Module

Uitkomst raming

Toelichting

Katheterwissel 

Geen financiële gevolgen 

Hoewel uit de toetsing volgt dat de aanbeveling(en) breed toepasbaar zijn (> 40.000 patiënten), volgt uit de toetsing dat het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft, het geen toename in het aantal in te zetten voltijdsequivalenten aan zorgverleners betreft en het geen wijziging in het opleidingsniveau van zorgpersoneel betreft. Er worden daarom geen financiële gevolgen verwacht.

GRADE

Definitie

Hoog

• Er is hoge zekerheid dat het ware effect van behandeling dicht bij het geschatte effect van behandeling ligt;
• Het is zeer onwaarschijnlijk dat de literatuurconclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Redelijk

• Er is redelijke zekerheid dat het ware effect van behandeling dicht bij het geschatte effect van behandeling ligt;
• Het is mogelijk dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Laag

• Er is lage zekerheid dat het ware effect van behandeling dicht bij het geschatte effect van behandeling ligt;
• Er is een reële kans dat de conclusie klinisch relevant verandert wanneer er resultaten van nieuw grootschalig onderzoek aan de literatuuranalyse worden toegevoegd.

Zeer laag

• Er is zeer lage zekerheid dat het ware effect van behandeling dicht bij het geschatte effect van behandeling ligt;
• De literatuurconclusie is zeer onzeker.

Implicaties van sterke en zwakke aanbevelingen voor verschillende richtlijngebruikers 

Sterke aanbeveling

Zwakke (conditionele) aanbeveling

Voor patiënten

De meeste patiënten zouden de aanbevolen interventie of aanpak kiezen en slechts een klein aantal niet.

Een aanzienlijk deel van de patiënten zouden de aanbevolen interventie of aanpak kiezen, maar veel patiënten ook niet. 

Voor behandelaars

De meeste patiënten zouden de aanbevolen interventie of aanpak moeten ontvangen. 

Er zijn meerdere geschikte interventies of aanpakken. De patiënt moet worden ondersteund bij de keuze voor de interventie of aanpak die het beste aansluit bij zijn of haar waarden en voorkeuren. 

Voor beleidsmakers

De aanbevolen interventie of aanpak kan worden gezien als standaardbeleid.

Beleidsbepaling vereist uitvoerige discussie met betrokkenheid van veel stakeholders. Er is een grotere kans op lokale beleidsverschillen. 

Richtlijn: SRI Blaaskatheters

Uitgangsvraag:  UV6  Op welk moment moet er een katheterwissel plaatsvinden om het risico op urineweginfectie te beperken?

Database(s): Ovid/Medline, Embase, Cinahl

Datum: 10-1-2022

Periode: nvt

Talen: nvt

Literatuurspecialist: Ingeborg van Dusseldorp

BMI zoekblokken: voor verschillende opdrachten wordt (deels) gebruik gemaakt van de zoekblokken van BMI-Online https://blocks.bmi-online.nl/ Bij gebruikmaking van een volledig zoekblok zal naar de betreffende link op de website worden verwezen.

Toelichting:

Voor deze vraag is gezocht met de volgende concepten:

Blaaskatheters EN (vervangen of blokkade)

Voor de vervanging van de katheter bestaan geen trefwoorden. Om deze reden is alleen in titel, abstract en auteurstrefwoord gezocht. 

Van de vier sleutelartikelen worden de richtlijnen niet gevonden. In de basisstrategie worden de artikelen van Tenin en Kunny gevonden. Vanwege het missende studiedesign worden de twee artikelen niet gevonden in het resultaat. 

Er wordt besloten de oriënterende zoekstrategie uit te breiden met richtlijnen, zodat deze niet worden gemist.

1. Tenny 1988 Bacteriuria in women with long-term catheters: paired comparison of indwelling and replacement catheters - PubMed (nih.gov)

2. Kunin 1987 Indwelling urinary catheters in the elderly. Relation of "catheter life" to formation of encrustations in patients with and without blocked catheters - PubMed (nih.gov)

Te gebruiken voor richtlijnen tekst:

In de databases Embase, Ovid/Medline en Cinahl is op 10-11-2022 met relevante zoektermen gezocht naar systematische reviews, clinical trials, RCT en observationele studies over het vervangen van blaaskatheters. De literatuurzoekactie leverde 706 unieke treffers op.

EMBASE

OVID/MEDLINE

Cinahl

Ontdubbeld

SRs

32

24

25

50

RCTs

178

99

132

309

Observationele studies

295

201

64

347

Overig

Totaal

706

No.

