PROFESSIONAL MISCONDUCT

Nurse whose inexperience and

negligence in biadder wasiiout put
her patient at risi(
fhe following case focuses on the procedure of bladder washout. medical or further expert nursing advice. At the end of the procedure,
It is usually a registered nurse's responsibility which is carried the nurse should clean the tip of the catheter again and connect a new
out after further training, supervision and evaluation of the clean drainage bag.
individual's competence. After cleaning away the equipment and making the patient
Bladder washout, or catheter irrigation as it is sometimes referred to, comfortable again, the nurse should document what she has done, the
is performed to maintain or restore the catheter's patency. The reasons patient's response and the outcomes of the procedure. The volume,
for the change in flow are usually caused by pus or blood clots. An open colour and consistency of the return urine flow should be noted and
method of irrigation or washout is carried out using a 50 ml bladder any resistance during instillation of the solution.
syringe and a sterile washout solution, such as 0.9% sodium chloride Polly was a registered nurse who had been qualified for 6 months
at room temperature. The risk of injecting a microorganism into when she was asked by a doctor to carry out a bladder washout on a
the bladder is high because the connection between the indwelling patient. She had only performed the procedure twice before but felt
catheter and the drainage tube is broken. Therefore, a sterile technique confident she could perform the task successfully The doctor stressed
should always be used to minimize the risk of infection. to Polly that there was a lot of pus and debris present and it would
The nurse should start by explaining the procedure to the patient, probably take a while to clear it.
and the reasons for carrying it out. Verbal consent and cooperation by Polly asked an auxiliary nurse and student to help her. She told them
the patient are important. to get the patient ready for the procedure and set up a trolley. Without
Bladder washout can be viewed as a very personal procedure which checking if they had done this correctly, Polly went straight to the patient
impinges on the patient's privacy and dignity. It is therefore important when the troUey was at his bedside and without warning commenced the
to be aware of this and carry out the task in a sensitive and considerate irrigation.When it was obvious that she was having difficulty introducing
manner. Privacy should be maintained and the environment around the the bladder solution, she gave up and left the patient's bedside.
patient screened off. Interruptions should be kept to a minimum. The She soon returned with a can of cola and to the shock of the student
nurse should prepare her troUey carefully and go through the procedure and auxiliary nurse, proceeded to introduce the contents into the patient's
in her head to visualize what will be needed. When the troUey is at the bladder via the bladder syringe. The patient becanie very distressed at
patient's bedside, the nurse should wash her hands and carefully open the what was happening and PoUy decided to stop the procedure.
appropriate sterile pack and any other necessary equipment. Antiseptic Polly was reported to the NMC who found that she did not accurately
solution should be poured into the galipot with the irrigation solution. follow the Trust's guidelines or standards relating to bladder irrigation. In
A clean catheter drainage track should be in a position where it can her defence, Polly claimed she thought the cola would break down the
easily be reached leaving the cover over its debris. Due to her inexperience and lack of
end. The nurse should then repeat her hand knowledge she was cautioned and advised
washing and put on a pair of sterile gloves. BREACH OF THE CODE OF about her future conduct.
A sterile field is set up using appropriate
sterile towels and drapes.
PROFESSIONAL CONDUCT The patient was lucky not to be harmed
and the Trust decided to keep PoUy on in
The patient should be lying in a In this case, the following clauses of the
new Code are relevant: employment and give her additional
comfortable semi-recumbent position. support and training. fSSi
Irrigation solution is poured into a sterile • 1.3. You are personally accountable for your
bowl or jug and the nurse slowly draws up practice. This means that you are answerable for
about 30 mis into the bladder syringe. The your actions and omissions, regardless of advice
catheter bag is detached from the catheter or directions from another professional. Note: All the case studies in this series are
based on true cases which were reported to
and the nurse carefully cleans around the • 1.4. You have a duty of care to your patients
and clients, who are entitled to receive safe the UKCC Professional Conduct Department
end of the catheter. Following this, the
and competent care. over the past 10 years. In some cases the
nurse introduces the bladder syringe, warns
names of those involved and some of the
the patient and slowly injects the irrigation • 6.2 To practice competently, you must
details may have been changed to respect
solution. If necessary, this procedure is possess the knowledge, skills and abilities
required for lawful, safe and effective anonymity and confidentiality.
repeated several times.
practice without direct supervision. You must
It is important to keep the patient fully acknowledge the limits of your professional Compiled by: George Castledine, Professor
informed of what is happening and check competence and only undertake practice and and Consultant of General Nursing,
for any signs of severe discomfort and pain. accept responsibilities for those activities in University of Central England, Birmingham,
If the procedure becomes too difficult and which you are competent.
and Dudley Group of Hospitals NHS Trust.
it appears the catheter is totally obstructed, Also see clause 6.3
it is important to stop immediately and seek

British Journal of Nursing. 2006. Vol 15, No 3

141