Faulty indwelling urinary catheter detection
A defective medical accessory can imitate a typical medical complication

Summary

Seldom, the physician faces cases of suboptimal quality of manufacture for various ancillary medical materials. More specifically, a defective medical aid can lend dimensions similar with those of a typical medical complication. Naturally the next step is the investigation and management of complication. The physician will be supposed to have in mind that certain defective medical accessories can be accountable for causing a particular complication. The ultrasonic investigation is a initiative that probably will display the problem and may solve it. In this particular case, unfortunate stitching of indwelling catheter in tissues was not compatible with timing of its insertion at the end of operation. Ultrasonography was rendered possible in the proof of the medical complication absence. Also it guided to the direct and instantaneous resolution of the subject.

Key words:
indwelling urinary catheter, ultrasonography.

INTRODUCTION

There are few cases where the physician faces difficulties that slip from his perception, as long as most excellent operator being. Concretely, report becomes in cases where complications creation pathogenesis passes henceforth in the quality of manufacture of various ancillary medical materials. More specifically a defective medical element can lend dimensions similar with those of formal medical complication. As the insouciance physician investigates the nature of complication, sooner or later he will find out its not medical origin. Gynecologist must have in his mind that some medical accessories can slip the net of qualitative control in the various stages executed, from the company until the hospital. The unsuspected surgeon, investigating certain likely complication, should be suspected at the same time for the mentioned situation before. This, rather than ever, will happen always more often, as long as the criterion of squeezed cost is being imposed. While discussion becomes on a subject for which practical bibliography does not exist, however the first suspicion between complications and technical quality already had been arose since 2002 [1].

CASE

A routine operation of anterior colporraphy was held in Mesologi County Hospital before some months ago [2]. Concretely one woman aged 65 years old, was admitted in obstetric & gynaecologic department diagnosed as cystocele. She was submitted in typical anterior colporraphy within ordinal operational program. The predicted post-operational day, she was submitted in bladder capacity and function exercises of urinary system. Afterwards the successful result, the indwelling urinary catheter removal, was decided the next day.

The attempt of indwelling urinary catheter removal was impossible. After repeated unfortunate attempts, urologic assistance was asked for. This, particularly marked the following: the fidelity in protocols, the clinical situation on moment of processes, the timing of urologic assistance, any other complications else, the timing of process, the operational level and technical faults [3]. The fidelity of protocols was verified by the lege artis practical indwelling urinary catheter insertion at the end of operation. Also this step was checked out by the lege artis attempts of indwelling urinary catheter removal. The clinical situation of all organ systems was indeed excellent. The urologic assistance was judged convenient. Other type complications were not marked. Timing of catheter removal was judged satisfactory, while it did not puzzle the level of the operator physician. The investigation of technical faults began with the application of 5 stages of catheter removal guidelines. They are precisely written down at manufactory manual booklet [4]. Ever, communication has been proved between the indwelling urinary catheter two pipes. Concretely, iodised normal saline was supplied via the indwelling urinary catheter suspension pipe. It was revealed that iodised normal saline came out from the indwelling urinary catheter drainage pipe.

Ultrasonic investigation was ordered then, for the control of the catheter leading bubble distensibility. In point of fact, the bubble was found overdistensible (picture). It was realised that it was about an one-way valve bubble. Then, a guide-wire perforated the bubble and the indwelling urinary catheter removed.

DISCUSSION

This article attempts to show the ultrasound utility in the investigation of postoperational complications. Also the contribution of a technical fault causing a complication is shown. The importance of this article lies in the sensitization of the physician for the probability of patients problems caused due to technical faults of equipment. That enlarges as more widely equipment is permanently incorporated in the clinical practice.

More specifically, the 5^th stage manual does not predicts detailfully how the control of region around the bubble catheter would proceed. That’s why, ultrasonic investigation was a initiative of the operator displaying the problem. This was fundamental in further management. Generally the accidental urinary injury during gynaecologic operations is one infrequent event ordered ~ 0.5-1% [5]. From this percentage, two third concern the ureters and one third concerns the more inferior urinary, roughly ordered ~ 0.16-0.33%. According to unwritten information, from this last percentage of [0.16-0.33%], in the case of indwelling urinary catheter removal impossibility, true accidental stitching of indwelling urinary catheter into more inferior urinary tract, approximates over 95% of cases. On the contrary, the presence of one-way valve bubble, approximates less 5% of cases [6]. Generally speaking, when “inferior urinary tract injury” is reported, it will be meant that it is about: “accidental stitching of indwelling urinary catheter into more inferior urinary tract” during operation [7]. Although in that case, accidental stitching of indwelling urinary catheter into more inferior urinary tract was not compatible with insertion timing of indwelling urinary catheter at the end of operation, however, any medical complication absence had to be proved. Finally, ultrasonic display exonerated any medical responsibility and guided the direct and instantaneous resolution of the subject.

Constantinos Tsompos, MD.

Consultant B

Department Of Obstetrics & Gynecology

Mesologi County Hospital

Mesologi 30200

Greece

Constantinostsompos@yahoo.com