Leakage Associated With Urinary Catheter Usage

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

Urol Nurs. 2012;32(6):307-312.

Conclusion

It is imperative for nurses and other health care providers who provide care for those with indwelling bladder catheters to have a clear understanding of the mechanism involved inside the bladder that result in occurrences of urinary leakage. The authors suggest a design change consistent with a new hypothesis. Clinical research needs to be performed to determine the effectiveness of this modified bladder design has in reducing the incidence of bypassing. Reducing bypassing by using evidencebased care for patients will improve their quality of life and decrease medical costs.

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Table 1. Catheter Leakage Accompanied by Bladder Spasms
Authors	Cause(s) for Catheter Leakage	Interventions Suggested
Cruickshank & Woodward, 2001	Bladder overactivity, large catheter diameter that irritates the bladder trigone, large catheter balloon that irritates the bladder trigone, an under-inflated catheter balloon that causes the catheter tip to touch the bladder wall causing irritation.	A smaller size catheter, anticholinergic medication, smaller catheter balloon, inflation of the balloon at manufacturers' recommendations.
Daughty, 2000	Concentrated urine that irritates the bladder wall.	Increase fluid intake.
Getliffe & Dolman, 2003	An under-inflated catheter balloon that causes the catheter tip to touch the bladder wall causing irritation. Catheter-associated urinary tract infection (CAUTI), kinked tubing, constipation.	Inflate balloon at manufacturers' recommendations. Increase fluid, check constipation, check for infection, check for bladder calculi, smaller size catheter, anticholinergic medication.
Wilde, 1997	Large catheter and balloon that irritates the bladder trigone.	None

Table 2. Catheter Leakage Associated with Luminal Occlusion
Authors	Cause(s) for Catheter Leakage	Interventions Suggested
Getliffe, 2003	Encrustation of the catheter lumen or eyes.	Catheter change, bladder washouts with Suby G (3.23% citric acid solution) solution to prevent occlusion by encrustation.
Getliffe & Dolman, 2003	Kinked drainage tubing.	"Check for kinked tubing" (p. 290).
Pomflet, 2000	Blockage of the catheter eyes by the bladder mucosa due to hydrostatical suction.	Instill 20 to 30 ml of sterile water or saline into the catheter, raise the urine drainage bag above the level of the bladder for a short period of time, drainage bag positioned at less than 30 cm below the bladder.
Rigby, 1998	Constipation, which can cause pressure on the drainage lumen, preventing the catheter from draining.	Treat constipation.

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