ICU catheter care falls far short of evidence-based urinary leakage prevention
Urinary leakage around an indwelling catheter is more than a housekeeping problem in the intensive care unit. In critically ill patients, it can signal poor catheter positioning, inadequate fixation, drainage obstruction, bladder spasms, or gaps in routine surveillance, and each of those failures can create avoidable discomfort, skin injury, infection risk, and extra workload for bedside staff.
A baseline review conducted in the General ICU at Wuxi Second People’s Hospital in Jiangsu Province, China, found a wide disconnect between what current evidence recommends and what is happening in routine care. Investigators used the Joanna Briggs Institute Clinical Evidence Application Model to build audit indicators for urinary leakage prevention and management in ICU patients with indwelling catheters, then measured real-world compliance before developing change strategies.
The gap was not subtle.
Evidence was converted into 21 audit indicators, then tested against routine practice
The project began with evidence identification, synthesis, and the development of review criteria grounded in the JBI Clinical Evidence Application Model. From that process, 22 pieces of evidence on urinary leakage prevention and management were translated into 21 review indicators. The purpose was practical: create a structured way to check whether catheter care in the ICU matched what the literature supports.
Baseline data were collected between April and May 2025 using convenience sampling. The review included 39 nurses and 75 patients with indwelling catheters in the General ICU. That local audit design matters because it captures bedside behavior rather than theoretical agreement with best practice. In other words, it measures what actually happens when a ventilated or unstable patient needs continuous catheter management, not what clinicians say they would do under ideal circumstances.
The investigators then compared practice against each indicator and mapped barriers and facilitators to implementation. The result was a detailed picture of where catheter care broke down and where improvement might be realistically achieved.
Most indicators failed to clear a 60% compliance threshold
Of the 21 indicators, 16 had compliance rates below 60%. In a unit setting where urinary drainage is a daily and often hourly responsibility, that pattern suggests systematic inconsistency rather than isolated lapses. The findings imply that nurses and physicians may be working without a unified prevention protocol, or that existing routines are not sufficiently embedded into the ICU workflow to be executed reliably.
In practical terms, low compliance across most indicators increases the likelihood that leakage prevention is reactive rather than preventive. When catheter security, drainage monitoring, perineal skin care, and timely reassessment are not delivered in a consistent sequence, leakage can become a recurring event instead of a preventable complication. For fragile ICU patients, even minor leakage can lead to prolonged moisture exposure, skin breakdown, sleep disruption, and more frequent device manipulation.
The review also identified 27 barriers and 17 facilitators to evidence implementation. Those numbers point to a familiar hospital problem: knowledge alone does not change care unless the environment supports the behavior. Staffing patterns, role clarity, workflow design, access to supplies, and local norms can either slow or accelerate adoption of evidence-based catheter management.
Change strategies focused on turning evidence into bedside behavior
On the basis of the baseline findings, 25 change strategies were developed. The article does not present these as a single universal fix; instead, they are intended as implementation responses to specific local barriers. That approach fits the logic of the JBI model, which treats evidence translation as a structured process rather than a one-time educational campaign.
The clinical appeal of this framework is straightforward. If urinary leakage is driven by modifiable practice failures, then the response should target those failures directly: standardizing assessment, reinforcing catheter fixation, improving surveillance for leakage, clarifying who is responsible for which checks, and making the prevention pathway visible enough to be followed at the bedside. Where the evidence exists but the unit does not operate from a shared protocol, variation becomes the enemy of prevention.
This is especially relevant in the ICU, where patients often cannot report discomfort clearly and where several other priorities can crowd out catheter care. In that setting, a protocol is not bureaucratic excess. It is a way to make an easily neglected complication less likely to be missed during a busy shift.
Why this baseline review matters for catheter-associated complications
The study does not claim that the new strategies have already solved the problem. What it does provide is a hard baseline: evidence is available, indicators can be defined, and current practice at the studied hospital does not yet match the standard implied by that evidence. That distance between research and routine care is exactly where implementation science is supposed to intervene.
For ICU teams, the implications extend beyond leakage alone. A leaking catheter can be a marker of suboptimal device care, and suboptimal device care often travels with other preventable harms. Reducing leakage may therefore improve skin integrity, patient comfort, nursing efficiency, and potentially downstream catheter-related complications, although those outcomes were not measured in this baseline review.
The most concrete message from this work is also the most demanding one: hospitals cannot assume that evidence-based catheter care will occur simply because the evidence exists. Without local indicators, auditing, and explicit change strategies, practice can remain stuck below acceptable compliance levels even in a high-acuity environment where the clinical stakes are obvious.
Future evaluation will need to show whether the 25 change strategies actually raise compliance and reduce leakage in the same ICU setting. Until then, the central finding stands on its own: current practice was substantially weaker than the available evidence, and the gap was broad enough to justify a formal implementation effort.