Document Detail


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.
MedLine Citation:
PMID:  16751167     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Subramanian Vaidyanathan; Bakul M Soni; Gurpreet Singh; Peter L Hughes
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Advances in therapy     Volume:  23     ISSN:  0741-238X     ISO Abbreviation:  Adv Ther     Publication Date:    2006 Mar-Apr
Date Detail:
Created Date:  2006-06-05     Completed Date:  2006-07-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8611864     Medline TA:  Adv Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  354-8     Citation Subset:  T    
Affiliation:
Regional Spinal Injuries Center, District General Hospital, Southport, Merseyside, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Catheters, Indwelling / 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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