长期留置导尿患者成功拔除导尿管的最佳指南意见

Guideline Summary on Successful Removal of Urinary Catheter in Patients with Long-term Indwelling Urinary Catheters

目的评价总结长期留置导尿患者成功拔除导尿管的最佳指南意见。方法计算机检索Cochrane Library、JBI、安大略注册护士协会、美国指南网、循证医学数据库、Pub Med、荷兰医学文摘数据库、中国生物医学文献数据库,并补充检索各国卫生行政部门的官方网站,查找长期留置导尿患者尿管拔除的相关指南。经过2名具有循证基础的研究员独立进行文献质量评价和资料提取后,对符合纳入标准的指南进行证据总结。结果共纳入指南5篇,最终总结出5条最佳证据,分别为:(1)每日评估尿管留置的必要性,尽早拔除无需留置的尿管(A级推荐);(2)采用护士主导的尿管拔除提示信息系统及医嘱终止系统(A级推荐);(3)拔管前应当进行膀胱功能训练,但不推荐通过夹闭尿管的方式训练膀胱功能(B级推荐);(4)除非具有临床指征,否则尿管拔除后不应常规使用抗菌药物来预防尿路感染(A级推荐);(5)尿管拔除后应密切关注患者排尿功能的恢复情况(A级推荐)。结论临床上应准确评估尿管拔除时机,规范拔管操作,减少尿路感染风险及拔管后的不良事件,以实现成功拔管。当前有关尿管拔除的相关证据还存在诸多争议,未来应开展更多高质量的临床随机对照试验,以指导实践指南的制定,更好地维护患者安全。

Objective To evaluate and summarize the available guidelines on the successful removal of urinary catheter in patients with long-term indwelling urinary catheters.Methods We searched the Cochrane Library,Joanna Briggs Institute Library(JBI),Registered Nurses’Association of Ontario(RNAO),National Guideline Clearing house(NGC),EBM reviews,PubMed,EMbase,CBM,as well as the official websites of public health department of many countries,to retrieve the related guidelines on urinary catheter removal.Two trained reviewers assessed the quality and extracted the data independently.Results Five guidelines were included,and five items of best evidence were summarized including evaluating the necessity of catheterization and promoting the earlier removal of non-clinically indicated catheter(grade-A recommendation);employing the nurse-oriented urinary catheter reminder system and order terminating system(grade-A recommendation);performing bladder training before the removal,but not through the clipping of catheter before the removal(grade-B recommendation);no wide usage of antimicrobials before or after catheter removal without clinical indication(grade-A recommendation)and close monitoring after catheter removal to know about the bladder function(grade-A recommendation).Conclusion More attention should be paid to the timing and skill of catheter removal,so as to reduce the occurrence of catheter-associated adverse events.Since there are still controversies on evidence about catheter removal,more prospective studies of high quality are needed to guide evidence-based clinical practice and ensure patients’safety.