Query

Results

#22

#18 NOT #17 NOT #16 Observationele studies

295

#21

#17 NOT #16 Clinical trials, RCT

178

#20

#8 AND #19 sleutelartikelen worden niet gevonden met studiedesign

0

#19

#16 OR #17 OR #18

505

#18

#9 AND (#14 OR #15)

477

#17

#9 AND #13

195

#16

#9 AND #12 SR

32

#15

'case control study'/de OR 'comparative study'/exp OR 'control group'/de OR 'controlled study'/de OR 'controlled clinical trial'/de OR 'crossover procedure'/de OR 'double blind procedure'/de OR 'phase 2 clinical trial'/de OR 'phase 3 clinical trial'/de OR 'phase 4 clinical trial'/de OR 'pretest posttest design'/de OR 'pretest posttest control group design'/de OR 'quasi experimental study'/de OR 'single blind procedure'/de OR 'triple blind procedure'/de OR (((control OR controlled) NEAR/6 trial):ti,ab,kw) OR (((control OR controlled) NEAR/6 (study OR studies)):ti,ab,kw) OR (((control OR controlled) NEAR/1 active):ti,ab,kw) OR 'open label*':ti,ab,kw OR (((double OR two OR three OR multi OR trial) NEAR/1 (arm OR arms)):ti,ab,kw) OR ((allocat* NEAR/10 (arm OR arms)):ti,ab,kw) OR placebo*:ti,ab,kw OR 'sham-control*':ti,ab,kw OR (((single OR double OR triple OR assessor) NEAR/1 (blind* OR masked)):ti,ab,kw) OR nonrandom*:ti,ab,kw OR 'non-random*':ti,ab,kw OR 'quasi-experiment*':ti,ab,kw OR crossover:ti,ab,kw OR 'cross over':ti,ab,kw OR 'parallel group*':ti,ab,kw OR 'factorial trial':ti,ab,kw OR ((phase NEAR/5 (study OR trial)):ti,ab,kw) OR ((case* NEAR/6 (matched OR control*)):ti,ab,kw) OR ((match* NEAR/6 (pair OR pairs OR cohort* OR control* OR group* OR healthy OR age OR sex OR gender OR patient* OR subject* OR participant*)):ti,ab,kw) OR ((propensity NEAR/6 (scor* OR match*)):ti,ab,kw) OR versus:ti OR vs:ti OR compar*:ti OR ((compar* NEAR/1 study):ti,ab,kw) OR (('major clinical study'/de OR 'clinical study'/de OR 'cohort analysis'/de OR 'observational study'/de OR 'cross-sectional study'/de OR 'multicenter study'/de OR 'correlational study'/de OR 'follow up'/de OR cohort*:ti,ab,kw OR 'follow up':ti,ab,kw OR followup:ti,ab,kw OR longitudinal*:ti,ab,kw OR prospective*:ti,ab,kw OR retrospective*:ti,ab,kw OR observational*:ti,ab,kw OR 'cross sectional*':ti,ab,kw OR cross?ectional*:ti,ab,kw OR multicent*:ti,ab,kw OR 'multi-cent*':ti,ab,kw OR consecutive*:ti,ab,kw) AND (group:ti,ab,kw OR groups:ti,ab,kw OR subgroup*:ti,ab,kw OR versus:ti,ab,kw OR vs:ti,ab,kw OR compar*:ti,ab,kw OR 'odds ratio*':ab OR 'relative odds':ab OR 'risk ratio*':ab OR 'relative risk*':ab OR 'rate ratio':ab OR aor:ab OR arr:ab OR rrr:ab OR ((('or' OR 'rr') NEAR/6 ci):ab)))

13591278

#14

'major clinical study'/de OR 'clinical study'/de OR 'case control study'/de OR 'family study'/de OR 'longitudinal study'/de OR 'retrospective study'/de OR 'prospective study'/de OR 'comparative study'/de OR 'cohort analysis'/de OR ((cohort NEAR/1 (study OR studies)):ab,ti) OR (('case control' NEAR/1 (study OR studies)):ab,ti) OR (('follow up' NEAR/1 (study OR studies)):ab,ti) OR (observational NEAR/1 (study OR studies)) OR ((epidemiologic NEAR/1 (study OR studies)):ab,ti) OR (('cross sectional' NEAR/1 (study OR studies)):ab,ti)

