CASE PRESENTATION: A tetraplegic patient started sweating profusely following insertion of a Foley
catheter per urethra. The
catheter was draining urine; there was no bypassing, no
bleeding per urethra, and no haematuria. Patient's wife, who had been looking after her tetraplegic husband for more than forty years, told the health professionals that the
catheter might have been placed incorrectly but her concerns were ignored. Ultrasound scan of urinary tract revealed no
urinary calculi, no
hydronephrosis. The balloon of Foley
catheter was not seen in urinary bladder but this finding was not recognised by radiologist and spinal cord physician. Patient continued to sweat profusely; therefore, CT of pelvis was performed, but there was a delay of ten days. CT revealed the balloon of Foley
catheter in the over-stretched prostate-membranous urethra; the tip of
catheter was not located within the urinary bladder but was lying distal to bladder neck. Flexible cystoscopy was performed and Foley
catheter was inserted into the bladder over a guide wire. The intensity of sweating decreased; noxious stimuli arising from traumatised urethra might take a long while to settle.
CONCLUSION: Inserting a
catheter in a tetraplegic patient should be carried out by a senior health professional, who is familiar with
spasm of bladder neck which occurs frequently in tetraplegic patients. Facilities for urgent CT scan should be available to check the position of Foley
catheter in
spinal cord injury patients when a patient manifests signs and symptoms of
autonomic dysreflexia following insertion of a
urethral catheter. When an isolated symptom such as
flushing or sweating is noticed in a tetraplegic patient, doctors should seek out other signs/symptoms of
autonomic dysreflexia.