Long-term indwelling catheters are employed by community-dwelling adults who have complete urinary retention due to a variety of chronic conditions, such as progressive neurological disorders, and are not able to independently perform intermittent catheterization. Many of these persons are supported by formal home-care programs for catheter care and replacement of indwelling catheters, however the day-to-day self-care management of the catheter is the responsibility of the patient. For example, persons with an indwelling catheter may only receive in-home nursing support when the indwelling catheter is due to be changed. A recent Canadian case cross-over study found that having an indwelling catheter increased the risk of emergency department use (1). Reasons for these emergency department visits included urinary tract infection, mechanical complications of the catheter (i.e., not draining), and urinary retention (1). Catheter-related complications have a significant negative impact on quality of life, well-being and health. While research evidence is available on preventing some complications of indwelling catheters, these findings are less relevant to the home setting, where persons do not have daily clinical oversight of the catheter. Guidelines on the management of long-term indwelling catheters do not include recommendations on how to effectively provide self-care support and education for persons to manage the care and prevent complications. 

The purpose of this scoping review was to identify the breadth of the literature reporting self-care recommendations on the management of complications related to indwelling catheters in community-dwelling adults.

The Joanna Briggs Institute methodology for scoping reviews was employed (2).  A systematic search of the literature was conducted in CINAHL, MEDLINE, and Embase from the period of 2000-2023. A grey literature search was also conducted of professional organizational websites to identify best practice guidelines.  Documents were reviewed for inclusion by two independent researchers at both the title and abstract screening and full text review stages. Data extraction was conducted by one researcher with an independent review and verification completed by another researcher. Data extraction of the included literature was analyzed by content analysis, directed by the middle range theory of self-care in chronic illness.

A total of 47 documents were included; 14 expert opinion articles; 12 qualitative research studies; seven quality improvement projects, six quantitative research studies, seven clinical resource or guide, and one mixed methods study. Overall, the methodological quality of the studies was poor. The majority of the located documents were based solely on expert opinion and not substantiated with evidence. Most of the recommendations were regarding maintenance of the catheter (e.g., cleaning perineum, caring for drainage bags) and monitoring (e.g., monitoring urine flow, maintaining healthy fluid intake), and less on management (e.g., when to seek support from a health-care professional. The main focus of the included documents was recommendations for important topics to consider in patient education and nursing interventions to prevent complications. Very little evidence was located on how to support self-care for patients to prevent catheter complications and practical materials to enact that support (e.g., patient-facing documentation or instructions).

The state of knowledge on the topic of self-care recommendations on the management of complications in adults with long-term indwelling catheters is limited. Given necessity of self-care for adults with long-term indwelling catheters, how to provide self-care support, what education and training that should include, and how to monitor the effectiveness of self-care support is required.

Further, high-quality research is required to inform the development of recommendations for home health care professionals, in particular nurses, to provide effective self-care management support to persons with long-term indwelling catheters and prevent complications.

Schumacher, C., Jones, A., & Costa, A. P.. (2021). Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?. Canadian Journal of Nursing Research, 53(4), 376–383. https://doi.org/10.1177/0844562120949426
Peters, M. D., Godfrey, C. M., Khalil, H., McInerney, P., Parker, D., & Soares, C. B. (2015). Guidance for conducting systematic scoping reviews. JBI Evidence Implementation, 13(3), 141-146.