Problem solving and troubleshooting: the indwelling catheter.

Long-term use of an indwelling catheter is seldom free of problems, and the complications associated with indwelling catheters cause significant morbidity and mortality. Often there are alternatives to long-term catheterization; it is assumed in this article that the patient will have been appropriately assessed for other methods of continence control. In this article, leakage around the catheter (bypassing) is discussed. This problem is multifactorial: irritation caused by the catheter balloon, improper sizing of catheter, confusion of the patient, bacteriuria, constipation or fecal impaction, blocked catheters, problems related to materials used in catheter construction, and improper positioning of the catheter are all potential problems contributing to leakage in the patient with an indwelling catheter. Emphasis is placed on etiology because understanding the underlying problem is crucial to implementing effective treatment.