Marijke Vroomen-Durning

In a recent review, expert rheumatologists examine patterns of treatment failure in gout, in light of six recent guidelines on the condition. Here, basics about the guidelines and the clues to optimal treatment are summarized in a few slides.Links to the published review and other resources appear in the slide captions.

Slideshows

Expert rheumatologists examine patterns of treatment failure in gout, in light of six recent guidelines on the condition. This brief slide show based on their review summarizes basics about the guidelines and the clues to optimal treatment, linking to the review itself.

Review in Brief: Optimizing Gout Management

I had a situation at work last week that I never had come across before. I am currently working in a long-term care facility, with limited acute care resources. We can provide basic life support in case of emergency and the doctors on staff can do minor procedures, but anything beyond that requires a trip to an acute care clinic or emergency department.

A few weeks ago, an older gentleman, in his 80s, was admitted from an acute care institution. He had a history of prostate cancer with metastases the bones, as well as a rather significant cardiac disease history. He arrived with an indwelling urinary catheter, which drained well. After about 10 days, the catheter blocked and did not unblock with irrigation. So, the nurse on duty removed the catheter and recatheterized him with a new one. At this point, it’s important to know that there was no resistance to the catheterization and no complaints of pain or discomfort.

Fast forward eight days and the catheter is blocked again. Irrigation was tried again and, once again, with no success. The decision was made to remove this catheter and perhaps see if he could manage without one. The gentleman’s urine was slightly cloudy but not foul-smelling. 

When the nurse went to remove the catheter, she couldn’t deflate the bladder, the balloon that had been filled with 10 ccs of normal saline. Drawing back on the syringe gave resistance. We left it for a bit and then tried again. Still nothing. Ok, that’s not unheard of, so it was decided to cut the catheter above the Y junction, to open the tubing to the bladder. Then, the water would leak out. It didn’t. Nothing happened. The nurse tried to remove the catheter — it wouldn’t budge. She tried pushing back on it, but that caused pain to the patient.

So, now we had not only a catheter that couldn’t be removed, we had an open catheter that would be a good route for infection. This was now a case of “we need to deal with this right now.” With that, arrangements were made to send the patient to the acute care hospital to have the Foley removed. 

I’ve not been back since so I don’t know what happened to the patient, but I am very curious. I am also curious about how other nurses deal with issues like this outside of the acute care system. If we had been in an acute care institution, I imagine that x-rays or ultrasounds would have been ordered right away to see what may be blocking the catheter. Perhaps an injection of a local anesthetic to the penis? Perhaps a relaxant to the patient? I don’t know; I’m just throwing things out there.

I guess the point of the article this week is to get a bit of feedback from nurses who work in this type of situation and I’d like to learn how you cope, how you learn, how you adapt to not having everything at your fingertips.

Have you ever heard of a situation like I just described? If so, what happened?

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I had a situation at work last week that I never had come across before.