Ileal conduit and post-op management

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Anonymous (not verified)
Ileal conduit and post-op management

Okay, this has been bugging me for 2 months now... MSIV here, and I had been sent home after AM rounds, and I really didn't want to go back to the hotel room and stare at the TV, so I was re-rounding on an ICU patient who had an ileal conduit created 3 days prior in addition to multiple medical problems. I examined the patient's ostomy, and noticed that the bag was not draining and was actually tense with urine. The line was connected to the foley bag and the valve was open, but was not draining. I asked the nurse, and she said that she'd noticed that and was just squeezing the bag to make the urine drain. I put about 10 pounds of pressure on the bag and it did not drain at all, and can only assume she must have been putting much more pressure than that. I said that that was probably not a good idea, and drained the bag into a bucket and had the ostomy nurse paged. She was in a procedure and was upset and flustered that I paged her on the patient in ICU. Well, that evening, I got a phone call from my resident who was very upset with me because apparently I came across as rude and unprofessional in how I communicated that I was just a medical student and not a physician, I was to stay away from patients without supervision, and that I was just all around a horrible student who was too big for his britches. The next morning after crying myself to sleep (not something I would admit except in an anonymous forum) there was a note from the previous afternoon from the nephrologist stating that many of the problems that the patient was having was secondary to a URINE LEAK from a bad anastomosis. My resident was very offended and was certain the anastomosis was perfect. Now, my impression is I got dinged by defensive nursing. They saw the note from the nephrologist and they realized that I would tell my resident about what happened, so they beat me to the punch. The ostomy nurse and the resident were good friends (ie baby showers and stuff outside of work) so when she commented about me it was taken seriously. I ought to have just told my resident what was going on instead of saying or doing anything, and avoided the whole situation. I guess hindsight is ... yeah I am not a rude person and I always identify myself as a medical student (though I have a short coat, name tag says student). Do you think the resident caught on to what was going on? =\ Is it even likely that the nurse putting >10 lbs of force on the ostomy bag would cause a leak through a new anastomosis? I mean its not like the ureters are sitting all that superficial within the diversion, so I don't know how much of that pressure would communicate back. It has been bothering me because the rest of my month was awesome, but this happened on a Tuesday and the rest of that week I wanted to crawl under a rock because I thought the resident hated me.

Edited by: nicky on 05/11/2015 - 19:50 Reason: Updated by FeedsNodeProcessor