Ask an answerable question (PICO)：
Postoperative patients commonly use indwelling urinary catheters to monitor urine output, reduce wound pollution, and avoid urine retention. However, there is no consensus on whether bladder training is necessary before removing the indwelling urinary catheter in postoperative patients. Bladder training before removal of the catheter has been reported to reduce the incidence of urinary retention and urinary re-catheterization rate. However, if inadequately control of the time of clamped urinary catheter, may increase the urinary tract infection rate. In our hospital, the procedures before the catheter removal were different for patients who placed indwelling catheters after surgery in the three surgical wards. Therefore, this article aims to review the literature to explore whether bladder training before removing the indwelling Urinary Catheter can reduce the re-catheterization rate in postoperative patients. The result of this article may provide an empirical reference for clinical practice.
The Method and Analysis of Literature Review：
This article searched for empirical articles that focused on the effectiveness of bladder training before removing the indwelling catheters in patients after surgery. The search database contained three electronic literature databases, including EBSCO, PubMed, and Cochrane Library. Searching keywords including “indwelling urinary catheter”, “bladder training”, and “urinary re-catheterization rate”. A total of 122 articles were initially extracted by the search criteria. After carefully reviewing the abstracts and texts of the manuscripts based on the inclusion criteria, 3 articles were recruited in this review, including 1 systematic review and 2 randomized controlled trials.
Critical Appraisal：
Two researchers conducted the critical appraisal of the manuscripts by using the CASP-Systematic Review Checklist_2018 for the systematic review article and the CASP- Randomized Control Trial Checklist_2018 for the articles of randomized controlled trials. The results complied with 8-9 items out of 10-11standard criteria. Then, the Joanna Briggs Institute levels of evidence was used for the reviewed literature. The results indicated systematic review article was rated as evidence level 1.b, and the randomized controlled trials articles were rated into evidence level 1.c.
Results, Conclusions and Recommendations：
This article used a systematic literature review method to explore whether the bladder training before removing the indwelling urinary catheter can reduce the urinary re-catheterization rate in postoperative patients. The results of the 3 articles indicated there were no significant differences in the urinary re-catheterization rate, the risk of urinary tract infection, and acute urinary retention in post-operative patients whether they were using bladder training before removing the indwelling urinary catheter or not. Therefore, it is suggested that bladder training is not necessary for patients with short-term catheter placement who are receiving surgery, except for urinary tract surgery. Further clinical empirical nursing research is needed to clarify the applicable populations and confirm related positive and negative effects of this strategy. The results of this article may provide useful knowledge to clinical practice to improve patient safety and the quality of health care.
