing catheter-associated urinary tract infections.
Discussion:
Indications for urinary catheterization in hospitalized children largely mirror adult practices, with ambiguity concerning routine catheterization for acute urinary retention. The results of this integrative review predominantly reflect local preferences.
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