Urinary catheter insertion

Mick was 64 years of age when he was diagnosed with a calcification in the lower lobe of his left kidney (kidney stone). This occurred after a presentation to the emergency department of the local tertiary hospital.

Mick was referred to a urologist within the local health district who recommended a procedure to laser the stone, known as a pyeloscopy.

The surgery was scheduled and conducted at the hospital by way of probe. During the operation it was noted that Mick had an abnormally large prostate and a particularly prominent median lobe, which made access to the bladder difficult via the urethra.

Following the operation

After the operation an indwelling urinary catheter was left in due to the prominent prostate and blood in the urine.

The next day the indwelling urinary catheter was removed by a nurse as the patient had trouble going to the toilet and was replaced by a three-way indwelling catheter which allowed for irrigation for inflation of fixing balloon within the bladder and for the removal of urine. Unfortunately, there were significant complications in the process of inserting the three-way indwelling urinary catheter by the nurse, who apparently did not have the necessary experience with a difficult catheterisation such as Mick’s.

Three days after the surgery Mick was due to be discharged from the hospital and the intention was to remove the three-way catheter and replace with a two-way indwelling catheter for discharge.

Attempted removal of catheter

Several attempts were made to remove the three-way indwelling catheter by an endorsed enrolled nurse and then multiple attempts to insert the two-way catheter. The process was so difficult and so much force needed to be applied that ultimately the nurse called for the urological registrar to insert the urinary catheter. That was done by way of cystoscopy and at the time the urological registrar noted severe disruption of the posterior (back edge) wall of the urethra. He experienced difficulty accessing the bladder and ultimately used a guide wire to insert into the bladder.

Subsequent to the insertion of the catheter he ordered a CT scan which showed that the urinary catheter had passed through the wall of the urethra and the prostate and the tip was sitting within the recto-vesicle pouch between the prostate and the rectum, fortunately without having perforated the rectum.

Mick was taken back to the operating room and the catheter was placed in the correct position under vision.

Ultimately, Mick was discharged to be reviewed in the outpatient’s section of the hospital in three weeks, with the indwelling catheter to remain to allow for the tearing and the perforation to heal. He was advised that he may require a return to surgery for dilation of the scarring (removal).

For some unknown reason Mick was called back by the operating urologist only 6 days after his discharge. It is thought that the operating urologist had not reviewed the notes and seen the difficulties that were had during the post-operative attempts at catheterisation.

The urinary catheter was removed by cystoscope and an attempt made to extract the stent in the ureter which was put there to allow for the remnants of the stone to be passed. An indwelling catheter was inserted after the procedure but subsequently fell out when Mick stood up and there was frank blood oozing from his penis.

Mick came back to the hospital having experienced high fevers and a hypertensive event (low blood pressure). The rapid response team was called, and he was admitted to ICU with septic shock which was later felt to be the result of the instruments used in the outpatients visit the day before. To make matters worse Mick was given penicillin when it was clearly marked on his records that he had an allergy.

Outcome

Subsequently, Mick had multiple urinary tract infections. He required further surgery by an alternative urological surgeon to remove the stent and investigate the injury. He suffered urinary infrequency and incontinence, depression, deconditioning, insomnia and nightmares and a deterioration in his Parkinson’s.

This meant that he had to give up his part time work as a music teacher and to sell his semi-rural property because he could not maintain it. He needed help from his wife around home and the injury now makes any further procedure more complicated.

Unfortunately, it was later discovered that the kidney stone had not been removed.

What went wrong

It should had been obvious after the initial procedure that there was a very large prostate which would make catheterisation difficult. Given this circumstance this should have alerted staff that they needed to exercise more care and expertise. The catheterisation should have been carried out by a competent person under optimal conditions, for example by a registrar in an operating room under vision.

Also, several weeks should have been allowed to pass after discharge for the tear and perforation to heal properly before an attempt was made to remove the catheter and the stent.

We acted for Mick in proceedings in the District Court of NSW and were successful in resolving this claim for a substantial amount of money, and to obtain an apology from the local health district.

If you have been a victim or suffered loss as a result of medical negligence, call us today to speak to our friendly team.