Nursing Error

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Specializes in Clinical, Hospice, Home Care, and HH.

I inserted a foley catheter on a spina bifida pt and I set up the procedure table and my sterile field. I did everything as I was instructed. I advanced the foley and stopped when I met resistance. I asked the pt to relax because I felt him tense up. When he relaxed I was able to advance the 16Fr 5cc foley further. I felt when I passed the sphincter and noted urine in the tubing. After noting urine in my tubing I advanced the foley 2 more inches. And as I was inflating the balloon with 10cc (thats what the order called for) the pt started tensing up and once I removed my syringe from the port I slightly tugged at the foley to make sure that it was at the neck of the bladder. I looked down at the pts member and blood was leaking from around the entrance of the foley and then blood started flowing thru the tubing. I don't understand. I done the procedure the way I was taught and the same way that I have inserted any other foley. Can someone please give me some input. Has anyone ever experienced this before?

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Specializes in Med/Surg, ICU, educator.

yes. If the patient was tensed up good enough or has a sphincter issue, or perhaps cath size needed to be smaller, then you may have irritated the lining of the sphincter. As long as the bleeding slows down--pink tinged in 1-2 hours--then not really an issue. Longer, the MD needs contacted. Make sure that you documented this.

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Specializes in OB, NICU, Nursing Education (academic).

I don't know if I would call this a nursing error ....maybe an unexpected consequence......

Sometimes things don't go the way we planned. No procedure is without risk.

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Specializes in Clinical, Hospice, Home Care, and HH.

Has this ever happened to you or are you speaking of an experience that you've heard of. This has never happened to me. I am freaking out!! The doctor was notified and she stated that she wasn't giving any orders because it was close to 5pm on a Friday afternoon and instructed family to take pt to the hospital if need be but the family didn't feel it was necessary. I, on the other hand, did!!

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Specializes in Clinical, Hospice, Home Care, and HH.

I have worked to hard for my license to lose them! Plus, the fact that I'm a worry wart doesn't help either!!

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Specializes in Med/Surg, ICU, educator.

I've had it happen before, a few times in fact. As I said in my original post, document this, and watch to see if the bleeding slows down. Contact MD if needed, etc. You won't lose your license over this.....take a deep breath, relax. Just make sure that the patient is kept comfortable, not freaking out, and explain as best as you can--I know some spina bifida patients have learning difficulties and it can be difficult to explain, but I know you'll do your very best. Really, it's okay.

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Specializes in Clinical, Hospice, Home Care, and HH.

Thank you so much!! You don't know what that means to me!!

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KCB007

Anyone inserting a catheter can cause trauma, so don't feel bad. Catheter trauma is a risk associated with catheter insertion and urologists who work with patients who have neurogenic bladder are well aware of this problem. The patient's urologist should be notified that the patient had hematuria post cather insertion. Likely, the urologist will arrange for the patient to have a cystoscopy in a week or 2 to assess the trauma and rule out whether or not a stricture or false passage was created.

The cystoscopy is usually done about 1-2 weeks after the trauma to allow enough time for healing to occur and to prevent further bleeding when the cystoscope is inserted. It is important for the patient to know if there is a false passage or a stricture before resuming intermittent catheterization.

One final tip, sometimes it is better to let patients who self catheterize insert their own indwelling catheter because they are usually very experienced with their own body and can tell if the resistance feels unusual and this makes them less likely to cause urethral trauma.

Kindest regards

Dishes

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Specializes in Clinical, Hospice, Home Care, and HH.

Well this pt does not do self caths. The doctor sent an order for an indwelling foley to be placed. I'm not this patients primary nurse. I was only trying to help out another nurse because she was busy at the time and needed someone else to place the foley for her. Well, after all this is said and done, I call the primary nurse and let her know what happened, she comes over, we contact the MD, and the primary nurse removes the foley. Blood comes pouring out. It starts to slow down and then stops. The primary nurse placed the foley again and gets more blood and urine back. So she then thought it was best just to remove foley and have pt transported to ER but the family didn't want to take the pt to the ER, even though we both, the primary nurse and I, suggested them to do so. But the pts father use to be an MD and felt that going to the ER was not necessary. But what bothers me is the fact that this happened to the pt about 3-4 weeks ago in the hospital, per the family, and they failed to tell us about it until after the fact.

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Well it doesn't sound like an emergency. I would just monitor it to see if the bleeding stops. Is the pt on coumadin. I would be concerned then but if it stops then no reason to go

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Specializes in Clinical, Hospice, Home Care, and HH.

No, they're not on coumadin. It's just that I've always taken pride in taking good care of my patients. Now I feel like I've failed!!

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You did take good care of him! :)

An unexpected outcome happened during the same exact care you've given before without any unexpected outcomes. It happens!

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