What to do when a catheter is inserted but only scant urine is evacuated and some urine stays in the tubing?

Managing a Catheter with Scant Urine Evacuation and Urine Retention in Tubing

When a catheter is inserted but only scant urine is evacuated and some urine remains in the tubing, you should ensure the drainage bag and connecting tube are positioned below the level of the bladder, straighten any curls or kinks in the tubing, and gently irrigate the catheter if necessary to maintain patency 1.

Step-by-Step Management Algorithm

1. Check positioning of the drainage system:

   • Ensure the drainage bag is positioned below the level of the bladder 1
   • Verify that no part of the tubing is elevated above bladder level, which can create air locks

2. Examine the tubing for mechanical obstructions:

   • Straighten any curls or loops in the tubing that may be causing air locks
   • Research shows that for every 1 cm in curl height, obstruction pressure increases by 1 cm H2O within the bladder 2
   • Traditional Foley catheter systems can leave significant residual urine (average 96-136 ml) due to these air locks 2

3. Check for catheter blockage:

   • Inspect for visible obstructions (blood clots, sediment, etc.)
   • If blockage is suspected, gentle irrigation with sterile saline may be necessary

4. Verify proper catheter placement:

   • Ensure the catheter is fully inserted into the bladder
   • Improper placement can result in poor drainage or complications 3

5. Assess for catheter size adequacy:

   • A catheter that is too small may not drain effectively
   • A catheter that is too large may cause urethral trauma and subsequent drainage issues

Important Considerations

Maintaining Closed Drainage System

Maintain a closed catheter drainage system to prevent infection. The introduction of closed drainage systems has been the most important infection prevention advance in catheter-associated bacteriuria 1. Breaking the closed system significantly increases infection risk.

Catheter Patency

Blockage is a common issue with indwelling catheters, particularly when bacteriuria is present. Some bacteria can cause encrustations that block catheters within 24 hours 4. Regular assessment of catheter function is essential.

Preventing Catheter-Associated UTI

Catheter-associated urinary tract infections (CAUTIs) account for almost half of all hospital-acquired infections 5. Minimizing catheter use duration and maintaining proper drainage are crucial preventive measures.

Common Pitfalls to Avoid

1. Elevating the drainage bag above bladder level: This creates backflow of urine into the bladder, increasing infection risk and preventing proper drainage 1.

2. Disconnecting the closed system: Disconnection of the catheter junction should be minimized as it significantly increases infection risk 1, 6.

3. Ignoring residual urine: Traditional Foley systems can leave significant residual volumes in the bladder, which can lead to infection and patient discomfort 2.

4. Prolonged catheterization: Evidence suggests that indwelling catheters should be changed at intervals of not more than 5 days in some circumstances to prevent blockage from encrustations 4.

5. Accidental catheter traction: Secure the catheter properly to prevent movement that can cause trauma and drainage issues 4.

By following this systematic approach, you can effectively manage situations where a catheter is inserted but only scant urine is evacuated and some urine remains in the tubing, reducing the risk of complications and improving patient outcomes.