Randomized Controlled Trial

. 2025 Apr 7;15(4):e087206.

doi: 10.1136/bmjopen-2024-087206.

Patient and healthcare professionals' perception of weekly prophylactic catheter washout in adults living with long-term catheters: qualitative study of the CATHETER II trial

Sheela Tripathee¹, Mohamed Abdel-Fattah², Diana Johnson³, Lynda Constable⁴, Seonaidh Cotton³, David Cooper⁵, Graeme MacLennan⁶, Suzanne Evans⁷, Amanda Young⁸, Konstantinos Dimitropoulos⁹, Hashim Hashim¹⁰, Mary Kilonzo¹¹, James Hugh Larcombe¹², Paul Little¹³, Peter Murchie¹⁴, Phyo Kyaw Myint¹⁵, James NDow¹⁶, Catherine Paterson¹⁷, Karen Powell⁷, Graham Scotland¹⁸, Nikesh Thiruchelvam¹⁹, John Norrie²⁰, Muhammad Imran Omar^{21

22}, Sara J Maclennan²¹

Affiliations

¹ Academic Urology Unit, University of Aberdeen, Aberdeen, UK sheela.tripathee@abdn.ac.uk.
² Aberdeen Centre for Women's Health Research, Institute for Applied Health Sciences, 2nd Floor, Aberdeen Maternity Hospital, Foresterhill, University of Aberdeen, Aberdeen, UK.
³ Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK.
⁴ Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK.
⁵ Health Services Research Unit, Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK.
⁶ Centre for Healthcare Randomised Trials, Health Sciences Building Foresterhill, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK.
⁷ Bladder Health UK, Birmingham, UK.
⁸ Queen's Nursing Institute, London, UK.
⁹ Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
¹⁰ Bristol Urology Institute, North Bristol NHS Trust, Westbury on Trym, Bristol, UK.
¹¹ Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
¹² NHS Durham Dales Easington and Sedgefield CCG, Sedgefield, County Durham, UK.
¹³ University of Southampton, Medical School, Southampton, UK.
¹⁴ Academic Primary Care, University of Aberdeen, Aberdeen, UK.
¹⁵ Institute of Applied Health Sciences, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK.
¹⁶ Department of Surgery, University of Aberdeen, Aberdeen, UK.
¹⁷ School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia.
¹⁸ Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, UK.
¹⁹ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁰ Edinburgh Clinical Trials Unit (ECTU), Edinburgh Royal Infirmary, Edinburgh, UK.
²¹ Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
²² Guidelines Office, European Association of Urology, Arnhem, The Netherlands.

PMID: 40194879
PMCID: PMC11977465
DOI: 10.1136/bmjopen-2024-087206

Randomized Controlled Trial

Patient and healthcare professionals' perception of weekly prophylactic catheter washout in adults living with long-term catheters: qualitative study of the CATHETER II trial

Sheela Tripathee et al. BMJ Open. 2025.

. 2025 Apr 7;15(4):e087206.

doi: 10.1136/bmjopen-2024-087206.

Authors

Affiliations

¹ Academic Urology Unit, University of Aberdeen, Aberdeen, UK sheela.tripathee@abdn.ac.uk.
² Aberdeen Centre for Women's Health Research, Institute for Applied Health Sciences, 2nd Floor, Aberdeen Maternity Hospital, Foresterhill, University of Aberdeen, Aberdeen, UK.
³ Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK.
⁴ Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK.
⁵ Health Services Research Unit, Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK.
⁶ Centre for Healthcare Randomised Trials, Health Sciences Building Foresterhill, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK.
⁷ Bladder Health UK, Birmingham, UK.
⁸ Queen's Nursing Institute, London, UK.
⁹ Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
¹⁰ Bristol Urology Institute, North Bristol NHS Trust, Westbury on Trym, Bristol, UK.
¹¹ Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
¹² NHS Durham Dales Easington and Sedgefield CCG, Sedgefield, County Durham, UK.
¹³ University of Southampton, Medical School, Southampton, UK.
¹⁴ Academic Primary Care, University of Aberdeen, Aberdeen, UK.
¹⁵ Institute of Applied Health Sciences, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK.
¹⁶ Department of Surgery, University of Aberdeen, Aberdeen, UK.
¹⁷ School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia.
¹⁸ Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, UK.
¹⁹ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁰ Edinburgh Clinical Trials Unit (ECTU), Edinburgh Royal Infirmary, Edinburgh, UK.
²¹ Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
²² Guidelines Office, European Association of Urology, Arnhem, The Netherlands.

