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

The Clinical Scenario

The clinical experience of the first author includes four years as a community-based cathe ter care nurse. This required the coordination and provision of care to approximately 800 cases of complex catheter situations. These include difficult catheter insertions, trials without catheter, catheter blockages, catheter bypassing, CAUTIs, and patients who are non-compliant. Based on the lead author's clinical experience and expertise, the following hypotheses support the notion that the catheter tip is kinked during episodes of leakage or bypassing.

  • Changing an indwelling bladder catheter that is believed to be occluded does not prevent leakage. The catheter occlusion is usually not debris because urinary patency is re-established after an episode of leakage. If the leakage occurs during or immediately after a bladder spasm, it may be likely that as the spasm ceases, the catheter tip un-kinks, allowing urine flow to resume.

  • Injecting a bladder washout solution into the bladder may not always confirm the presence of an occlusion. Frequently, this fluid may not immediately return, and the slow or delayed return may be due to a kinked catheter. Once sufficient fluid allows the catheter to become un-kinked, urinary flow resumes.

  • When attempting to retrieve the bladder washout fluid using a 60 ml syringe, resistance is encountered on the syringe plunger. This may be due to a kinked catheter tip because if the catheter tip was not kinked, the suction associated with pulling on the syringe plunger would result in severe pain, and resistance would not be encountered.

  • Some patients experience bladder catheter leakage during a bowel movement. This is the result of an increase in abdominal pressure against the bladder, which is likely to kink the catheter tip, thus forcing urine to bypass the catheter.

  • Anecdotal: Two patients into whom indwelling bladder catheters were inserted with the tip slightly longer than current catheters began to experience severe leakage. The authors speculate that longer catheter tips kink more readily.

  • Anecdotal: The bladder catheter of one patient was not draining at all. Different types and sizes of catheters had been tried unsuccessfully. When the balloon was deflated at regular intervals, about 600 ml of urine drained out. It is suggested that the catheter tip became un-kinked as the balloon deflated, allowing the catheter tip to migrate into another position and become unkinked.

  • Anecdotal: A patient on a catheter valve rather than a free drainage system was experiencing bypassing at the end of emptying the bladder. Because the bladder reduces in size while emptying, it kinks the catheter tip. A bladder contraction then results in leakage.

  • It is unclear how the use of antimuscarinic drugs sometimes reduces catheter leakage. Perhaps by preventing detrusor contractions, these medications may relieve the pressure against the catheter tip. While this intervention decreased bladder leakage, the cause of bypassing remains unaddressed.

  • Treating constipation prevents bypassing by reducing the abdominal pressure against the bladder, thus relieving the pressure on the catheter tip. This intervention also decreased urinary leakage but fails to treat the reason for urinary leakage.

  • Another size, material, or brand of indwelling urinary bladder catheter may reduce the incidences of catheter leakage. This may be associated with the compliance of the catheter and/or the configuration of the catheter eyes and its natural position within the bladder.

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