IDPH has cited and fined Marigold Rehabilitation & Healthcare Center in Galesburg after a resident suffered a urinary tract injury due to improper insertion of an indwelling urinary catheter.
The resident at issue had an indwelling catheter. An indwelling catheter is a tube which goes up the urethra to the bladder. Once the tip reaches the bladder, urine should begin to pass down the catheter tube. The passage of urine through the catheter is the signature that the catheter has reached the bladder. At that point a balloon at the tip of the catheter should be inflated which holds the opening to the bladder open and allow urine to continue to drain through catheter.
The male resident at issue had a catheter which needed to be replaced. He apparently suffered from significant dementia and struggled with the staff during catheter changes. This time, he was held down by the staff while a nurse inserted the catheter. She encountered some resistance in passing the catheter, but did not have urine draining from the catheter. Thinking she had reached the bladder, she inflated the balloon and attempted to remove the port for blowing up the balloon. When they did so, the catheter came out of the penis as did large amounts of blood.
The resident was sent to the emergency room to get the bleeding under control which was made more difficult due to the fact that he was taking blood thinners (which is part of why nursing home falls are such a serious issue for residents who are on blood thinners – internal bleeding can progress much further than would otherwise be the case).
The fundamental issue in this case is an issue of poor nursing technique. The nurse who was responsible for replacing the catheter did not use proper technique in placing the new catheter. Instead of inflating the balloon after the catheter had entered the bladder, she inflated the balloon while the catheter tip was still within the urethra – in other words, she inflated the balloon too early. The signature of a proper placed catheter is a flow of urine from the bladder into the bag. The nurse saw that there was no urine entering the bag but nonetheless inflated the balloon on the catheter. When nurses fail to follow proper technique, this is a form of nursing home abuse and neglect and can be the basis for a civil lawsuit.
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