An indwelling catheter is often used for patients who have difficulty urinating, or who are unable to urinate after surgical anesthesia. While catheters offer a great deal of convenience, they can also present a variety of problems. Leakage of urine is one of the most common and troublesome problems.

In the clinical setting, when indwelling catheter leakage occurs, it is necessary to promptly assess the patient's bladder function, check the status of catheter use, and identify the cause of the leakage and take appropriate measures.

According to the current clinical experience, indwelling catheter leakage is related to catheter blockage, catheter type mismatch, inappropriate amount of fluid injected into the balloon, bladder spasm, and relaxation of the urethral sphincter and pelvic floor muscles. Among them, catheter blockage and bladder spasm are the two main causes of indwelling catheter leakage.

Catheter blockage causes urine leakage:

It is common in patients who have indwelling urinary catheter for a long time, the secretion in the bladder as well as the detached necrotic mucosal tissues are more likely to block the urinary catheter. In addition, the indwelling catheter is not regularly replaced, flushing, or patients drink too little water caused by calcium salt deposition can also lead to catheter blockage, resulting in poor drainage. When urine is stored in the bladder to a certain pressure, it will flow out along the periphery of the catheter to form leakage.

Solution:

Encourage the patient to drink as much water as their physical condition allows to achieve the effect of flushing the bladder in a physiologic way. Promptly replace the catheter or perform bladder irrigation when sediment is found in the drainage bag. If necessary, sodium bicarbonate can be given 100-200 ml to flush the bladder to prevent calcium salt deposition, or oral sodium bicarbonate tablets to alkalize the urine to reduce mucus secretion, to prevent the formation of urinary scales, and to keep the drainage of the catheter unobstructed.

Bladder spasm causes urine leakage:

The patient's bladder contracts erratically, resulting in a sudden increase in pressure over a short period of time, and the urinary catheter does not have time to drain, and urine will flow out along the periphery of the catheter to form leakage. This condition is common in patients with innervation disorders, such as cerebral infarction and neurogenic bladder.

In addition, the bladder triangle and bladder neck mucosa are sensitive to stimulation, and the catheter tip and balloon can stimulate the bladder neck muscles to cause strong contractions, resulting in leakage.

Solution:

For patients with innervation disorders, drugs can be used to alleviate the severe contraction of the bladder, for example, tolterodine tartrate belongs to a class of competitive M cholinergic receptor blockers and betanil belongs to β3 agonists, which are both effective in inhibiting the involuntary rhythmic contraction of the bladder. However, when applying anticholinergic drugs, it is important to be aware of the adverse effects of the drugs, such as dry mouth, nausea and vomiting.

For patients with bladder spasms triggered by catheter irritation, on the premise of not dislodging the catheter without too much effect on the catheterization effect, the method of reducing the fluid in the balloon can be used to avoid direct contact between the catheter and the bladder wall, which will lead to excessive contraction of the bladder muscle.