Tampa Lakes Health and Rehabilitation Center has been cited after a resident was sent to the emergency room with blood in his catheter bag and tubing. The facility was cited because it failed to “provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.” The facility had physician’s orders to “change urinary catheter every evening shift every 30 days.” The resident’s care plan had catheter care each shift, which could include covering the catheter bag for privacy and dignity, checking the placement of devices to anchor the catheter and tubing, preventing tension on catheter tubing to prevent injury, making sure that the drainage bag was below the level of the bladder, and to “change catheter as ordered and as needed.”
The facility’s records included a written statement from a Registered Nurse who provided catheter care before the resident went to the emergency room. The Registered Nurse wrote that they “cleansed area with iodine, deflated balloon, and removed the old catheter, and a small blood clot came out. I inserted the catheter and inflated the balloon and a small amount of yellowish, blood-tinged colored urine drained into the bag. [The resident] did not complain of pain at this time.” The Registered Nurse’s progress notes also commented on this incident, when they saw a “jelly-like red fluid” in the resident’s catheter. A small amount of clotted blood was later seen in the catheter bag.
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Another Registered Nurse submitted a written statement, noting that there was blood on a towel covering the resident’s groin area, in the catheter tubing, and in the drainage bag. This Registered Nurse visited the resident approximately three hours after the first Registered Nurse, and the resident told them “I’m feeling discomfort in my abdomen.” The second Registered Nurse flushed the catheter, but the resident continued to complain of discomfort. The Registered Nurse called the doctor’s answering service, but was not able to reach the doctor right away. Shortly after, a Nurse Practitioner issued an order for the resident to go to the hospital.
The emergency room report noted that the resident had an indwelling catheter due to an enlarged prostate and had suddenly shown blood in his urine and experienced abdominal cramping. This is what the nursing home facility disclosed to the staff at the emergency room. The resident shared that he had experienced pain before from the catheter, but this instance was more severe. The emergency room report noted that it was “unclear if this [had] happened before or not.” The hospital staff conducted a CT scan before proceeding further. The results of the scan showed that the catheter “had initially had the balloon inflated in the penile part of the urethra.” This type of catheter requires that the balloon portion be father along, at the opening of the bladder.
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When the emergency room staff removed the resident’s catheter after a CT scan, “it was noted that the patient had a small laceration to the tip of his penis, inferior to the urethra…. There [was] bleeding that stopped with direct pressure. There [was] also bleeding from the urethra.” The urologist on call at the hospital recommended re-inserting the catheter to stop the resident’s bleeding. With continued care, the bleeding stopped.
The resident was interviewed by a state investigator regarding this issue:
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I just know that the night nurse came in to change my [catheter] at night, and something happened. I don’t know what she did. I was out of it, because it was so early in the morning. I just know that the next nurse came on, and there was blood, and she tried to fix it. She couldn’t and I had to go to the ER. By that time, I was really out of it, and didn’t really know what was going on.
He was asked if the night shift nurse had inserted his Foley prior to this date, and he said, “Yes, many times, so I don’t know what happened. I do remember she came in and was in a big rush that morning, so maybe she made a mistake.” When asked if he felt the day shift nurse had done anything different, the resident said, “No, it wasn’t the day shift nurse, she was very good and caring. It was the night shift nurse. I asked that she not do the catheter changes after that all happened.” When asked if he had any long term effects, any skin irritation from using the catheter for so long, he said, “No. I don’t think so.”
There was no documentation of nursing staff members changing the resident’s catheter or noting the details of the procedure, although this is required per the facility’s Catheter Removal Policy. There was conflicting information about the condition of the resident due to consistent catheter use. The resident did not disclose skin irritation, but the emergency room report noted a laceration on the resident. The Director of Nursing at the facility stated that “the resident has had a chronic indwelling catheter from admission, and he has had erosion on his penis for a long time. She must have mistaken that for the tear.”
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