Diane Newman: Welcome. This is Diane Newman. I am a practicing nurse. I am also an incontinence nurse specialist and I specialize in pelvic floor dysfunction. I have been practicing in the field of urology for more than 35 years. I am also proud to tell you that I am the editor of UroToday.com Upper Bladder Health Center. As part of the center, I created a resource sub-center for individuals who visit our UroToday website and want to learn about bladder management. What I found in the urology department is that there is very little information on how to manage patients who may have urinary retention or incomplete bladder emptying, and how to manage them through catheters such as indwelling catheters, intermittent catheters, and external catheters. Therefore, if you visit our website, you will find a resource center about this content, which provides a lot of information. This is more information about indwelling catheters. I want to introduce what to do when urine is not discharged.

You may meet patients in hospital or home care, or your family members call you, you are a visiting nurse and say: "Hey, my father's catheter is not drained. What should I do?" Or, you may be in In the nursing home, a patient had a catheter inserted for a long time, but you found that it was not draining. So what I want to give you is what might be the problem and what actions you can take. If you can, and you have a portable bladder scanner, you should scan the bladder. Because if no urine is discharged through the catheter into the drainage bag, you need to really confirm that there is urine in the bladder. So this is one way to confirm this is by scanning the bladder. If there is residual urine in the bladder, then you know that there is some blockage in the catheter system. It may be higher in an actual Foley catheter, or it may be lower in a drainage system. You want to check the position of the drainage bag and pipe, I want to emphasize this, but many times, it is kinked. The tube may be under the patient's leg or under the wheel of the wheelchair. It is basically kinked, which is why it does not drain. It can also be twisted. So you may want to adjust the position of the bag, but in fact you want to follow that catheter, of course, under good high-end sanitary conditions, you want to wear gloves. You want to really track the tube from the port connected to the drainage tube all the way to the bag to ensure that there are no obstacles in the system that can flow freely. It may also be in the perineum, especially for women, it may be kinked, so you also want to check its insertion position. The bladder mucosa may block the catheter eye. If you use the indwelling catheter for a long time, the bladder capacity will indeed be reduced to the actual size of a 10 CC balloon. In fact, the mucous membrane, the inner lining of the bladder muscles, may actually block the eyes. So just to remove the bladder mucosa from those eyes, remember that the eyelet is where the urine drains into the catheter. You may wish to move the catheter bag over the bladder to relieve suction pressure, and then of course it only takes a few seconds, and then put it back in place. This may also be due to the presence of bacteria. It may be that crusts, minerals, and crystal deposits may block the bladder holes. I suggest you milk gently along the catheter. If it still does not drain, you may really want to change the entire system. You will find that it actually started to drain, because maybe for some reason, it stayed there too long, maybe there are too many deposits around its holes to allow urine to drain. I have information about crusts and blockages on the box next to it. There is another thing I always teach nurses, they may change the catheter every 30 days, this is a practice that really starts because of reimbursement. But some patients may block earlier, which means they start to respond to the catheter and they need to replace the new system within three or two weeks. Therefore, you need to determine that this may happen too frequently, and you need to change the change schedule to a more frequent interval.

It may be blocked by affected stool again. Due to fecal impaction, we have seen many problems, especially in the elderly population or people who take an indwelling catheter home and take opioids (such as oxycodone or other drugs) after surgery, which can cause constipation and they have Stool impaction. All you need to do is to replace the catheter, eliminate the patient's impact, and then, of course, start their bowel management. There may be stones. I have many cases. They did form stones in the bladder two, three, five, ten years after using the catheter. Basically, these stones will block the holes and will not allow any urine to pass out. This is why I really recommend that patients have a cystoscopy at least every two years, because the longer the catheter is inserted, the easier it is to form stones, which are basically formed in the bladder.

If it is not inexplicable, I always say that you try something, just change the catheter, record and see if you need to change the interval between the catheters to make it shorter so that you can change more frequently, you may be able to change it before Blocking will occur. Another thing to consider is that due to allergies to latex, blockages sometimes occur frequently. Many urology patients are allergic to latex because we use many products that contain latex. So maybe it can be replaced with an all-silicone catheter. I really don't like your change from being a 14 French person, but this may be necessary for some patients. So you may need to change the catheter size. If you think this is another way of obstruction, encourage the person to increase their daily fluid intake. Then, of course, finally get rid of the catheter and try other types of bladder management, for example, if they have urinary retention or if they have an incontinence catheter, intermittent catheterization is not an indication, but we do see Indwelling urinary catheters in patients with urinary incontinence. Consider some other alternatives, such as external catheters for male patients. thank you very much.

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