| 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. | |
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MedLine Citation:
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PMID: 16751167 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Subramanian Vaidyanathan; Bakul M Soni; Gurpreet Singh; Peter L Hughes |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Advances in therapy Volume: 23 ISSN: 0741-238X ISO Abbreviation: Adv Ther Publication Date: 2006 Mar-Apr |
Date Detail:
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Created Date: 2006-06-05 Completed Date: 2006-07-05 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8611864 Medline TA: Adv Ther Country: United States |
Other Details:
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Languages: eng Pagination: 354-8 Citation Subset: T |
Affiliation:
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Regional Spinal Injuries Center, District General Hospital, Southport, Merseyside, United Kingdom. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Catheters, Indwelling
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adverse effects Cystostomy / adverse effects* Diagnosis, Differential Enterococcus faecalis Escherichia coli Fatal Outcome Hemorrhage / diagnosis, etiology Humans Male Middle Aged Myocardial Ischemia Postoperative Complications / diagnosis, etiology, microbiology Pseudomonas Quadriplegia Sepsis / diagnosis*, etiology, microbiology Spinal Cord Injuries Urinary Bladder / surgery Urinary Catheterization / adverse effects |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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