This case involves a misplaced catheter resulting in long term urological damage. On the date of the incident in question, the patient was admitted to a hospital in Vermont in order to undergo surgery to repair a shoulder injury. Before the surgery, a nurse attempted to place a urinary catheter, however the catheter was not installed correctly and failed to reach the patient’s bladder. The catheter remained in the patient for hours, despite not producing a good return of urine. As a result of the nurse’s error, the patient was forced to undergo another surgery to repair damage to her urethra, and has since suffered incontinence as well as disfigurement.
Question(s) For Expert Witness
- 1. Are you able to address standard of care as it relates to using a catheter improperly?
Expert Witness Response E-014220
I am very familiar with the current standard of care for catheter placement and management, as well as catheter related complications, such as trauma related complications and catheter associated UTIs. I’m also familiar with risk factors associated with catheter related complications which include, but not limited to, prior lower urinary tract surgery, presence of urinary tract devices such as sphincter or sling, and prior lower urinary tract trauma or infections. I was a member of a multidisciplinary committee at my institution addressing catheter associated complications, such as UTIs and traumatic injury due to placement of catheters. Our committee’s findings led to significant changes in urethral catheter management in inpatients. Protocols were created for placement and subsequent management of catheters for all inpatients. This included, specific to minimizing risk of traumatic catheterization, that catheter balloons should not be inflated until the catheter is completely in and there is return of urine. Also, if the patient has risk factors for catheter related complications (as described above), developed blood per urethra upon initial attempts to catheterize, or require a Coude cath (specialized catheter) Urology should be consulted. In many cases, the malposition is not recognized for hours or days later. The subsequent history usually involves blood/urine bypassing around the catheter and poor urine output via catheter. A significant number of these patients have encountered long term sequelae from the injury due to the inflation of the balloon within the urethra.