foley insertion problems
Reply With QuoteOriginally Posted by penrose715
Interesting.
It sounds like there is more than one thing going on here. Since you encountered prolonged bleeding and this patient is comatose, there are a number of questions in my mind but let's start with one. Is he aticoagulated for DVT prophylaxis and if so, could the dose be excessive- not that it has to be in order to have this bleeding occur. Regardless, changing a chronic foley has some risks involved, fiberous scar tissue being the most common. You met resistance but eventually positioned the catheter and got a urine return. Amber urine is not always a cause for concern unless the patient has other signs of bleeding or dehydration. Red urine that is clear and without clots isn't necessarily problematic unless it doesn't lighten soon or becomes frank blood. In this case, the patient had an old catheter removed, a new one placed and then another new one placed. If frank bleeding occurs and in this case, could be expected, and doesn't cease within say, five minutes, the doctor should be called, IV access should be established and STAT CBC,PT and INR, Type and Cross done. While at it, send a urine for C/S too, so you know what bugs you will be dealing with later. Your first thought is bleeding so monitor that and watch for catheter obstruction due to clot formation. Three-way irrigation may be needed for awhile. A potentially more serious complication to watch for is sepsis. This patient with a chronic foley is likely colonized and due to the trauma, translocation of bacteria into his bloodtream could easily occur. You will take q 30 minute vital signs for a few hours and watch for shock. This is scary stuff. The only thing I might've done differently is not change your foley out. If it appeared to be draining urine albeit red, it should've been left. The additional trauma could've been avoided and for a host of reasons, another pass may have been impossible.
For conversation sake, let's talk about your description of two openings. Is there a urethral meatus in the usual place and a second opening on the underside of his penis or has there been erosion of tissue as a result of prolonged catheterization enlarging the normal opening? The congenital condition of ectopic urethral meatus in males is called hypo or hyperspadis- either the opening is on the top or bottom and can be anywhere along the urethra. Your guy probably had erosion with maybe some scar tissue formation.
Hope this helps,
R
