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

Literature Review

A literature review was under taken without limit of time using the BNI, OVID, CINAHL, and MEDLINE search engines and the keywords catheter, by passing, leak, urinary, supra pubic, and indwelling. A result of this search identified three research articles related to indwelling bladder catheter leakage. The first of these articles describes a successful use of an injection of Botulinum-A toxin into the bladder wall of three patients during a cystoscopy procedure performed to reduce catheter leakage (Lekka & Lee, 2006). The second article uses a case study to discuss the success related to altering the catheter by placing extra holes below the catheter balloon, which successfully eliminated catheter leakage (Mohapatra, 2010). The last article, also a case study, describes the positive results, defined as leakage stoppage, when an additional hole was placed at the very end of the catheter above the two current holes. This intervention successfully stopped the leakage of a suprapubic catheter (Vaidyanathan, Soni, Hughes, & Singh, 2009). None of these articles identified a cause or causes for the catheter leakage; thus, recommended interventions cannot be generalized.

While a myriad of articles were identified using the key words catheter, bypassing, leak, urinary, suprapubic, and indwell ing, these articles focus on catheter care in general. Catheter leakage is frequently mentioned as a problem along with other catheter problems, such as catheter-associated urinary tract infection (CAUTI), catheter blockage, difficult catheter insertion, and catheter expulsion. These articles provide anecdotal evidence with respect to the possible cause of catheter leakage and suggest techniques aimed at managing this problem. These interventions are based on professional opinions rather than clinical research, with the rare reference indicative of other health care professionals' opinions. Table 1 and Table 2 present a list of authors and their opinions of the cause(s) of catheter leakage and its management.

Using a retrospective re search design, Roe and Brocklehurst (1987) explored the experience of having an indwelling urinary catheter from the patient's perspective. Data were obtained from 36 community-dwelling patients who had an indwelling urinary catheter. Demo graphically, 20 (56%) were male, with a mean age of 68.9 years (range 50 to 93); 28 (78%) were living in their own home. The most reported (46%) reason for catheter placement was as treatment of urinary retention. Fortyfour percent of these patients reported using a catheter for five years or more, with 33% reporting a diagnosis of multiple sclerosis. Results of this study revealed that these individuals had both understanding and knowledge of their catheter's location and function, its acceptance, problems associated with its use, social implications, and subsequent management. Analysis of the interviews determined that the majority of these participants (89%) experienced leakage of urine around the catheter, resulting in wet clothing and bedding. The median occurrence of this leakage was reported as once a week. Four participants (11%) stated they had had no incidences of catheter-associated leakage or bypassing. Of the 89% that reported incidences of catheter leakage, 22 (61%) were able to identify factors that precipitated this leakage: five (14%) stated this occurred while having a bowel movement; 6 (17%) stated leakage occurred when they were constipated; the remaining 11 (31%) associated catheter leakage during a combination of activities. These include position changes, coughing, movement of any kind, and during a bowel movement in any combination. Twenty-six (72%) of these participants stated they could do nothing to prevent leakage of urine, although 6 (17%) would change their position or their catheter to prevent leakage. Twenty-three (64%) participants reported cathe ter blockages, which resulted in impaired flow of urine with a median occurrence between 1 and 3 months.

Research by Getliffe (1994) determined that 47% of the study population experienced catheter leakage. The purpose of this study was to determine if patients with indwelling catheters can be identified as "blockers" or "non-blockers" and to identify factors that contribute to recurrent catheter encrustation and blockage. A secondary finding was the incidence of catheter leakage, or bypassing. Interview data were obtained from 42 patients who resided either in their own homes or in wardencontrolled housing. Female participants (77.8%) had a median age of 70 years, while male participants (22.2%) reported a median age of 77.5 years. Reasons for catheterization in cluded incontinence (73.8%) and urinary retention (23.8%). One patient used a urinary catheter to provide relief from diurnal and nocturnal urinary frequency. The study failed to denote how long these patients had been using catheters and how often leakage occurred.

In a study by Kennedy and Brocklehurst (1982), 40% of the study population experienced catheter bypassing, a result that was not dependent upon the catheter placement site. Twentyeight (32%) of these individuals in hospitals and community settings underwent a catheter change because of leakage. The aim of this study was to investigate the nursing management of patients with long-term in dwelling catheters and to describe methods used to manage catheter problems. Of the 107 participants, 39 (37%) resided in the community and 68 (63%) were hospitalized. The hospitalized participants had a hospital stay between 1 to 416 weeks (median 20 weeks). The gender and age of these participants were not reported, but catheter placement was stated to have occurred after 2 weeks and lasted greater than 104 weeks.

In a review article, Wilde (1997) provides a summary of the literature focused on urinary catheter care, and identified major areas of research and gaps in knowledge. Catheter leakage, according to this summary, appears to be very common and occurred between 40% and 87% of the time. This review concludes that most research in the previous decade has focused on understanding how catheter encrustations develop and how such encrustations may contribute to leaking/blockage of the catheter and urinary tract infection. Despite the large percentages of catheter leakage reported, Wilde (1997) fails to recommend further research for catheter leakage.

Health literature provides several hypotheses for in dwelling bladder catheter-associated leakage. These hypotheses can be divided into two main categories – 1) leakage accompanied with bladder spasms where occlusion of the catheter lumen or the drainage tubing has not been identified, and 2) leakage associated to occlusion of the catheter lumen or the drainage tubing. Definitive research correlating bladder catheter-associated leakage to bladder spasms was not found in the literature. Since 1987, when Roe and Brocklehurst reported that 72% of their study population stated that in their perspective, nothing could be done to prevent bypassing, little research attention has focused on this devastating consequence associated with the necessity of placing an indwelling bladder catheter.

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