Management of bladder spasms in patients with indwelling urinary catheters: A systematic review

Introduction:: Bladder spasms caused by indwelling urinary catheters are a serious burden in patients in all settings. Medication may help, but comes with side effects. Little has been described on non-pharmacological interventions in day-to-day care. This systematic review aims to present an overview of interventions that nurses can apply to reduce bladder spasms in patients with indwelling urinary catheters, when removing the catheter is not an option. Material and methods:: A systematic review was conducted, in accordance with PRISMA-guidelines. Terms focusing on urinary catheters and bladder spasms were searched for in EAUN Guidelines, Pallialine (NL), Cochrane, Cinahl, PubMed and Embase. A quality assessment was executed, using a critical review form, resulting in low, good or high quality reports. A best-evidence synthesis was carried out for similar interventions. Strong evidence means consistent findings in more than one high-quality report. Moderate evidence means consistent findings in one good-quality and at least one low-quality report. Insufficient evidence means one report found or inconsistent findings in more than one report. Results:: After deduplication of 4.208 records, 2.658 unique records were screened for inclusion criteria, resulting in 20 included reports. The quality assessment identified 15 reports of low, 4 reports of good and 1 report of high quality. The best-evidence synthesis resulted in seven interventions with moderate evidence: reduce balloon size, fixation of catheter, use catheter valve, secure urine bag, treat constipation, increase fluid intake and a balanced, fiber-rich diet. Some interventions were only described in low-quality reports, resulting in low to moderate evidence: avoid bladder irritants, wait 24–48 h, resolve blockage of catheter and tubing, place urine bag lower than bladder. Other found interventions had insufficient evidence. Discussion:: Most reports found were of low or good quality. However, many articles advocate for the same interventions, resulting in seven interventions of moderate evidence. Conclusions:: Five interventions with low to moderate evidence need to be researched more thoroughly. In conclusion, the following interventions, easily applied by nurses, were found: reduce the balloon size, fixate the catheter, secure the urine bag or use a catheter valve, treat constipation, increase fluid intake and advice a balanced, fiber-rich diet.