6767914

#13

'clinical trial'/exp OR 'randomization'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp OR 'placebo'/exp OR 'prospective study'/exp OR rct:ab,ti OR random*:ab,ti OR 'single blind':ab,ti OR 'randomised controlled trial':ab,ti OR 'randomized controlled trial'/exp OR placebo*:ab,ti

3302394

#12

'meta analysis'/exp OR 'meta analysis (topic)'/exp OR metaanaly*:ti,ab OR 'meta analy*':ti,ab OR metanaly*:ti,ab OR 'systematic review'/de OR 'cochrane database of systematic reviews'/jt OR prisma:ti,ab OR prospero:ti,ab OR (((systemati* OR scoping OR umbrella OR 'structured literature') NEAR/3 (review* OR overview*)):ti,ab) OR ((systemic* NEAR/1 review*):ti,ab) OR (((systemati* OR literature OR database* OR 'data base*') NEAR/10 search*):ti,ab) OR (((structured OR comprehensive* OR systemic*) NEAR/3 search*):ti,ab) OR (((literature NEAR/3 review*):ti,ab) AND (search*:ti,ab OR database*:ti,ab OR 'data base*':ti,ab)) OR (('data extraction':ti,ab OR 'data source*':ti,ab) AND 'study selection':ti,ab) OR ('search strategy':ti,ab AND 'selection criteria':ti,ab) OR ('data source*':ti,ab AND 'data synthesis':ti,ab) OR medline:ab OR pubmed:ab OR embase:ab OR cochrane:ab OR (((critical OR rapid) NEAR/2 (review* OR overview* OR synthes*)):ti) OR ((((critical* OR rapid*) NEAR/3 (review* OR overview* OR synthes*)):ab) AND (search*:ab OR database*:ab OR 'data base*':ab)) OR metasynthes*:ti,ab OR 'meta synthes*':ti,ab

733409

#11

#3 AND #8

2

#10

#8 AND #9

0

#9

#3 NOT ('conference abstract'/it OR 'editorial'/it OR 'letter'/it OR 'note'/it) NOT (('animal'/exp OR 'animal experiment'/exp OR 'animal model'/exp OR 'nonhuman'/exp) NOT 'human'/exp)

989

#8

#4 OR #5 OR #6 OR #7

4

#7

diagnosis, AND prevention, AND treatment AND 'catheter associated' AND urinary AND tract AND infection AND in AND adults AND 2009 AND international AND clinical AND practice AND guidelines AND from AND the AND infectious AND diseases AND society AND of AND america AND hooton

1

#6

guideline AND for AND prevention AND of AND 'catheter associated' AND urinary AND tract AND infections AND 2009 AND gould

1

#5

indwelling AND urinary AND the AND elderly. AND relation AND 'catheter life' AND to AND formation AND of AND encrustations AND in AND patients AND with AND without AND blocked AND catheters

1

#4

bacteriuria AND in AND women AND with AND 'long term' AND paired AND comparison AND of AND indwelling AND replacement AND catheters

1

#3

#1 AND #2

1636

#2

(catheter* NEAR/3 (replace* OR chang* OR exchang* OR life OR block* OR obstruct*)):ti,ab,kw

9023

#1

('catheter'/de OR 'catheterization'/de OR 'catheter infection'/exp OR 'catheter care'/exp) AND ('bladder'/de OR 'urinary tract infection'/exp OR 'bacteriuria'/exp) OR 'urological catheter'/exp OR 'bladder catheterization'/exp OR (((urin* OR urethr* OR ureteral OR nelaton OR foley OR coude OR intermitt* OR straight OR suprapubic OR bladder OR urolog* OR demeur* OR permanent* OR 'long term' OR longterm) NEAR/3 catheter*):ti,ab,kw) OR 'actreen':ti,ab,kw OR 'axxcess':ti,ab,kw OR 'bd bonnano':ti,ab,kw OR 'flexima':ti,ab,kw OR 'lofric':ti,ab,kw OR 'redicath':ti,ab,kw OR 'reliacath':ti,ab,kw OR 'speedicath':ti,ab,kw OR 'vapro':ti,ab,kw OR 'variotip':ti,ab,kw

60023

#

Searches

Results

13

11 not 10 not 9 observationele studies

201

12

10 not 9 Clinical trial, RCT

99

11

(6 or 7) and 8

283

10

5 and 8

111

9

4 and 8 SR

24

8

3 not ((exp animals/ or exp models, animal/) not humans/) not (letter/ or comment/ or editorial/)

