Improper Positioning of Urinary Drainage Bag During Catheter Care
Penalty
Summary
A deficiency occurred when staff failed to properly position a urinary drainage bag for a resident with an indwelling catheter. During incontinence care, the urinary drainage bag was observed in the bed with the resident, and at one point, a CNA held the drainage bag above the resident's waist, causing urine to back up into the bladder area. The resident's care plan directed staff to provide catheter care every shift, secure the catheter and tubing appropriately, and observe for signs and symptoms of urinary tract infection. The facility's policy also required catheter care to reduce bladder and kidney infections. Interviews with the CNAs involved revealed a lack of adequate training and awareness regarding proper catheter and drainage bag positioning. One CNA was unsure of the correct procedure due to limited experience, another did not realize the implications of holding the drainage bag above the bladder, and a third, who was still in training, acknowledged the risk of urine flowing back into the bladder. The resident involved had a history of urinary tract infections and was admitted with an indwelling catheter for urinary retention.