Anything that assists clinical staff in making the decision as to which device to use when considering an indwelling urinary catheter is to be welcomed and the latest guidance comes from the prolific group at Ann Arbor. Using the RAND/UCLA Appropriateness Method, a system of identifying the most fitting option in the absence of ‘gold standard’ RCTs, the authors have produced a practical and helpful guide that fills a gap, since existing guidance does take into account commonly-encountered patient characteristics, such as the bariatric or oedematous patient, that make lists of ‘appropriate indications’ in current guidelines challenging to implement.

Decisions have to be made in everyday practice and making reference to guidelines solely based on RCTs frequently dos not provide the answers. This methodology (comprehensively described in the paper) enables clinicians faced with difficult decisions an alternative source of information on which to base their practice. I have always been interested in the decison-making process for placement of these potentially damaging devices and this set of critera follows on from where existing guidance leaves us dangling when faced with a patient in whom a catheter may indeed be an appropriate device but who does not fit the current definition of ‘appropriate use’. It would be interesting to see this methodology used in other areas in which the lack of RCTs means that we often see guidance littered with ‘No recommendation’.