784

7

Case-control Studies/ or clinical trial, phase ii/ or clinical trial, phase iii/ or clinical trial, phase iv/ or comparative study/ or control groups/ or controlled before-after studies/ or controlled clinical trial/ or double-blind method/ or historically controlled study/ or matched-pair analysis/ or single-blind method/ or (((control or controlled) adj6 (study or studies or trial)) or (compar* adj (study or studies)) or ((control or controlled) adj1 active) or "open label*" or ((double or two or three or multi or trial) adj (arm or arms)) or (allocat* adj10 (arm or arms)) or placebo* or "sham-control*" or ((single or double or triple or assessor) adj1 (blind* or masked)) or nonrandom* or "non-random*" or "quasi-experiment*" or "parallel group*" or "factorial trial" or "pretest posttest" or (phase adj5 (study or trial)) or (case* adj6 (matched or control*)) or (match* adj6 (pair or pairs or cohort* or control* or group* or healthy or age or sex or gender or patient* or subject* or participant*)) or (propensity adj6 (scor* or match*))).ti,ab,kf. or (confounding adj6 adjust*).ti,ab. or (versus or vs or compar*).ti. or ((exp cohort studies/ or epidemiologic studies/ or multicenter study/ or observational study/ or seroepidemiologic studies/ or (cohort* or 'follow up' or followup or longitudinal* or prospective* or retrospective* or observational* or multicent* or 'multi-cent*' or consecutive*).ti,ab,kf.) and ((group or groups or subgroup* or versus or vs or compar*).ti,ab,kf. or ('odds ratio*' or 'relative odds' or 'risk ratio*' or 'relative risk*' or aor or arr or rrr).ab. or (("OR" or "RR") adj6 CI).ab.))

5284442

6

Epidemiologic studies/ or case control studies/ or exp cohort studies/ or Controlled Before-After Studies/ or Case control.tw. or cohort.tw. or Cohort analy$.tw. or (Follow up adj (study or studies)).tw. or (observational adj (study or studies)).tw. or Longitudinal.tw. or Retrospective*.tw. or prospective*.tw. or consecutive*.tw. or Cross sectional.tw. or Cross-sectional studies/ or historically controlled study/ or interrupted time series analysis/ [Onder exp cohort studies vallen ook longitudinale, prospectieve en retrospectieve studies]

4287190

5

exp clinical trial/ or randomized controlled trial/ or exp clinical trials as topic/ or randomized controlled trials as topic/ or Random Allocation/ or Double-Blind Method/ or Single-Blind Method/ or (clinical trial, phase i or clinical trial, phase ii or clinical trial, phase iii or clinical trial, phase iv or controlled clinical trial or randomized controlled trial or multicenter study or clinical trial).pt. or random*.ti,ab. or (clinic* adj trial*).tw. or ((singl* or doubl* or treb* or tripl*) adj (blind$3 or mask$3)).tw. or Placebos/ or placebo*.tw.

2517604

4

meta-analysis/ or meta-analysis as topic/ or (metaanaly* or meta-analy* or metanaly*).ti,ab,kf. or systematic review/ or cochrane.jw. or (prisma or prospero).ti,ab,kf. or ((systemati* or scoping or umbrella or "structured literature") adj3 (review* or overview*)).ti,ab,kf. or (systemic* adj1 review*).ti,ab,kf. or ((systemati* or literature or database* or data-base*) adj10 search*).ti,ab,kf. or ((structured or comprehensive* or systemic*) adj3 search*).ti,ab,kf. or ((literature adj3 review*) and (search* or database* or data-base*)).ti,ab,kf. or (("data extraction" or "data source*") and "study selection").ti,ab,kf. or ("search strategy" and "selection criteria").ti,ab,kf. or ("data source*" and "data synthesis").ti,ab,kf. or (medline or pubmed or embase or cochrane).ab. or ((critical or rapid) adj2 (review* or overview* or synthes*)).ti. or (((critical* or rapid*) adj3 (review* or overview* or synthes*)) and (search* or database* or data-base*)).ab. or (metasynthes* or meta-synthes*).ti,ab,kf.

628382

3

1 and 2

828

2

(catheter* adj3 (replace* or chang* or exchang* or life or block* or obstruct*)).ti,ab,kf.

