Indications for urinary catheterization in hospitalized children: An integrative review: An integrative review

Introduction: Appropriate indications for urinary catheterization are crucial to prevent catheter-associated complications, but current guidelines lack specificity for hospitalized children. This review aimed to evaluate reported indications for urethral catheterization in hospitalized children aged <18 years. Secondary, we aimed to identify factors influencing catheter insertion and removal, and to review the effectiveness of interventions to reduce inappropriate catheter usage. Methods: For this integrative review, a search was conducted in January 2024 in Medline, Embase, Cochrane library, CINAHL, and Web of Science, and additional sources for guidelines and grey literature. Two reviewers independently selected the studies and executed structured data extraction and categorization. Results: Of 15,910 search results, 49 studies were included. The main reported indications for urinary catheterization in hospitalized children include managing acute urinary retention, urine output monitoring, specific surgeries, lumbar epidural analgesia, perineal wounds, and end-of-life care. Ambiguous policies were reported regarding routine catheterization to prevent acute urinary retention. The main factors influencing catheter insertion and removal were the risk of re-catheterization, patient distress, staff capacity and skills, awareness of catheter presence, variation of local practice, usage of protocols, and established criteria for urinary retention. Studies that described a sustained effect on reducing inappropriate urinary catheter use included a daily checklist, with or without a designated expert focusing on reducing catheter-associated urinary tract infections. Discussion: Indications for urinary catheterization in hospitalized children largely mirror adult practices, with ambiguity concerning routine catheterization for acute urinary retention. The results of this integrative review predominantly reflect local preferences.