Improper Management of Indwelling Urinary Catheter and Lack of Securement
Penalty
Summary
Failure to provide appropriate catheter care occurred when a resident with an indwelling urinary catheter was observed with the drainage bag hanging from the top drawer handle of the bedside table, with the drainage tubing pulled back to the right side and not maintained below the level of the bladder. The resident’s anchoring device was folded around the tubing and not secured to his leg. The resident, who had multiple diagnoses including obstructive and reflux uropathy, benign prostatic hyperplasia, and other comorbidities, reported having tearing to his penis from a previous facility because staff were not using the anchoring device and were not emptying the drainage bag, allowing the weight of the bag to pull on his penis. He stated he had requested a new anchoring device the previous day, but staff did not act on his request. During interview, an LPN acknowledged the resident had a catheter, was followed by a urologist, and had a penile tear, which she attributed to poor hygiene, and stated she did not think the wound nurse was doing anything for it. She reported she had not assessed the area that morning and stated that 1600 cc of urine had been emptied from the drainage bag that morning, and that staff should empty the bag every shift and as needed. When the LPN entered the room, she questioned why the drainage bag was hooked on the top drawer handle, lifted the bag above the level of the bladder, and then handed it to an aide to reposition. The resident’s meatal tear was present at the catheter insertion site without a securement device in place, which the LPN confirmed should have been used to prevent pulling. The ADON stated catheter care should be done every shift and as needed, including emptying the bag at least every shift, using a privacy bag, and ensuring the stat lock is in working condition, and explained that a full bag can put pressure on the urethra and cause urine backflow and potential bacterial infections, and that stat locks are used to prevent trauma or tearing. The resident’s care plan included interventions to secure tubing to prevent pulling and to keep the drainage bag below bladder level, but did not address the existing meatal tear. The facility’s indwelling catheter policy required consideration of a securement device and support of catheter tubing to prevent tugging or inadvertent removal.
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