Fatality due to septicemia and hemorrhage in a patient with spinal cord injury and ischemic heart disease with the need for long-term catheter drainage

Abstract

Percutaneous suprapubic cystostomy is generally considered to be a safe procedure provided the bladder is distended adequately, as palpable bladder is the landmark for insertion of a trocar. This report describes fatality due to septicemia and hemorrhage following suprapubic catheter insertion in a tetraplegic male patient with long-term indwelling urethral catheter drainage and urine infection with Escherichia coli, Pseudomonas species, and Enterococcus faecalis. Before the surgical procedure was begun, the urinary bladder was distended by repeated injection of 50 mL of sterile, 0.9% sodium chloride through the urethral catheter with a catheter-tip syringe until the bladder became palpable in the suprapubic region; by this time, the bladder had been filled forcibly with 500 mL of saline. Percutaneous cystostomy was performed with the use of an Add-a-Cath trocar and cannula (Femcare Limited, Nottingham, Nottinghamshire, UK). Immediately after a 16 French Foley catheter had been inserted, the drainage fluid appeared heavily stained with blood. The patient developed septicemia, and a blood culture report, received posthumously, showed growth of E. coli. Despite resuscitative measures, the patient expired 13 hours after suprapubic catheter insertion. Postmortem examination revealed bilateral hydronephrosis with fluid and clotted blood in the renal pelves and ureters; the urinary bladder showed a thick wall and hemorrhagic mucosa. This fatal incident raises the question of whether forcible distention of the urinary bladder for percutaneous cystostomy is safe in patients with spinal cord injury who have a small-capacity bladder, infected urine, and ischemic heart disease. In such patients, it may be prudent to avoid forcible distention of the urinary bladder and instead perform ultrasound-guided or fluoroscopically guided suprapubic cystostomy.

Concept Analysis and Content Validation of Risk of Injury to the Urinary Tract: Nursing Diagnosis

“…The identified substitute term was damage to the urinary tract (Gray, ; Head, ; Madeo & Roodhouse, ; Mangnall, ; Nazarko, ; Pomfret & Nazarko, ; Sarica, Akkoc, Karapolat, & Aktug, ; Storr & Quibell, ; Turner & Dickens, ). The related terms were infection (Billington, Crane, Jownally, Kirkwood, & Roodhouse, ; Gray, ; Head, ; Igawa, Wyndaele, & Nishizawa, ; Kashefi, Messer, Barden, Sexton, & Parsons, ; Lenz, ; Madeo & Roodhouse, ; Mangnall, ; Nazarko, ; Ortega, Ng, Sekhar, & Song, ; Pomfret & Nazarko, ; Sarica et al., ; Stamm, Fortes, Kelly Suga Sakamoto, Campos, & Cipriano, ; Storr & Quibell, ; Turner & Dickens, ; Vaidyanathan, Soni, Singh, & Hughes, ) and trauma (Billington et al., ; Cury et al., ; Elgammal, ; Gray, ; Head, ; Igawa et al., ; Kondo et al., ; Lenz, ; Madeo & Roodhouse, ; Ortega et al., ; Pomfret & Nazarko, ; Sarica et al., ; Shlamovitz & McCullough, ; Storr & Quibell, ; Turner & Dickens, ; Vaidyanathan et al., ).…”

Long‐term bladder drainage: Suprapubic catheter versus other methods: A scoping review

“…Only one study addressed the complication of urethral leakage in people with SP catheters20 but the authors did not address the nursing care or QoL issues associated with urethral leakage. One case study was found emphasizing the need for secure anchoring of the suprapubic catheter to prevent traction on the stoma and subsequent skin breakdown 37. No articles were found that addressed exit site granulation, bleeding, or other skin care issues related to the catheter stoma site.…”

Decreasing Suprapubic Tube-Related Injuries: Results of Case Series and Comprehensive Literature Review

“…They noted a low minor compli-cation rate of 1.6% and a bowel injury rate of 0.4% (Flock et al, 1978). Additional complications have been reported after percutaneous SPT placement, including intraper itoneal extravasation, extra peritoneal extravasation, infection, ureteral obstruction, cath eter obstruction or dislodgement, hematuria, hernia, bowel obstruction, subcutaneous em phy sema, urosepsis, and bladder penetration with associated rectal, vaginal, or uterine injury (Dangle, Tycast, Vasquez, Geary, & Chehval, 2010;Heit, 1997;Lobel & Sand, 1997;Vaidyanathan, Soni, Singh, & Hughes, 2006). An additional review by Sheriff et al (1998) reported a 10% intraoperative complication rate, 2.7% rate of bowel injury, and a 0.8% mortality rate in patients with neurogenic bladders.…”