"Blocked Catheter Care"

My husband has twice been discharged from Forth Valley Royal Hospital with a catheter in place and on each occasion it has blocked several times. The following timeline shows his experiences a year apart:

In September 2022  - Discharged with catheter in place after surviving out of hospital cardiac arrest. Ribs and sternum broken from CPR and suffering from hospital acquired pneumonia. On discharge we sought guidance from District Nurses. Hospital had not informed District Nurses of discharge. We were not aware complications such as blockage could occur.

One day in October 2022 early in the afternoon - Catheter blocked - message left on District Nurses answering machine.  Not aware at this time that a blocked catheter is a medical emergency which requires immediate intervention.

Later in the afternoon - As District Nurses had not responded to message, called NHS24 on 111. This call lasted approx 45 minutes. Advised to attend Emergency Department at Forth Valley Royal Hospital.

Early evening - Arrived at ED and after triage catheter was changed.

In the very early hours of the next morning - Discharged 

The morning after we had left the message with the District Nurses,  - they telephone in response to the message left -  some 20 hrs ago on previous day.

Just over a week later in the early hours of the morning - Attended FVRH Emergency Department with blocked catheter. Catheter flushed clear. Shown how to flush catheter and supplied with flush kits. 

Further two blockages flushed at home by me as husband’s sole carer.

Catheter was subsequently removed by Urology and husband undergoing treatment for enlarged prostate.  Nearly exactly one year later:

In October this year, late in the evening - Admitted to Surgical Admission Unit with URO Sepsis and CRP inflammation marker of 289. Long term catheter inserted. Diagnosed with bladder stone.

A week a later- Discharged from Ward B12 with catheter in place. Guidance provided that if catheter blocks during work hours to contact District Nurses. Out of hours to attend Emergency Department. Informed appointment will be made at Urology Trial Without Catheter Clinic in 4 weeks to check/replace long term catheter with surgery in 6 weeks for bladder stone. Assured District Nurses will be informed. Issued with Urinary Catheter Care Passport. Told not to self flush.

Issued with Discharge Lounge Checklist which showed my husband’s  details but another patient’s next of kin name and contact number. (I have a photo of this).

At the beginging of this month (december)- Attended Emergency Department with blocked catheter. Husband fainted in waiting room and taken to Resus whereupon I became distressed as it was the same bay he received treatment for his cardiac arrest. Catheter flushed and he remained in ED overnight as there were no beds and 10 patients in front of him waiting for beds.

Discharged from ED after approx 20 hours on a trolley with instructions to attend GP in 3 days to check kidney function. This was done.

About a week later, late in the evening - Emptied catheter bag and attached night bag but Night bag empty when husband woke next morning.

We left message of District Nurses answering machine. When I did not receive a response after one hour I liaised with GP practice & also telephoned Urology at Forth Valley Royal Hospital but got answer machine message directing me to contact District Nurses for catheter issues.

 Two hours later the District Nurse telephoned in response to my message. Hospital had not informed them my husband was discharged with a catheter but his name would be added to their afternoon calls. 

 1 hour 45 mins after the call the  District Nurse and student nurse called at our home and flushed the catheter but it did not unblock. Nurse advised that she had spoken with Advanced Nurse Practitioner prior to attending who instructed District Nurses should not change the catheter in the community without a letter from Urology stating it was safe to do so. My husband was to seek this letter from Urology. We were advised to attend at Forth Valley Royal Emergency Department and request an Open Ended catheter be inserted.

We attended Emergency Department at were triaged late in the afternoon - Informed no Open Ended catheters were available. Catheter changed by student nurse and bloods taken. Husband was wheeled on trolley into a corridor where he remained until early afternoon the next day.

After midnight - seen by doctor & urine test.  

 0140hrs - informed husband would have to remain in ED overnight as he had reduced kidney function probably due to delay in changing catheter.  

 1340hrs Discharged after approx 21hrs on a trolley in corridor of Forth Valley Royal Emergency Department.  

Once discharged we received a Telephone call from District Nurse Advanced Nurse Practitioner who stated future catheter changes will be conducted in community and prescription issued for supplies.   

A few days later we attended Cardiology to check kidney function. Telephoned Urology as had not received any appointment for Trial Without Catheter Clinic to review catheter health. Informed no need to attend clinic but asked to contact District Nurses and schedule appointment in 2 weeks to change catheter as Emergency Department had not inserted a Long Term Catheter. Asked to call in person at Urology and collect catheters as the ones issued on prescription may not be suitable. I have collected these.

My question is where do we turn if the catheter blocks again especially during public holidays during the festive period? 

Previous use of 111 only delayed unblocking of the catheter. 

Can my husband access the Urgent Care facility as he did when admitted in October this year? 

Can he attend the Minor Injuries Unit?

Are there out of hours community nurses?

Even during business hours District Nurses do not regularly screen their answering machine when out on calls and it may be several hours before they get the message.

Please don’t tell me the only option is to attend Emergency Department. Surely that should be for saving lives like they did for my husband in September 2022.