Urine Not Draining from Transurethral Catheter - Diane Newman
April 12, 2020
Diane K. Newman, DNP, ANP-BC, FAAN, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health. She is the author of several books. The most recent is as lead editor of the 1st edition of the SUNA Core Curriculum for Urologic Nursing and of Clinical Application of Urologic Catheters, Devices, and Products.
Download: Urine (Catheter) Not Draining
Diane Newman: Welcome. I'm Diane Newman. I'm a nurse practitioner. I'm also a continence nurse specialist and I specialize in pelvic floor dysfunction. I've been practicing in the area of urology for over 35 years. I'm also proud to tell you that I am the Editor of the Bladder Health Center on UroToday.com. As part of that center, I've created resource sub-centers for individuals who come to our website on UroToday and want to know about bladder management. What I found in urology is there's very little information on how to manage patients who may have urinary retention or incomplete bladder emptying and how to manage them with catheters such as an indwelling catheter, intermittent catheterization, and external catheters. So if you come to our website, you will find a resource center on these and it provides a lot of information. This is about more information on indwelling urinary catheters. And I want to present what to do when that urine does not drain.
You come upon the patient maybe in the hospital or in-home care, or the family calls you, you're a visiting nurse and says, "Hey, my father's catheter is not draining. What do I do?" Or you may be in a nursing home with a patient that has a catheter in for a long period of time and you find it not draining. So what I want to give you is what may be the problem may be and what actions you can take. If you can, and if you do have a portable bladder scan available, you should scan the bladder. Because if there's no urine draining through the catheter into, say, a drainage bag, you need to really confirm that there's actually urine in the bladder. So that's one way to confirm that is by scanning the bladder. If there is residual urine in the bladder, then you know that there's some blockage in the catheter system. It might either be higher up in the actual Foley catheter, or it may be lower in the draining system.
You want to check the position of the drainage bag and the tubing, and I want to stress this, but a lot of times, it's kinked. The tubing may be under the patient's leg or it may be literally underneath the wheels of a wheelchair, and it's basically kinked and that's why it is not draining. It can also be twisted. So you want to maybe adjust the position of the bag, but really you want to follow that catheter, of course, with good high-end hygiene, you want to put gloves on. You want to really trace that catheter from the port where it's hooked to the drainage tube all the way down to the bag to make sure that there is free-flowing none obstruction in the system. It could also be up in the perineum, especially with women, it could be kinked, so you want to check that also, as far as where it's inserted.
The bladder mucosa may be obstructing the catheter eyes. If you've had an indwelling catheter in for a long period of time, the bladder capacity really decreases to actually the size of that 10 CC balloon. And actually the mucosa, the lining of the bladder interlining the bladder muscle may be actually obstructing the eye. So just to kind of get that bladder mucosa off those eyes, which remember, the eyelets are where the urine drains through into the catheter. You may want to move the catheter bag above the level of the bladder to relieve that suction pressure, and then of course only for a few seconds and put it back down.
It could be also due to the fact that there's bacteria and it could be encrustations, mineral, crystal deposits that might be blocking the eyelets of the bladder. I suggest that you milk the catheter gently along its length. If it still does not drain, you may really want to change the entire system. And what you'll find is that actually it starts draining because perhaps for some reason, it's been in there too long and maybe it has too many deposits around the eyelets that allow for the urine to drain. And I have on that side box there about encrustations and blockage. And one I always teach nurses who are changing catheters maybe every 30 days, which is a practice that really was just started because of reimbursement. But some patients may block earlier, which means that they start to react to that catheter and they need a new system change in three weeks or two weeks. So you need to determine that as far as that may be happening too frequently and you need to change that changing schedule to a more frequent interval.
It could be again, blocked by impacted stool. There are many problems that we see because of stool impaction, especially in that older population or someone who goes home after surgery with an indwelling catheter and is on an opioid, say, such as oxycodone or something, which causes constipation and they have stool impaction. What you got to do is you need to change a catheter, disimpact that individual, and then, of course, start them on bowel regime.
There could be stones and I've had many cases of patients who've had catheters in for two, three, five, ten years who have really developed stones in the bladder. And basically, those stones block the eyelets and do not allow any urine to drain. And that's why I really recommend that patients have a cystoscopy at least every one to two years because the longer you have a catheter in, the more apt you then develop stones, calculi that basically develop in the bladder.
If it's not unexplained, I always say you try things, just change the catheter, record and see possibly if you need to change that interval between a catheter, make it shorter so that you're changing more frequently, you're changing it before that blockage may occur.
The other thing to consider too is that sometimes blockage is occurring frequently because of an allergy to latex. Acquired allergy to latex is being seen in a lot of urology patients because we use a lot of products with latex. So maybe change to an all silicone catheter. I really do not like you changing from a 14 French, but that may be necessary in certain patients. So you may need to, you have to change the catheter size. Another way if you think it's blockages, encourage that person to increase their daily fluid intake.
And then, of course, the ultimate is get rid of the catheter, try some other kind of alternative bladder management, such as, say, intermittent catheterization if they have urinary retention or if they have the catheters in for incontinence, which is no indication, but we do see patients with indwelling catheters in place for urinary incontinence. Consider some other alternative methods such as an external catheter with male patients. Thank you very much.