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  1. Article ; Online: Should in-line filters be used in peripheral intravenous catheters to prevent infusion-related phlebitis? A systematic review of randomized controlled trials.

    Niël-Weise, Barbara S / Stijnen, Theo / van den Broek, Peterhans J

    Anesthesia and analgesia

    2010  Volume 110, Issue 6, Page(s) 1624–1629

    Abstract: Background: In this systematic review, we assessed the effect of in-line filters on infusion-related phlebitis associated with peripheral IV catheters. The study was designed as a systematic review and meta-analysis of randomized controlled trials. We ... ...

    Abstract Background: In this systematic review, we assessed the effect of in-line filters on infusion-related phlebitis associated with peripheral IV catheters. The study was designed as a systematic review and meta-analysis of randomized controlled trials. We used MEDLINE and the Cochrane Controlled Trial Register up to August 10, 2009.
    Methods: Two reviewers independently assessed trial quality and extracted data. Data on phlebitis were combined when appropriate, using a random-effects model. The impact of the risk of phlebitis in the control group (baseline risk) on the effect of in-line filters was studied by using meta-regression based on the bivariate meta-analysis model. The quality of the evidence was determined by using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method.
    Results: Eleven trials (1633 peripheral catheters) were included in this review to compare the effect of in-line filters on the incidence of phlebitis in hospitalized patients. Baseline risks across trials ranged from 23% to 96%. Meta-analysis of all trials showed that in-line filters reduced the risk of infusion-related phlebitis (relative risk, 0.66; 95% confidence interval, 0.43-1.00). This benefit, however, is very uncertain, because the trials had serious methodological shortcomings and meta-analysis revealed marked unexplained statistical heterogeneity (P < 0.0000, I(2) = 90.4%). The estimated benefit did not depend on baseline risk.
    Conclusion: In-line filters in peripheral IV catheters cannot be recommended routinely, because evidence of their benefit is uncertain.
    MeSH term(s) Data Interpretation, Statistical ; Evidence-Based Medicine ; Filtration ; Humans ; Infusions, Intravenous/adverse effects ; Infusions, Intravenous/instrumentation ; Phlebitis/epidemiology ; Phlebitis/prevention & control ; Quality Control ; Randomized Controlled Trials as Topic/standards ; Risk Assessment ; Treatment Outcome
    Language English
    Publishing date 2010-06-01
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Review
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0b013e3181da8342
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Urinary catheter policies for long-term bladder drainage.

    Niël-Weise, Barbara S / van den Broek, Peterhans J / da Silva, Edina M K / Silva, Laercio A

    The Cochrane database of systematic reviews

    2012  , Issue 8, Page(s) CD004201

    Abstract: Background: People requiring long-term bladder draining commonly experience catheter-associated urinary tract infection and other problems.: Objectives: To determine if certain catheter policies are better than others in terms of effectiveness, ... ...

    Abstract Background: People requiring long-term bladder draining commonly experience catheter-associated urinary tract infection and other problems.
    Objectives: To determine if certain catheter policies are better than others in terms of effectiveness, complications, quality of life and cost-effectiveness in long-term catheterised adults and children.
    Search methods: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 September 2011). Additionally, we examined all reference lists of identified trials.
    Selection criteria: All randomised and quasi-randomised trials comparing catheter policies (route of insertion and use of antibiotics) for long-term (more than 14 days) catheterisation in adults and children.
    Data collection and analysis: Data were extracted by two reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the data in trials had not been fully reported, clarification was sought from the authors. When necessary, the incidence-density rates (IDR) and/or the incidence-density differences (IDD) within a certain time period were calculated.
    Main results: Eight trials met the inclusion criteria involving 504 patients in four cross-over and four parallel-group randomised controlled trials. Only two of the pre-stated six comparisons were addressed in these trials. Four trials compared antibiotic prophylaxis with antibiotics when clinically indicated. For patients using intermittent catheterisation, there were inconsistent findings about the effect of antibiotic prophylaxis on symptomatic urinary tract infection (UTI). Only one study found a significant difference in the frequency of UTI favouring prophylaxis. For patients using indwelling urethral catheterisation, one small trial reported fewer episodes of symptomatic UTI in the prophylaxis group.Four trials compared antibiotic prophylaxis with giving antibiotics when microbiologically indicated. For patients using intermittent catheterisation, there was limited evidence that receiving antibiotics reduced the rate of bacteriuria (asymptomatic and symptomatic). There was weak evidence that prophylactic antibiotics were better in terms of fewer symptomatic bacteriuria.
    Authors' conclusions: No eligible trials were identified that compared alternative routes of catheter insertion. The data from eight trials comparing different antibiotic policies were sparse, particularly when intermittent catheterisation was considered separately from indwelling catheterisation. Possible benefits of antibiotic prophylaxis must be balanced against possible adverse effects, such as development of antibiotic resistant bacteria. These cannot be reliably estimated from currently available trials.
    MeSH term(s) Adult ; Anti-Bacterial Agents/adverse effects ; Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis/adverse effects ; Bacteriuria/prevention & control ; Catheter-Related Infections/prevention & control ; Catheters, Indwelling/adverse effects ; Child ; Drainage/instrumentation ; Humans ; Randomized Controlled Trials as Topic ; Urinary Catheterization/adverse effects ; Urinary Catheterization/methods ; Urinary Tract Infections/etiology ; Urinary Tract Infections/prevention & control
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2012-08-15
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
    ISSN 1469-493X
    ISSN (online) 1469-493X
    DOI 10.1002/14651858.CD004201.pub3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: An evidence-based recommendation on bed head elevation for mechanically ventilated patients.