5521

1

(Urinary Bladder/ and Catheters/) or exp Urinary Catheters/ or ((urin* or urethr* or ureteral or nelaton or foley or coude or intermitt* or straight or suprapubic or bladder or urolog* or permanent* or demeur*) adj3 catheter*).ti,ab,kf. or actreen.ti,ab,kf. or axxcess.ti,ab,kf. or bd bonnano.ti,ab,kf. or flexima.ti,ab,kf. or lofric.ti,ab,kf. or redicath.ti,ab,kf. or reliacath.ti,ab,kf. or speedicath.ti,ab,kf. or vapro.ti,ab,kf. or variotip.ti,ab,kf. or (urinary drainage adj3 (bag* or system*)).ti,ab,kf.

23012

#

Query

Results

S11

S9 NOT S8 NOT S7 observationele studies

64

S10

S8 NOT S7 Clinical trials, RCT

132

S9

S3 AND S6

99

S8

S3 AND S5

148

S7

S3 AND S4 SR

25

S6

(MH "Case Control Studies+") OR (MH "Case Studies") OR (MH "Cross Sectional Studies") OR (MH "Prospective Studies+") OR (MH "Retrospective Panel Studies") OR (MH "Correlational Studies") OR TI "case control" OR TI “case referent” OR AB “case referent*” OR TI “case stud*” OR AB “case stud*” OR TI “case series” OR AB “case series” OR TI cohort* OR AB cohort* OR TI “cross sectional” OR AB “cross sectional” OR TI “follow up” OR AB “follow up” OR TI longitudinal OR AB longitudinal OR TI retrospective* OR AB retrospective* OR TI prospective* OR AB prospective* OR TI observational OR AB observational OR TI “Controlled before and after” OR AB “Controlled before and after” OR TI “Interrupted time series” OR AB “Interrupted time series” OR TI Correlational OR AB Correlational

1,494,683

S5

(MH "Clinical Trials+") OR (PT (Clinical trial)) OR (MH "Random Assignment") OR (MH "Quantitative Studies") OR (TX ((clini* N1 trial*) OR (singl* N1 blind*) OR (singl* N1 mask*) OR (doubl* N1 blind*) OR (doubl* N1 mask*) OR (tripl* N1 blind*) OR (tripl* N1 mask*) OR (random* N1 allocat*) OR placebo* OR ((waitlist* OR (wait* and list*)) and (control* OR group)) OR "treatment as usual" OR tau OR (control* N3 (trial* OR study OR studies OR group*)) OR randomized OR randomised))

1,932,921

S4

(MH "Meta Analysis") or TX (meta-analy* or metanaly* or metaanaly* or meta analy*) or TX (systematic* N5 review*) or (evidence* N5 review*) or (methodol* N5 review*) or (quantitativ* N5 review*) or TX (systematic* N5 overview*) or (evidence* N5 overview*) or (methodol* N5 overview*) or (quantitativ* N5 overview*) or TX (systematic* N5 survey*) or (evidence* N5 survey*) or (methodol* N5 survey*) or (quantitativ* N5 survey*) or TX (systematic* N5 overview*) or (evidence* N5 overview*) or (methodol* N5 overview*) or (quantitativ* N5 overview*) or TX (pool* N2 data) or (combined N2 data) or (combining N2 data) or (pool* N2 trials) or (combined N2 trials) or (combining N2 trials) or (pool* N2 studies) or (combined N2 studies) or (combining N2 studies) or (pool* N2 results) or (combined N2 results) or (combining N2 results)

293,982

S3

S1 AND S2

353

S2

(TI (catheter* N3 (replace* OR chang* OR exchang* OR life OR block* OR obstruct*))) OR (AB (catheter* N3 (replace* OR chang* OR exchang* OR life OR block* OR obstruct*)))

1,978

S1

((MH "Catheters" OR MH "Catheterization+") AND MH "Bladder") OR MH "Urinary Catheterization+" OR (MH "Catheters, Urinary+") OR (TI ((urin* OR urethr* OR ureteral OR nelaton OR foley OR coude OR intermitt* OR straight OR suprapubic OR bladder OR urolog*) N3 catheter*) OR actreen OR axxcess OR bd bonnano OR flexima OR lofric OR redicath OR reliacath OR speedicath OR vapro OR variotip OR ("urinary drainage" N3 (bag* OR system*)) OR (AB ((urin* OR urethr* OR ureteral OR nelaton OR foley OR coude OR intermitt* OR straight OR suprapubic OR bladder OR urolog*) N3 catheter*) OR actreen OR axxcess OR "bd bonnano" OR flexima OR lofric OR redicath OR reliacath OR speedicath OR vapro OR variotip OR ("urinary drainage" N3 (bag* OR system*))

8,737