Foley catheter: Is a small amount of leaking when sitting normal?

[Raccoon-Eyed-Nurse]

I’m a new nurse. Today I had a patient with a Foley catheter. It was draining fine (normal UOP, no bladder distention), but she complained of small leaks. They’ve had to change it a couple times before, so I thought maybe she needed a bigger size again. An LPN (many years experience) spoke to her and found out that the leaks only happen when she’s sitting in a chair. The LPN taught that in this case the leaks are probably due to the catheter kinking/bending because of her position, which is normal. The explanation sounded ok at the time, and the patient stopped complaining about those little leaks. But I’ve been thinking about it (maybe overthinking?), and now I’m not sure if that’s normal. I looked it up and found nothing relevant.

Tl;dr: If a female patient has a Foley, is a little leaking when she sits in a chair normal?

[TriciaJ, RN]

I'm not aware of that. I worked on a urology unit and our Foleys were of short-term duration (1-3 days generally). Are you working LTC? Is the Foley a more-or-less permanent thing?

I'm just wondering if the balloon isn't inflated all the way (which actually causes the patient discomfort) or if the patient has some urethral damage?

[Raccoon-Eyed-Nurse]

2 minutes ago, TriciaJ said:

I'm not aware of that. I worked on a urology unit and our Foleys were of short-term duration (1-3 days generally). Are you working LTC? Is the Foley a more-or-less permanent thing?

I'm just wondering if the balloon isn't inflated all the way (which actually causes the patient discomfort) or if the patient has some urethral damage?

Yeah, the catheter is pretty much permanent.

The nurse who put it in documented filling the balloon the recommended amount. I think there’s a 5mL leeway. Should I have tried putting in those extra 5mL?

As far as I know, she doesn’t have any urethral damage. I didn’t see any bleeding from the urethra or in the bag. Are there other ways to check for damage?

[TriciaJ, RN]

You could check the port for balloon capacity; then withdraw the water to see how much there actually is. If it's short I would refill the balloon to its full capacity. You probably already know this, but when the balloon is being filled, it fills to one side, then the other. A partially filled balloon is therefore asymmetrical. It puts uneven pressure on the bladder neck and causes discomfort. Possibly leakage.

Hope this helps.

[Raccoon-Eyed-Nurse]

10 minutes ago, TriciaJ said:

You could check the port for balloon capacity; then withdraw the water to see how much there actually is. If it's short I would refill the balloon to its full capacity. You probably already know this, but when the balloon is being filled, it fills to one side, then the other. A partially filled balloon is therefore asymmetrical. It puts uneven pressure on the bladder neck and causes discomfort. Possibly leakage.

Hope this helps.

Right, I didn’t consider that! In school I remember seeing the balloon fill up asymmetrically, but it never occurred to me that it may have this effect on the patient. Thanks for your input.

Still, I’d like to know if sitting might cause some minor leakage. If filling the balloon to full capacity doesn’t work, then it would be nice to know if I have to change the catheter or not.

[MunoRN, RN]

There are a number of reasons why a foley may leak, it's certainly not unheard of for there to be some leakage.

Keep in mind the main purpose of the balloon is to keep the foley tip in the bladder, not necessarily to seal urethral tract. While the trigone area (base of the bladder) is fairly flat, the balloon is not custom fitted to the shape and contours of the trigone area, so it shouldn't be surprising that some urine could leak around it. What mainly prevents leakage is that the catheter is larger than the narrowing and sphincters of the urethra, but it's certainly possible that these narrowings might be larger than the diameter of the catheter, allowing urine to leak, particularly in certain positions like sitting.

[BettyGirard, BSN]

In addition to the balloon placement already mentioned, check the tubing itself. As you were told by others any blockage due to kinking or anything else can cause the bypassing. Also with somewhat active patients, when the catheter isn't secured well (notice this more in boys) that the balloon can be pushed up from being seated in the neck of the bladder. However, usually, that settles back in place in short order.

Of course, the other thing is to make sure you're using the right size catheter and balloon.