Chapter 1469: Chapter 589: The Cause of Death Was Not Catheter Insertion, Dependency
The cause of the patient’s death is related to improper urinary catheterization, which means the Digestive Internal Medicine department needs to take responsibility.
"The patient’s abdomen was as swollen as a drum, and the skin was brownish, indicating long-term retention of urine and feces in the body. This could lead to toxins harming the body, causing severe organ failure and possibly resulting in death. The urinary catheter failed to drain urine, so there indeed is a problem."
Director Shi from the hospital’s Infection Control Office also reached a similar conclusion.
All are professionals, and their analysis of the patient’s cause of death is unlikely to be mistaken.
The preliminary investigation results from both parties pointed to responsibility within the Digestive Internal Medicine’s treatment, causing the attending physician and Director Shang to feel anxious.
The nurse who inserted the urinary catheter showed the same fearful expression.
"Dr. Zhou, what is your opinion?"
Assistant Qin turned his gaze to Zhou Can, who had not yet spoken.
Director Shang looked at Zhou Can with a pleading expression, hoping he could help reduce the Digestive Internal Medicine’s responsibility in this incident.
"The patient’s death is unrelated to the urinary catheter!"
Zhou Can spoke with a resolute tone.
Upon hearing this, Director Shang and several medical staff immediately showed extremely grateful expressions towards Zhou Can.
Xiao Zhou still favors old ties!
"Hmph, Dr. Zhou is participating in this investigation as a member of the Quality Control Department now, and must not allow past relationships to bias the findings,"
Director Shi from the Infection Control Office snorted, expressing dissatisfaction with the conclusion Zhou Can provided.
He surely knew that Zhou Can had previously trained in the Digestive Internal Medicine department and had certain relationships with its doctors.
As a referee, it is most taboo to lack impartiality.
Members of the Quality Control Department must not cover up wrongdoing; even if problems are found during the investigation, they should not turn a blind eye just because they are familiar with the department or doctor under investigation.
"Dr. Zhou, you must pay attention to your stance and adapt to your new identity,"
Assistant Qin gave him a subtle reminder nearby.
"I do not intend to favor the Digestive Internal Medicine department; I am just drawing conclusions based on my own judgment. The patient has been unable to excrete feces, and despite using an enema and family members helping to manually remove the stool, the efforts were largely ineffective. The patient had no urine output from around five o’clock yesterday morning until three o’clock this morning when he died."
Zhou Can recounted the patient’s care record.
"I have examined the urinary catheter; although changes occurred in the corpse post-mortem, the catheter was tightly positioned but both the depth and angle of insertion should be correct. Even if an autopsy were conducted, I am more than 99% certain that the catheter correctly entered the bladder."
In terms of the implantation technique, Director Ju from the Nursing Department and Director Shi from the Infection Control Office are likely far inferior to Zhou Can.
Especially after reaching Level 6 implantation technique, Zhou Can’s assessments of various insertions have become even more accurate; he can even determine placement at a glance.
"Then why was there no urine drain for four hours before death despite the catheter being inserted?"
Director Shi questioned discontentedly.
"Under normal circumstances, even if urine output is low, the urinary catheter should lead to some drainage,"
The bladder is a very miraculous organ.
The mechanism of urine formation and discharge in the human body is also quite ingenious.
As blood passes through the small arteries of the renal glomerulus, large-molecule proteins and blood cells can freely pass, and with the filtration function of the renal glomerulus, they travel unimpeded in the renal arteries and return to the body’s blood system.
Most of the water, glucose, inorganic salts, and urea are filtered by the renal glomerulus and enter the bladder. The renal tubules also have some reabsorption functionality.
This is the formation of urine.
When doctors test urine, if they find albumin and blood cells, they can confirm the patient’s kidneys have an issue.
This indicates a problem with the renal glomerulus filtration.
Albumin and blood cells are very important nutrients to the body, and if expelled via urine, the body becomes weak. Gradually, symptoms such as emaciation, anemia may appear.
Sometimes patients can’t urinate because urine output is too low and the bladder doesn’t reach a full state, causing the lack of urination desire.
If urine output is too low, then even if the patient wants to urinate, it might not occur.
And if internal pressure is insufficient, even a small amount of urine can’t be squeezed out.
However, after inserting a urinary catheter, even when urine output is minimal, it typically can be drained out.
Of course, this depends on the doctor’s catheterization technique.
Both Director Shi and Director Ju observed that, after catheter insertion, there was a long delay without any urine drainage, indicating improper catheter placement. The abdomen swelling as a drum, if only due to feces retention, usually wouldn’t be this exaggerated.
Only when both urine and feces can’t be expelled would the abdomen become drum-like, bulging as if pregnant.
The high internal abdominal pressure can cause many issues.
This is their diagnostic view.
"First, everyone should know that if urine isn’t expelled for a long time, it is absorbed back into the body,"
Zhou Can analyzed his perspective.
Doctors often warn patients against holding urine; even without the urge, it’s best to urinate at least once every one or two hours.
This is because urine contains a lot of toxins and harmful substances.
If not promptly expelled, once reabsorbed into the body, it can cause significant harm.
Occasionally holding urine once or twice might be fine, but frequent occurrences can lead to various major illnesses.
Moreover, these individuals’ skin tends to lose its luster and becomes dull.
Dark circles appear, and the individual may resemble someone with uremia.
