IDPH has cited and fined Friendship Manor nursing home in Nashville, Illinois after a resident suffered injury due to improper insertion of an indwelling catheter.
The resident at issue was a 36 year old quadraplegic who had a neurogenic bladder as a result of his injuries, meaning that due to his spinal cord injury, he was unable to control his bladder. Part of his regimen of care for the neurogenic bladder was use of an indwelling catheter which would drain urine from his bladder into a bag.
One of the risks associated with the use of an indwelling catheter is an increased chance of developing a urinary tract infection. In the days immediately prior to the injury, the resident was showing signs and symptoms of a urinary tract infection, so his doctor ordered replacement of the indwelling catheter and a urinalysis.
An indwelling catheter has a balloon at the end which is inflated once the catheter is inserted into the opening of the bladder. The inflation of the balloon allows the urine to drain from the bladder down the catheter and into a bag.
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. Other staff members were not able to resolve the issue, so they contacted the resident’s doctor who ordered the resident sent to teh hospital.
At the hospital, a CT scan was done which confirmed that the catheter balloon was inflated within the urethra. A determination was made to transfer the resident to another hospital where a urologist would have to perform an open surgical procedure to resolve the problem.
The fundamental issue in this case is an issue of poor nursing technique. The signature of a proper placed catheter is a flow of urine from the bladder into the bag. The nurse in this case claimed “maybe a dribble” of urine entered the bag and nurses who attempted to resolve the issue were unable to verify that there was any urine in the bag at all. 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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