EAUN Guideline Intermittent Catheterisation receives new update

The revised guidelines for intermittent catheterisation including urethral dilatation were presented at EAUN24. The guideline from 2013 was revised and due to the large time span, a lot of literature had to be reviewed. Hence, those responsible have agreed to do an update in 2-3 years next time.

A working group of care specialists in practice and science and a urologist spent 2,5 years working on the update. 1,433 abstracts were read, and after reviewing these, 273 studies were processed in full text, of which 49 new studies were included in the guidelines. A second literature search yielded a further 533 abstracts, of which 30 were read as full texts and 17 were added to the guidelines.

There is still little high evidence on the practical aspects of catheter placement, choice of catheter, troubleshooting and documentation. More high-quality evidence is available when it comes to preventing urinary tract infections and improving quality of life in people doing intermittent catheterisation. Many recommendations are still based on empirical knowledge – the weakest level of evidence in evidence-based guidelines, which is 4C. The working group aims to develop guidelines where we integrate the latest, highest level scientific research into the daily nursing practice, with regard to theoretical knowledge, nursing experience and the patient perspective.

Fortunately, where high level literature is missing, this gap is filled with empirical evidence from experienced urology nurses, and this experience forms the basis of these 4C recommendations.

Some highlights of the revised guidelines: In the updated guidelines, the indications, contraindications, as well as benefits and risks of the different types of catheters have been revised. The definitions for urinary tract infections have been clarified. Further definitions such as urethral stenosis or urethral meatus stenosis, as well as the terms dilatation, urinary retention or residual urine have been added The choice of catheter and catheter materials of the most common catheter companies have been presented and illustrated in a table making it easy to see different properties of the products.

Unfortunately, some of the aids (help devices) for intermittent catheterisation had to be removed due to a lack of availability. Special attention was paid to the prevention, identification, and management of catheter-related complications. The information on training, support and empowerment of patients and caregivers was extended. New studies on quality of life in connection with intermittent catheterisation have been included in the guideline. The patient perspective has been added as a new chapter. This chapter highlights what nurses should consider regarding the patient perspective and what barriers and facilitators catheter users experience when they need to incorporate catheterisation into their daily lives and activities.

In the appendices, nurses, patients and caregivers can find support on how to perform the procedures. The micturition and drinking diary has been renewed and a new appendix deals with tools for evaluating intermittent catheterisation or self-catheterisation. These include a satisfaction questionnaire, acceptance questionnaire, quality of life, adherence scale and difficulties questionnaire.

The EAUN24 session featuring these revised guidelines began with a voting tool for feedback from participants on their own practice. They were asked if on-going support for catheterisation would be important beyond discharge. This question, which is also a recommendation in the guideline, was described as important by 100%. In response to the second question about the situation in daily practice, i.e. whether resources (time and manpower), were available, only 70% were of the opinion that this would be the case. This also showed the discrepancy between evidence-based recommendations and daily practice, to take just one example. There is still a lot to do in this respect!

The working group, under the leadership of Dr. Vahr Lauridsen with the following members: S. Chagani (PK), A. Daniels (IE), T. Kelly (IE), H. Lurvink (NL), I. Pearce (GB), M. Popiński (PL), B. Thoft Jensen (DK), G. Villa (IT), S. Wildeman (NL), V. Geng (DE), agreed on the text and recommendations in the end.

We have learned a lot; by reading new studies, discussing them with each other and receiving the responses of the reviewers. We hope that this updated guideline will achieve the goal of being implemented into the clinical practice for intermittent catheterisation and urethral dilatation, considering country or region-specific regulations and the individual situation of the patients.

You can download the updated EAUN Guideline Intermittent Catheterisation.


By Dr. Susanne Vahr Lauridsen (DK), Chair, and Ms. Veronika Geng (DE), Vice Chair, EAUN Guidelines on Intermittent Catheterisation.