Nursing Error

[kcb007]

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?

[Ms.RN]

it happened to another nurse i worked with and a doctor told her to irrigate her foley with normal saline. can this be done with your patient?

[dishes, BSN, RN]

KCB007

It is more important to focus on this as a learning experience then to beat yourself up. Think of the things you learned from this and know that you will be better prepared for this if it happens in the future. Things to think about include:

1. When there is hematuria following catheter insertion and the catheter is draining leave the catheter insitu. Rationale: if you remove the catheter you will disturb the clotting process and re-injure the urethra (as you saw when the primary nurse removed the catheter)
   
2. The only way to determine the extent of the damage is through cystoscopy, which cannot be done immediatly, cystoscopy is done after healing has taken place ( the family's reluctance to go to emerg is reasonable)
   
3. Contacting the patient's urology clinic will provide the specialized advice the patient and family need in this situation better than the family physician
   

Kindest regards

Dishes

[dskrninpa]

Don't beat yourself up. If you've done everything the way you learned it, what can you change? Trauma happens when you insert a foley, it's a risk of the procedure as most others have said. Best advice I can give is go slowly.

[kcb007]

Yes but MD would not give order to do so. MD stated it was close to 5pm on a Friday and she wasn't writing any orders. You know how MDs can be!

[kcb007]

I definitely can say that this has been a learning experience for me!! Slowly sounds real good!!

[leslie :-D]

I definitely can say that this has been a learning experience for me!! Slowly sounds real good!!

i would also use extra lubricant.

i am wondering if this spina bifida pt, has had a lifetime's worth of catheterization...

and that the bladder neck (or urethra?) just may be extremely friable.

or, if not friable, traumatized enough where bleeds may occur more frequently now.

i don't know.

but slow and extra lubed, sounds like a plan.

leslie

[kcb007]

You know there is one thing that puzzles me. The pt had a box of self caths lying on the bedside table and the mother stated to me that he hasn't been self cath since he was 13 yrs old and he is now in his late 20's. The box looked new! Something tells me that maybe she had been performing in and out caths on the pt and maybe done something traumatic and here I am going in behind her and they're playing it off like they've done nothing!!