PMID: 40194879
PMCID: PMC11977465
DOI: 10.1136/bmjopen-2024-087206

Abstract

Objectives: To explore trial participants' experience of long-term catheters (LTC), the acceptability of washout policies, their experience of the CATHETER II trial (a randomised controlled trial comparing the clinical effectiveness of various washout policies versus no washout policy in preventing catheter associated complications in adults living with long-term catheters) and their satisfaction with the outcomes. The objectives of the healthcare professionals (HCPs) focus group and interview were to explore their attitudes towards weekly prophylactic catheter washout, views on the provision of training and participants' ability to enact washout behaviours.

Methodology: A longitudinal qualitative study embedded within the CATHETER II randomised controlled trial, which included semi-structured interviews and focus groups with participants from multiple trial sites. Data were analysed using the Theoretical Framework of Acceptability and Theoretical Domains Framework. This UK community-based study included 50 (24 female, 26 male) CATHETER II trial participants, aged between 23 and 100 years, with LTC and able to self-manage the washout and study documentation either independently or with the help of a carer. Seven HCPs (five female, two male) also participated.

Results: The participants had positive attitudes towards weekly prophylactic saline or acidic catheter washouts and other trial elements, such as washout training, catheter calendar and monthly phone calls. Participants and HCPs found the 'ask' of the CATHETER II trial and the weekly self-administered prophylactic washout policies to be feasible. The participants reported that the catheter washout training provided during the trial enhanced their self-efficacy, skills and self-reported capability to carry out the washouts. Participants reported having positive outcomes from the weekly washout. These included reduced blockage, pain or infection, reduced need for HCP support and greater psychological reassurance. HCPs attested to the participants' understanding of and adherence to the weekly washouts and other elements of the trial.

Conclusions: This study shows acceptability, feasibility and self-reported fidelity of the CATHETER II trial on a behavioural level. Self-management for prophylactic catheter washouts is both feasible and, following training, achievable without any need for additional support.

Trial registration number: ISRCTN17116445.

Keywords: clinical trial; health services; qualitative research; self-management; urinary incontinences; urology.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare support from the NIHR Health Technology Assessment Programme for the submitted work. MA-F declares B. Braun Medical donated the supply of washout solutions for use in the CATHETER II study. B. Braun Medical commented on the manuscript prior to submission and these comments were considered so long as they did not compromise the scientific nature or neutrality of the publication. MAF declares travel sponsorship and, on occasion, speaker’s fees from numerous national and international conferences and non-profit organisations as a guest speaker and/or expert surgeon. DC reports grants, other than CATHETER II, from NIHR. JHL reports consulting fees as a MRCGP examiner; honoraria and fees for Pulse Live/Virtual, North-East Fellowship scheme and RCGP/RPS-CPCS (pharmacists) lectures and teaching; travel expenses for BNFC formulary committee and RCGP examiners; roles in NE England faculty RCGP Co Durham CCG, NICE; stocks in GSK, Haleon, Hikma Pharm, Smith and Nephew, Unilever and other non-medical companies and interests as a locum GP and COVID-19 consultant. All other authors have no completing interest to declare. No other financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years are declared by all the authors.

References

1. International Continence Society Urinary Retention. 2018. https://www.ics.org/committees/standardisation/terminologydiscussions/ur... Available.
1. Gage H, Avery M, Flannery C, et al. Community prevalence of long-term urinary catheters use in England. Neurourol Urodyn. 2017;36:293–6. doi: 10.1002/nau.22961. - DOI - PubMed
1. Wilde MH, McMahon JM, Crean HF, et al. Exploring relationships of catheter-associated urinary tract infection and blockage in people with long-term indwelling urinary catheters. J Clin Nurs. 2017;26:2558–71. doi: 10.1111/jocn.13626. - DOI - PMC - PubMed
1. Wilde MH, McDonald MV, Brasch J, et al. Long-term urinary catheter users self-care practices and problems. J Clin Nurs. 2013;22:356–67. doi: 10.1111/jocn.12042. - DOI - PMC - PubMed
1. Getliffe K. Managing recurrent urinary catheter encrustation. Br J Community Nurs. 2002;7:574. doi: 10.12968/bjcn.2002.7.11.10888. - DOI - PubMed

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Patient and healthcare professionals' perception of weekly prophylactic catheter washout in adults living with long-term catheters: qualitative study of the CATHETER II trial

Affiliations

Patient and healthcare professionals' perception of weekly prophylactic catheter washout in adults living with long-term catheters: qualitative study of the CATHETER II trial

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous