Factors associated with symptomatic urinary tract infection in persons with spinal cord lesions who perform clean intermittent catheterization with single-use catheters.

OBJECTIVES: To investigate factors associated with symptomatic urinary tract infection (sUTI) in persons with chronic spinal cord lesion (SCL) who were using single-use catheters for intermittent self-catheterization (ISC). METHODS: Among respondents to an internet survey on the burden of illness on persons with SCL who were considered to be able to perform ISC, 111 persons using single-use catheters were included to examine factors associated with self-reported sUTI by univariate as well as multivariable analysis. RESULTS: The incidence of sUTI was significantly higher in males than in females (56.9% vs. 31.6%, p = .011), persons with stocks of antibiotics than those without it (82.9% vs. 28.6%, p < .011), and persons with more frequent bleeding during catheterization than those with less frequent bleeding (100% vs. 46.5%, p = .036). The incidence did not significantly differ between respective groups when various variables were evaluated by other characteristics of the participants, adherence to ISC procedures, and complications. On multivariable analysis, male gender and stocks of antibiotics were significant independent factors for sUTI. CONCLUSIONS: Male gender and stocks of antibiotics were associated with sUTI in persons with SCL who were performing ISC with single-use catheters.

Penile urinary sheaths: a continence management system for men.

Urinary leakage is prevalent in men. To contain and manage this leakage, men are often advised about urinary devices. However, sometimes this advice does not include penile sheaths. Penile sheaths are a good way of managing urinary leakage if an individual is suitable for sheaths. This article will explore this suitability, advantages to using a sheath, reasons why sheaths may not be suitable, and will discuss optimum fitting to ensure the sheath is a secure drainage device.

Inappropriate placement of urinary catheters into the ureter: A case report and literature review.

OBJECTIVE: To emphasize preventive measures and outline management strategies for inadvertent ureteral cannulation. METHODS: We present a case report and conduct a literature review of 39 case reports on ureteral cannulation, examining a total of 48 patients. RESULTS: About 67% of the cases were female, and long-term catheterization was observed in 67% of the cases. Neurological conditions such as spinal cord injury (SCI), stroke, dementia, multiple sclerosis, and myasthenia gravis were the primary factors (48%) in ureteral cannulation. Symptoms included flank pain (46%), fever (31%), oliguria (27%), non-deflatable balloon issues (25%), hematuria (21%), abdominal pain (17%), urine leak (12.5%), and nausea/vomiting (8%). Complications varied, including acute pyelonephritis (35%), acute kidney injury (27%), urosepsis (21%), and ureter rupture (17%). Despite inadvertent catheter placement, 25% of patients had no complications. More than half of the patients (58%) were managed through catheter change, while 27% underwent cysto-ureteroscopy with or without balloon puncture or ureteral stenting. Additionally, 10% received interventional radiology procedures, 6.25% underwent surgical repair, and 4% underwent ultrasound-guided balloon puncture. CONCLUSIONS: Female gender, neurologic conditions, and long-term catheterization were identified as predominant risk factors. Early detection of ureteral cannulation can prevent severe complications, particularly in certain special populations such as patients with neurogenic bladder or SCI, who may have reduced sensation and expression capabilities.

[Antibacterial prophylaxis with fosfomycin at the time of the urethral catheter removal after radical prostatectomy (prospective randomized trial)].

AIM: To evaluate the effect of antibacterial prophylaxis using oral fosfomycin during the removal of a urethral catheter after radical prostatectomy on the development of urinary tract infection, severity of leukocyturia and bacteriuria, as well as the severity of lower urinary tract symptoms. MATERIALS AND METHODS: A single-center, non-blind, prospective, randomized controlled trial was carried out. The main group included 40 patients, and the control group included 37 patients. In the group 1, patients received two doses of oral fosfomycin, 3 g, namely in the evening on the day of catheter removal (the first dose) and 48 hours after catheter removal (the second dose). In the group 2, patients did not receive any antibacterial prophylaxis after urethral catheter removal. The endpoints of the study were confirmed episodes of urinary tract infection within 1 month after removal of the urethral catheter, leukocyturia and bacteriuria in urinalysis/urine culture) and severity of the lower urinary tract symptoms assessed by IPSS questionnaire. RESULTS: In the group 2, urinary tract infection was noted in 17.1%, while in the group 2 only in 2.6% of patients (p=0.032). Leukocyturia and bacteriuria were significantly less common in the group receiving antibacterial prophylaxis with fosfomycin (18.4% vs. 48.6%, respectively; p=0.006). Positive urine culture was observed in 7.9% vs. 25.7%, respectively (p=0.035). Four weeks after removal of the urethral catheter, the average IPSS score was significantly higher in the group 2 (13.2 vs. 9.5 points; p=0.002). There were no cases of allergic reaction and pseudomembranous colitis associated with C. difficile in both groups. Diarrhea cured with sorbents was noted in 2 patients (5.2%) in fosfomycin group. CONCLUSION: Antibacterial prophylaxis using two oral doses of fosfomycin 3 g on the day of urethral catheter removal and 48 hours after catheter removal after radical prostatectomy appears to be an effective scheme that reduces the incidence of urinary tract infection and the severity of lower urinary tract symptoms, and is characterized by a minimal risk of adverse events. It is necessary to carried out further research and develop clear recommendations for antibacterial prevention in urological interventions requiring prolonged urethral catheterization.

Managing External Urinary Catheters.

This narrative review explores the use of external urinary catheters. These devices are available in various types and materials for male and female patients. The indications for the use of external urinary catheters include managing incontinence linked to overactive bladder and neurogenic lower urinary tract dysfunction. Contraindications to the use of external urinary catheters include urinary obstruction. Proper skin care and proactive infection control measures are necessary to prevent complications. The collection of a urine specimen for culture requires a standardized technique to prevent contamination. Clinician-led patient education on catheter management plays a important role in ensuring patient comfort and safety.

Urinary Catheters: Materials, Coatings, and Recommendations for Selection.

Urinary catheters have been used for more than 3000 years, although materials have changed from wood to silver to rubber. Research continues to try and find the optimal catheter materials, which improve safety and quality of life. Advantages when comparing newer catheter materials are not always obvious but catheters coated with a hydrophilic layer may reduce urethral trauma and the incidence of urinary tract infections. However, extrapolation of the data is limited by lack of end-point standardization and heterogenous populations.

Unresolved issues in the diagnosis of catheter related candidemia: A position paper / Cuestiones no resueltas en el diagnóstico de la candidemia relacionada con el catéter: un documento de opinión

The incidence and recent trends of candidemia and the contribution of the COVID-19 pandemic to its evolution are not well documented. The catheter is a major focus of Candida spp. infections, but the methods used to confirm the origin of candidemia are still based on the data generated for bacterial infection. The presence of Candida spp. on the tip of a removed catheter is the gold standard for confirmation but it is not always possible to remove it. Conservative methods, without catheter removal, have not been specifically studied for microorganisms whose times of growth are different from those of bacteria and therefore these results are not applicable to candidemia. The different Candida species do not have a particular tropism for catheter colonization and fungal biomarkers have not yet been able to contribute to the determination of the origin of candidemia. Techniques such Candida T2 Magnetic Resonance (T2MR) has not yet been applied for this purpose. Finally, there is not yet a consensus of how to proceed when Candida spp. is isolated from an extracted catheter and blood cultures obtained from simultaneous peripheral veins are negative. In this lack of firm data, a group of experts has formulated a series of questions trying to answer them based on the literature, indicating the current deficiencies and offering their own opinion. All authors agree with the conclusions of the manuscript and offer it as a position and discussion paper. (AU)

La incidencia y las tendencias recientes de la candidemia y la contribución de la pandemia de COVID-19 a su evolución no están bien documentadas. El catéter es uno de los principales focos de infecciones por Candida spp., pero los métodos empleados para confirmar el origen de la candidemia siguen basándose en los datos generados para la infección bacteriana. La presencia de Candida spp. en la punta de un catéter retirado es el método de referencia para la confirmación, pero no siempre es posible proceder a dicha retirada. Los métodos conservadores, sin retirada del catéter, no han sido estudiados específicamente para microorganismos cuyos tiempos de crecimiento son diferentes a los de las bacterias y, por tanto, estos resultados no son aplicables a la candidemia. Las diferentes especies de Candida spp. no tienen un tropismo particular para la colonización del catéter y los biomarcadores fúngicos, aún no han podido contribuir a la determinación del origen de la candidemia. Técnicas como la resonancia magnética T2MR todavía no se ha empleado para este fin. Por último, todavía no existe un consenso sobre cómo proceder cuando se aísla Candida spp. en un catéter extraído y los hemocultivos obtenidos por venas periféricas simultáneas son negativos. Ante esta falta de datos firmes, un grupo de expertos ha formulado una serie de preguntas y ha tratado de responderlas en base a la literatura, indicando las carencias presentes y ofreciendo su propia opinión. Todos los autores están de acuerdo con las conclusiones del manuscrito y lo ofrecen como documento de posición y discusión. (AU)

Urinary catheter placement and adverse urinary outcomes with a focus on elevated risk in men with indwelling Foley catheters.

BACKGROUND: Prior studies indicated a link between urinary catheter use and urinary complications, highlighting the need for comprehensive, gender-specific investigations. This study explored the association through a national retrospective cohort, emphasizing gender disparities and long-term outcomes. METHODS: Our study utilized data from the entire population covered by Taiwan's National Health Insurance Research Database from 2000 to 2017. We included 148,304 patients who had undergone Foley catheter placement and their propensity-scores matched controls in the study. We evaluated urinary complications, which encompassed urinary tract cancer, urolithiasis, urethral stricture, obstructive uropathy, reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, urinary tract rupture, and urinary tract infection. These were assessed using the Fine and Gray sub-distribution proportional hazards model to compare between the Foley and non-Foley groups. Sensitivity analyses were conducted with different matching ratios. RESULTS: In the study, the non-Foley group presented a marginally higher mean age (75.24 ± 10.47 years) than the Foley group (74.09 ± 10.47 years). The mean duration of Foley catheterization was 6.1 ± 4.19 years. Men with Foley catheterization exhibited the highest adjusted sub-distribution hazard ratios for urinary tract cancer (6.57, 95% CI: 5.85-7.37), followed by women with Foley catheterization (4.48, 95% CI: 3.98-5.05), and men without catheterization (1.58, 95% CI: 1.39-1.8) in comparison with women without the procedure. Furthermore, men with Foley catheterization were found to be at the greatest risk for complications such as urolithiasis, urethral stricture, obstructive and reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, and urinary tract rupture. Conversely, women with urinary catheterization were most susceptible to urinary tract infections. CONCLUSIONS: The evidence confirms that urinary catheterization significantly increases urinary complications, particularly among men. Our study underscores the crucial need for healthcare providers to carefully evaluate the necessity of catheterization, aim to shorten its duration whenever feasible, and strictly adhere to established protocols to minimize complications.

Novel surface biochemical modifications of urinary catheters to prevent catheter-associated urinary tract infections.

More than 70% of hospital-acquired urinary tract infections are related to urinary catheters, which are commonly used for the treatment of about 20% of hospitalized patients. Urinary catheters are used to drain the bladder if there is an obstruction in the tube that carries urine out of the bladder (urethra). During catheter-associated urinary tract infections, microorganisms rise up in the urinary tract and reach the bladder, and cause infections. Various materials are used to fabricate urinary catheters such as silicone, polyurethane, and latex. These materials allow bacteria and fungi to develop colonies on their inner and outer surfaces, leading to bacteriuria or other infections. Urinary catheters could be modified to exert antibacterial and antifungal effects. Although so many research have been conducted over the past years on the fabrication of antibacterial and antifouling catheters, an ideal catheter needs to be developed for long-term catheterization of more than a month. In this review, we are going to introduce the recent advances in fabricating antibacterial materials to prevent catheter-associated urinary tract infections, such as nanoparticles, antibiotics, chemical compounds, antimicrobial peptides, bacteriophages, and plant extracts.

External urinary catheter devices: A multisite project involving point prevalence.

External urinary catheter devices used in hospitals can offer an alternative to indwelling urinary catheters. Prevalence and patient outcomes are not well understood. This multisite project involved point prevalence of device use in patients with labia on acute care units. All patients on included units with corresponding anatomy were observed for presence of device in addition to review of indication of use and chart audit. Device use was 28.8 %. Immobility was the leading indication, and most patients had severe dysfunction as to mobility. For most patients, level of mobility remained the same from admission to discharge. Many patients were either potentially physically able to mobilize out of bed to urinate or were likely continent. There was variation in suction setting and chart documentation. The project lacked a comparison group and collected limited patient information. Areas for future inquiry include prevalence and impact on mobility, continence, and skin integrity.

Characterization and Outcomes of Iatrogenic Urethral Catheterization Injuries.

INTRODUCTION: Iatrogenic injury during urethral catheterization is a common reason for inpatient urologic consultation and is associated with increased morbidity and resource utilization. Literature defining the patient population, interventions, or outcomes associated with traumatic catheterization is scarce. METHODS: We performed a retrospective review of consults for adult urethral catheterization at a single tertiary care center (July 2017-December 2019), with focus on patient characteristics and complications. Traumatic urethral catheterization was defined as catheterization by the primary team with at least 1 of these conditions: gross hematuria, meatal blood, or cystoscopic evidence of urethral trauma. Characteristics collected included urologic history, catheterization circumstances, procedural intervention, and subsequent visits. RESULTS: Three hundred urology consults for urethral catheterization were identified, including 98 (33%) traumatic events (5.3 incidents/1000 catheters placed). All traumatic catheterization consults were in men (median age 69 years). Most (71%) patients sustaining injury had significant urologic history (eg, benign prostatic hyperplasia, urethral stricture). Sixty-three (64%) consults were determined to be uncomplicated (not requiring any procedural intervention for catheter placement). Gross hematuria was the most common sequela (50% of patients). The 30-day catheter-associated urinary tract infection rate was 13%, and 2 patients developed sepsis. Complications required a total of 52 additional hospital admission days, 19 of which were intensive-care level, as well 113 outpatient urology visits. CONCLUSIONS: Traumatic urethral catheterization is associated with increased need for procedural intervention, risk of catheter-associated urinary tract infection, and additional resource utilization. Further studies on traumatic catheterization are needed to guide systemic efforts for minimizing injury and cost.

Prevention of Postoperative Urethral Strictures by Irrigation with 5-Fluorouracil via a Modified Urinary Catheter.

Background and Objectives: Urethral strictures are the most common complications after surgical treatments of benign prostatic hyperplasia (BPH). Despite various preventive measures, the search for medications with antiproliferative activity and the development of surgical procedures to prevent the development of urethral strictures are still relevant. We evaluated the preventive efficacy of 5-fluorouracil against urethral strictures in patients undergoing surgery for BPH. Materials and Methods: A non-randomized clinical trial including 246 male patients with an average age of 70.0 ± 8.0 years was conducted. The main study group included 124 patients who, in addition to the standard treatment, received lavage with a 5-fluorouracil solution (1000 mg/20 mL per 500 mL of 0.9% isotonic saline) using a modified three-way urethral catheter. The monitoring of clinical, laboratory, and instrumental parameters was carried out 10 days, 3 months, and 6 months after surgery. Results: The evaluation of severity for dysuria symptoms in patients using the IPSS scale throughout the entire follow-up period showed a statistically significant decrease in ischuria and stranguria, prolongation of the interval between urinations, a decrease in intermittent urination, urinary incontinence, and straining before urination in the main group in comparison with the control patients. The patients of both study groups noted an improvement in the quality of life. It was found statistically significant decrease in the maximum urinary flow rate in the main group (p < 0.001). In the control group, after three months, four cases of urethral strictures and stenosis were recorded; after six months, this rate reached nine cases (7.3%), while in the main group, only one patient with infravesical obstruction was found (0.8%) (χ2 = 3.855, p < 0.05). Conclusions: The results of our study could indicate the effectiveness of the antiproliferative drug 5-fluorouracil in combination with use of a modified catheter in relation to the development of postoperative urethral strictures.

The Knotted Urethral Catheter-Description of a Novel Technique and Steps for Removal.

ABSTRACT: The spontaneous intravesicular knotting of a feeding tube used for urethral catheterization is a rare but documented complication. The reported incidence in the world literature is 0.2 per 100,000, with only 40 cases reported. Removal of these intravesicular knots has been attempted in a number of ways, such as the use of a guide wire to untangle the knot, use of excess lubrication and traction with or without anesthetic, and percutaneous or open cystostomy. This cystoscopic technique for removal has not been previously described.Based on our experience and published recommendations, we formulate an algorithm for removal. We outline steps for prevention and techniques from simple to complex, which can be used to remove knotted catheters.Although a rare complication of catheterization in children, catheter knotting can be troublesome. Following the steps suggested in this algorithm may avoid the use of more invasive techniques for removal.

Effects of an intraoperative intravenous Bolus Dose of Dexmedetomidine on postoperative catheter-related bladder discomfort in male patients undergoing transurethral resection of bladder tumors: a randomized, double-blind, controlled trial.

PURPOSE: To investigate whether the effect of intravenous bolus doses of dexmedetomidine on postoperative catheter-related bladder discomfort (CRBD) was dose-dependent in male patients undergoing transurethral resection of bladder tumors (TURBT). METHODS: The study protocol was registered at the Chinese Clinical Trial Registry (ChiCTR 2,000,034,657, date of registration: July 14, 2020). Adult male patients were randomized to one of four groups: placebo (Group C); dexmedetomidine 0.2 µg/kg (Group D 0.2); dexmedetomidine 0.5 µg/kg (Group D 0.5); or dexmedetomidine 1 µg/kg (Group D 1). The primary outcome was the incidence of moderate-to-severe CRBD at 0, 1, 6, 24, and 48 h postoperatively. RESULTS: The incidence of moderate-to-severe CRBD was significantly lower in Group D 0.5 and Group D 1 than in Group C at 0 h (13% vs. 40%, P = 0.006; 8% vs. 40%, P = 0.001), 1 h (15% vs. 53%, P < 0.001; 13% vs. 53%, P < 0.001), and 6 h (10% vs. 32%, P = 0.025; 8% vs. 32%, P = 0.009) postoperatively. Compared with baseline, both the MAP and HR were significantly lower in Group D 1 at 1 min ([94 ± 15] vs. [104 ± 13] mm Hg, P = 0.003; [64 ± 13] vs. [73 ± 13] bpm, P = 0.001) and 30 min ([93 ± 10] vs. [104 ± 13] mm Hg, P < 0.001; [58 ± 9] vs. [73 ± 13] bpm, P < 0.001) postextubation. CONCLUSION: The effect of intravenous bolus doses of dexmedetomidine on postoperative CRBD was dose-independent, whereas intravenous administration of 0.5 µg/kg dexmedetomidine reduced the early postoperative incidence of CRBD with minimal side effects. TRIAL REGISTRATION: Clinical trial number and registry URL: ChiCTR 2,000,034,657, http://www.chictr.org.cn , date of registration: July 14, 2020.

Comparison of Superhydrophilic, Liquid-Like, Liquid-Infused, and Superhydrophobic Surfaces in Preventing Catheter-Associated Urinary Tract Infection and Encrustation.

Over the past decade, superhydrophilic zwitterionic surfaces, slippery liquid-infused porous surfaces, covalently attached liquid-like surfaces, and superhydrophobic surfaces have emerged as the most promising strategies to prevent biofouling on biomedical devices. Despite working through different mechanisms, they have demonstrated superior efficacy in preventing the adhesion of biomolecules (e.g., proteins and bacteria) compared with conventional material surfaces. However, their potential in combating catheter-associated urinary tract infection (CAUTI) remains uncertain. In this research, we present the fabrication of these four coatings for urinary catheters and conduct a comparative assessment of their antifouling properties through a stepwise approach. Notably, the superhydrophilic zwitterionic coating demonstrated the highest antifouling activity, reducing 72.3% of fibrinogen deposition and over 75% of bacterial adhesion (Escherichia coli and Staphylococcus aureus) when compared with an uncoated polyvinyl chloride (PVC) surface. The zwitterionic coating also exhibited robust repellence against blood and improved surface lubricity, decreasing the dynamic coefficient of friction from 0.63 to 0.35 as compared with the PVC surface. Despite the fact that the superhydrophilic zwitterionic and hydrophobic liquid-like surfaces showed great promise in retarding crystalline biofilm formation in the presence of Proteus mirabilis, it is worth noting that their long-term antifouling efficacy may be compromised by the proliferation and migration of colonized bacteria as they are unable to kill them or inhibit their swarming. These findings underscore both the potential and limitations of these ultralow fouling materials as urinary catheter coatings for preventing CAUTI.

A comprehensive status update on modification of foley catheter to combat catheter-associated urinary tract infections and microbial biofilms.

Present-day healthcare employs several types of invasive devices, including urinary catheters, to improve medical wellness, the clinical outcome of disease, and the quality of patient life. Among urinary catheters, the Foley catheter is most commonly used in patients for bladder drainage and collection of urine. Although such devices are very useful for patients who cannot empty their bladder for various reasons, they also expose patients to catheter-associated urinary tract infections (CAUTIs). Catheter provides an ideal surface for bacterial colonization and biofilm formation, resulting in persistent bacterial infection and severe complications. Hence, rigorous efforts have been made to develop catheters that harbour antimicrobial and anti-fouling properties to resist colonization by bacterial pathogens. In this regard, catheter modification by surface functionalization, impregnation, blending, or coating with antibiotics, bioactive compounds, and nanoformulations have proved to be effective in controlling biofilm formation. This review attempts to illustrate the complications associated with indwelling Foley catheters, primarily focussing on challenges in fighting CAUTI, catheter colonization, and biofilm formation. In this review, we also collate scientific literature on catheter modification using antibiotics, plant bioactive components, bacteriophages, nanoparticles, and studies demonstrating their efficacy through in vitro and in vivo testing.

Patient Removal of Urinary Catheters After Urogynecologic Surgery: A Randomized Controlled Trial.

OBJECTIVE: To compare postoperative urinary retention rates in the early postoperative period between home and office catheter removal. Secondary outcomes included pain, difficulty, satisfaction, likelihood to use again, and health care utilization. METHODS: We conducted a nonblinded, randomized controlled, noninferiority trial of women undergoing surgery for stress incontinence and prolapse from March 2021 to June 2022. Exclusion criteria were preoperative voiding dysfunction (need for self-catheterization or postvoid residual [PVR] greater than 150 mL), urethral bulking, and need for prolonged postoperative catheterization. Participants discharged with indwelling catheters because of an initial failed void trial were randomized 1:1 to home compared with office removal on postoperative day 3-4. For home removal, participants were instructed to remove the catheter at 7 am and to drink two glasses of water. If they had difficulty voiding 5 hours after catheter removal, they came to the office for a void trial. For office removal, participants returned for a backfill void trial with PVR assessment. Our primary outcome was rate of early postoperative urinary retention , defined as confirmed retention (PVR greater than half the voided volume) after catheter removal. Secondary outcomes were assessed at a 2-week call. Health care utilization (telephone calls and office visits) related to catheter issues was also assessed. At 80% power and α=0.05, we needed 100 participants (50/group) to detect a noninferiority margin of 11%. RESULTS: Among 117 participants, the home (n=59) and office (n=58) removal groups were similar in mean age (60 years vs 61 years), mean body mass index (29 vs 30), pelvic organ prolapse quantification system stage 3 or 4, and proportion who underwent hysterectomy or apical suspension. Sling procedures were more common in the office group (45.8% vs 77.6%). For our primary outcome, the rate of early postoperative retention was 11.9% in the home group and 22.4% in the office group ( P =.13). Our predetermined noninferiority margin was greater than the upper bound of our 95% CI; thus, we conclude noninferiority of home removal. For secondary outcomes, the home removal group was more likely to report "no pain" ( P =.02) and "very likely" to use this method again ( P =.004). There were no differences in difficulty or satisfaction between groups. Number of nursing calls was not different ( P =.66); however, number of office visits was higher in the office group (median 0 [interquartile range 0-1] vs 1 [1-1], P <.001). CONCLUSION: Postoperative urinary catheter removal by the patient at home was noninferior to office removal when early urinary retention rates were compared. Participants in the home removal group had fewer office visits and reported low pain, low difficulty, and high satisfaction. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT04783012.

Knowledge and beliefs of intensive care nurses about urinary catheter securement: Results of a national survey.

OBJECTIVE: To explore the knowledge and beliefs of intensive care nurses about urinary catheter securement. METHOD AND SETTING: A self-report survey tool comprising 19 questions (15 closed, 4 open-ended) was developed through consultation with a panel of experts and then disseminated electronically to nurse members of two societies for critical care medicine and nursing in Spain. Responses were analysed by calculating descriptive statistics and through qualitative analysis. MAIN OUTCOME MEASURES: Nurses' self-reported knowledge and beliefs about urinary catheter securement in the intensive care patient. RESULTS: Responses of 333 nurses were analysed. Most respondents considered that urinary catheter securement was beneficial for patients (n = 261, 78.4 %) and that it reduced the risk of both meatal pressure injury (n = 266, 79.9 %) and accidental tugging (n = 304, 91.3 %). Regarding the securement procedure, less than a quarter of nurses mentioned the use of barrier film to protect the skin at the securement site (n = 62, 18.6 %) or the need to leave slack in the tube to avoid tugging (n = 45, 13.5 %). Qualitative analysis of responses to open-ended questions revealed that some nurses believed that catheter securement was contraindicated due to the risk of skin injury, or that it interfered with some aspects of basic care, thus increasing their workload. CONCLUSIONS: There appears to be a lack of knowledge among Spanish intensive care nurses about recommended procedures for securing a urinary catheter. Clear and concise guidelines for the intensive care setting are required to ensure safe and standardised practice without creating additional burden for nurses. IMPLICATIONS FOR CLINICAL PRACTICE: Lack of knowledge among intensive care nurses about how to secure urinary catheters may pose certain risks to patients, therefore specific training in how to secure a urinary catheter is needed.