It's leaking again!! Catheters, we solve this problem in four ways.

Indwelling catheterization is a commonly used nursing technique in clinical practice. The purpose of indwelling catheterization is to relieve dysuria, incontinence, urine retention and monitoring urine volume. The incidence of inpatient urinary leakage with indwelling catheter is 5%-30%, and the longer the indwelling time of catheter, the higher the incidence of urinary leakage [1]. Persistent urine leakage can lead to secondary infection due to perineal skin damage, or secondary incontinence dermatitis due to persistent local dampness, as well as inaccurate recording of urine volume in severe patients [2]. So, how do we solve this problem?

Clinically, there are two common solutions:

① The normal saline in the air bag should be pumped back, and the normal saline larger than the first injection capacity should be re-injected according to experience;

② Replace a larger type of catheter.

Are these two approaches feasible? With this question in mind, we make the following discussion --

First, we need to find the cause of the leak. The causes of urine leakage are generally as follows:

① The urinary tube disintegrates and the drainage is blocked, thus increasing the pressure in the bladder;

② The balloon of urethral duct is not close to the inner urethral orifice;

③ The shape of the anterior catheter balloon is deformed;

(4) The choice of catheter type is not appropriate.

In view of these factors, we have adopted the following solutions --

First, the urinary tube disintegrates, the drainage is blocked, and the pressure in the bladder increases

Strengthen inspection, observe the color, character and quantity of urine, and observe whether the drainage is smooth.

2. The balloon of urethra is not close to the inner urethral orifice

If the catheter is not gently pulled outward in strict accordance with the operating procedures after placement, the balloon will be suspended on the internal urethral orifice and not fit well with the internal urethral orifice, which is easy to produce urine leakage. The displacement of urethral duct during turning over will also lead to the balloon not sticking closely to the internal urethral opening, resulting in urine leakage. At this time, the catheter should be gently pulled outward until there is resistance to make the balloon closely fit with the internal urethral opening.

3. The shape of the anterior catheter balloon is malformed

Methods of catheter placement:

After routine disinfection, the anterior end of the catheter is lubricated, and then gently inserted into the urethra, generally inserting 20~22cm in male patients and 4~6cm in female patients, and then inserting 6~8cm after urine is seen, injecting 10~15ml of normal saline into the balloon, and gently pulling the catheter outward until there is resistance.

After inserting the catheter in this way, we found that there was still urine leakage. At this time, we will pump back the saline inside the balloon, and as a rule of thumb, we will re-inject more saline than the first injection volume, but is it not the more water, the better.

We conducted an in vitro experiment and found that the catheter was likely to be a "flat ball" malformation after routine injection of 10~15ml normal saline, and the balloon presented a uniform elliptic sphere around the balloon only when the injection volume reached 30ml. At this time, when the liquid was pumped back at a uniform speed, it was found that the sphere would slowly shrink with the decrease of water volume, but it would still maintain a uniform sphere. Until the liquid is pumped back to 15ml, it still maintains a good spherical state. Therefore, the more water injected into the air bag is not the better, the key is whether the water bag can form a uniform sphere after injection and play a closed role.