    Niël-Weise, Barbara S / Gastmeier, Petra / Kola, Axel / Vonberg, Ralf P / Wille, Jan C / van den Broek, Peterhans J

    Critical care (London, England)

    2011  Volume 15, Issue 2, Page(s) R111

    Abstract: Introduction: A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, ...

    Abstract Introduction: A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one.
    Methods: A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based on the results of the systematic review and considerations beyond the scientific evidence in a three-round electronic Delphi procedure.
    Results: Three trials (337 patients) were included in the review. The results showed that it was uncertain whether a 45° bed head elevation was effective or harmful with regard to the occurrence of clinically suspected VAP, microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45° elevation for 24 hours a day increased the risk for thromboembolism or hemodynamic instability. A group of 22 experts recommended elevating the head of the bed of mechanically ventilated patients to a 20 to 45° position and preferably to a ≥ 30° position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes.
    Conclusions: Although the review failed to prove clinical benefits of bed head elevation, experts prefer this position in ventilated patients. They made clear that the position of a ventilated patient in bed depended on many determinants. Therefore, given the scientific uncertainty about the benefits and harms of a semi-upright position, this position could only be recommended as the preferred position with the necessary restrictions.
    MeSH term(s) Beds ; Evidence-Based Medicine ; Humans ; Patient Positioning/methods ; Practice Guidelines as Topic ; Randomized Controlled Trials as Topic ; Respiration, Artificial
    Language English
    Publishing date 2011-04-11
    Publishing country England
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/cc10135
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 5517: Show issues Location:
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  4. Article ; Online: Urethral catheters: can we reduce use?

    van den Broek, Pieter J / Wille, Jan C / van Benthem, Birgit H B / Perenboom, Rom J M / van den Akker-van Marle, M Elske / Niël-Weise, Barbara S

    BMC urology

    2011  Volume 11, Page(s) 10

    Abstract: Background: Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection.: Methods: The ... ...

    Abstract Background: Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection.
    Methods: The efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated.
    Results: Of a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13) and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13), decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96), but increased significantly in intensive care (IC) and coronary care (CC) units (OR 1.48; 95% CI 1.01 - 2.17). The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16) and neurology (ratio 0.97; 95% CI 0.80 - 1.18) and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96) and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90). The percentage of correct indications on the day of inclusion increased from 50 to 67% (p < 0.0001). The prevalence of urinary tract infections in catheterized patients did not change. The mean cost saved per 100 patients was € 537.
    Conclusion: Targeted implementation of recommendations from an existing guideline can lead to better adherence and cost savings. Especially, hospitals which use a lot of urethral catheters or where catheterization is prolonged, can expect important improvements.
    MeSH term(s) Adolescent ; Adult ; Aged ; Female ; Guideline Adherence/statistics & numerical data ; Humans ; Male ; Middle Aged ; Netherlands/epidemiology ; Practice Guidelines as Topic ; Risk Assessment ; Risk Factors ; Urinary Catheterization/standards ; Urinary Catheterization/statistics & numerical data ; Urinary Tract Infections/epidemiology ; Urinary Tract Infections/prevention & control ; Utilization Review ; Young Adult
    Language English
    Publishing date 2011-05-23
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2059857-9
    ISSN 1471-2490 ; 1471-2490
    ISSN (online) 1471-2490
    ISSN 1471-2490
    DOI 10.1186/1471-2490-11-10
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Urethral catheters

    van den Akker-van Marle M Elske / Perenboom Rom JM / van Benthem Birgit HB / Wille Jan C / van den Broek Pieter J / Niël-Weise Barbara S

    BMC Urology, Vol 11, Iss 1, p

    can we reduce use?

    2011  Volume 10

    Abstract: Abstract Background Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. Methods ... ...

    Abstract Abstract Background Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. Methods The efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated. Results Of a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13) and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13), decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96), but increased significantly in intensive care (IC) and coronary care (CC) units (OR 1.48; 95% CI 1.01 - 2.17). The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16) and neurology (ratio 0.97; 95% CI 0.80 - 1.18) and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96) and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90). The percentage of correct indications on the day of inclusion increased from 50 to 67% (p < 0.0001). The prevalence of urinary tract infections in catheterized patients did not change. The mean cost saved per 100 patients was € 537. Conclusion Targeted implementation of recommendations from an existing guideline can lead to better adherence and cost savings. Especially, hospitals which use a lot of urethral catheters or where catheterization is prolonged, can expect important improvements.
    Keywords Diseases of the genitourinary system. Urology ; RC870-923 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Urology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Subject code 610
    Language English
    Publishing date 2011-05-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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