Leakage Associated With Urinary Catheter Usage

Robert Theriault, BSN, RN; Peggy Ward-Smith, PhD, RN; Charles Soper, MB, MRCP

Disclosures

Urol Nurs. 2012;32(6):307-312. 

In This Article

Abstract and Introduction

Abstract

Indwelling bladder catheter-associated leakage, or catheter bypassing, is a frequently experienced problem, necessitating a carefully planned intervention. Once a bladder catheter is in place, urine may flow intermittently between the catheter shaft and the urethra mucosa, or from around the catheter when inserted suprapubically. A review of the literature identified several reasons for this leakage, including catheter size and anatomical abnormalities. Based on clinical experience, the authors posit that indwelling catheter leakage may also occur as a result of a catheter design flaw. This article provides the theoretical rationale for this hypothesis and a potential solution; formal, rigorous, and appropriate research should be performed to test the hypothesis.

Introduction

Roe and Brocklehurst (1987) identified in dwell ing bladder catheter-associated leakage, or catheter bypassing, as one adverse effect of these devices, resulting in distress and embarrassment for the patient. There is a paucity of research literature related to bladder catheter leakage, resulting in the lack of identifiable or standard interventions. Thus, prevention of bladder catheter leakage remains a challenging clinical scenario, with clinicians relying on anecdotally known remedies. Based on clinical expertise, the authors propose that an alteration in the current indwelling bladder catheter design may be an appropriate intervention toward decreasing the incidence of catheter leakage. This is based on the premise that leakage is the result of the catheter tip becoming kinked when bladder spasms occur. This kink occludes the two openings, or eyes, located on the catheter tip. Thus, urine bypasses the catheter, or leaks. Modification of the bladder catheter, along with formal research, should be performed to determine the effect of this hypothesis.

Catheter bypassing, or indwell ing bladder catheter-associated leakage, is an adverse effect that occurs among many cath eterized patients (Roe & Brocklehurst, 1987). Bladder catheter leakage occurs intermittently and is described as urine not flowing into the drainage bag, but rather, urine flowing between the catheter shaft and the urethra mucosa or around the catheter when inserted suprapubically. As urine leaks, clothing and bed linen become wet, resulting in personal and social embarrassment. While bladder catheter leakage has been correlated with the presence of bladder spasms (deGroat, 1993), a review of the literature failed to identify a satisfactory explanation for the cause(s) of this problem or identify efficient solutions. Health care professional management of indwelling bladder catheter leakage appears to be by trial and error. The purpose of this article is to define the problem, review the literature, and posit a device change, which may lessen or alleviate this condition. While catheter leakage routinely occurs in the presence of an indwelling bladder catheter, it is the clinical experience of the authors that bladder spasms increase the incidence or is a secondary cause of leakage. The purpose of this article is to present the results of a care alteration that offers promise in decreasing the incidences of indwelling bladder catheter leakage.

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