A catheter is a tube which drains urine from the bladder. In a nursing home setting, it used primarily for residents who suffer from urinary incontinence or alternatively from urinary retention.
There are basically two different kinds of catheters. One is a straight catheter, which is for one-time usage, generally for people who suffer from urinary retention or for help getting a urine sample. The other is an indwelling catheter which is intended for longer term usage. One area where we see frequent use of an indwelling catheter is to help treat bed sores, specifically Stage 3 and Stage 4 bed sores.
Federal regulations discourage the use of catheters in nursing homes. 42 Code of Federal Regulations, Part 483.25(e) provides that residents who are continent of urine on admission receive service to maintain their continence unless the clinical conditions makes it not possible to maintain. Once residents become incontinent, the regulations provide that a resident should not be catheterized unless it is necessary; that a resident who enters a facility with a catheter or receives one thereafter is assessed for removal as soon as possible unless the catheterization is necessary; and the resident must receive treatment and services necessary to prevent urinary tract infections and restore normal function.
The reason that the use of catheters, especially indwelling catheters, is discouraged is because they can cause significant harm to nursing home residents. Not only is the placement of a catheter something that is uncomfortable, there are significant risks of injury and infection. Here are just some of the issues that can crop up with the use of catheters:
Risk of catheter placement injuries – When the catheter is placed, injury can result. This may happen where the resident has unusual anatomy and the nurse forces the catheter through. Indwelling catheters have an inflatable balloon at the tip. When the catheter tip reaches the bladder, the balloon should be inflated which helps keep the bladder open and allows urine to flow through the catheter into the bag. Inflation of the balloon before it reaches the bladder does occur and can cause devastating injuries to the urinary tract.
Risk of improper removal – removing the catheter must be done carefully to avoid injury to the urinary tract. This can occur due to poor technique or inadvertent removal.
Potential for urinary tract infection – Urinary tract infections a serious illness for nursing home residents. They can cause profound mental status changes and weakness which increase the risk of nursing home falls. They frequently require hospitalizations and extended courses of antibiotic therapy which can lead to the development of a c-diff infection. Placement of a catheter opens up the urinary tract to infecting organisms. Nursing homes are health care institutions, and due to the common use of antibiotics and disinfectants, many of the infecting organisms in nursing homes are more virulent than you might find elsewhere.
Improper catheter care – When a catheter is placed, most nursing homes will specifically care plan for proper catheter care or will have policies and procedures or standing physician orders addressing catheter care. When the necessary steps to care for the catheter are not taken, unnecessary injuries and illnesses can result.
Failure to monitor for signs and symptoms of UTI – One of the more common scenarios we see involves the failure of the nursing staff to recognize the signs and symptoms of a UTI. Nurses are not required to be able to diagnose a urinary tract infection, but they do need to be able to identify signs and symptoms of a urinary tract infection. When signs and symptoms of infection are present physician notification by a nurse is required. At a minimum, a doctor’s orders are needed to administer an antibiotic to help try to cure the infection. For severe cases of urinary tract infection, hospital admissions may be required.
One of our core beliefs is that nursing homes are built to fail due to the business model they follow. Unnecessary catheter use is one of the consequences of that business model, and unnecessary accidental injuries and wrongful deaths of residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.