Authors (including presenting author) :
Yim MS(1)
Chu SF(1)
To WL(1)
Affiliation :
(1) Department of Surgery, Princess Margaret Hosptial
Introduction :
Ureteric obstruction is a common urological condition which caused by urinary stones, stricture or secondary to malignancy. Unmanaged ureteric obstruction may lead to hydronephrosis, impaired renal function, urosepsis or even death. As ureteric obstruction is a treatable condition, severe complications can be prevented and are rare.
One of the treatment options for ureteric obstruction is to insert a PCN catheter. It is a small pigtail tube that drains urine out of kidney percutaneously and prevent formation of hydronephrosis. The potential complications of PCN includes catheter blockage, kinking, haematuria and dislodgement of catheter. In 2018, there were total 108 emergency admissions related to PCN complications in Princess Margaret Hospital(PMH). Around 60% of the admission are related to catheter blockage, decreased urine output and dislodged catheter anchoring stitch. Timely management of these conditions by catheter flushing and re-anchoring in daycare setting can prevent deterioration in patients' condition or slip out of PC. Hence, prevent unnecessary AED attendance and emergency admission.
Objectives :
To minimize unnecessary AED attendance and hospitalization for patients with PCN catheter related complications
Methodology :
A new workflow and service for management of PCN related complications was setup in Urology nurse clinic in PMH. An education pamphlet with contact phone number of nurse clinic was issued to patients with PCN when discharge. Patients are encouraged to contact nurse clinic during office hours when experience PCN related complications.
Urology nurses are responsible for providing counselling, education and triage for those enquiries via phone. For stable patients, they are advised to come back to nurse clinic for assessment and management. Urology nurses will perform PCN flushing to relief catheter blockage and to re-anchor PC with loosen stitch if it is patent. If PC catheter obstruction cannot be relieved by flushing or catheter showed significant dislocation, patients will transfer to urology ward for further management. For patients with unstable conditions like fever and etc, urology nurses will advise them to seek medical advice or attend AED.
Result & Outcome :
During 2022, there were 190 patients presented with PCN related problems and attended PMH and out of which:
- 64(34%) were managed in nurse clinic. Only 8/64(12.5%) required admission and the other 56/64(87.5%) can be discharged after nursing interventions.
- 38(20.0%) with unstable condition and not suitable to manage in nurse clinic.
- 45(23.7%) attended hospital during non-service hour of nurse clinic.
- 43(22.6%) didn’t call back to nurse clinic.
PCN catheter management workflow and service successfully reduced the number of AED attendance and emergency admission.
