BLADDER IRRIGATION

Definition: continuous washing out of the bladder with sterile fluid

Assessment Determine rationale for irrigation. – To test and

maintain the patency of the retention catheter Note rate of urine flow from bladder, color of urine,

presence of clots or debris. Assess for distended bladder. Assess for bladder discomfort Note client’s I&O balance

Objectives To remove blood clots from client’s bladder To ensure patency of drainage system To relieve bladder spasms

Procedures: 3 Types of Bladder Irrigation1. Irrigating by Opening a Closed System2. Irrigating a Closed System3. Maintaining Continuous Bladder Irrigation

Expected Outcomes Blood clots are removed from client’s bladder Continuous flow of solution is maintained to evacuate

clots and prevent catheter obstruction Catheter remains patent and unobstructed by clots or

sediments Net urine output is determined

3 KINDS OF BLADDER IRRIGATION

1. IRRIGATING BY OPENING A CLOSED SYSTEM

Equipment: Clean glovesCatheter tipped syringe/ asepto syringeIrrigating solutionCatch basinSterile bowl/ basinAntiseptic swabAbsorbent pad

Pain or antispasmodic medication

Preparation:1. Check physician’s order for system irrigation and

client care plan.

2. Gather equipment3. Check client’s identaband4. Explain procedure and rationale to client.5. Wash your hands.6. Premedicate client as indicated. Rationale: Manual

irrigation causes painful bladder spasms.7. Provide privacy, and place client in a comfortable

position. The dorsal-recumbent position is most convenient if client can tolerate this position. Raise bed, and lower side rails if needed.

Procedure:1. Fanfold linen to expose catheter.2. Palpate client’s bladder to check for distention.3. Open sterile container on bed or on over-bed table.

Maintain sterility of inside of the container.4. Don clean gloves 5. Place an absorbent pad under connection of tubing and

catheter. Rationale: This will form a working field for irrigating catheter.

6. Pour irrigant into solution container.7. Place catheter tipped syringe in container. Do not

contaminate syringe tip.8. Place catch basin on pad to form working field.

(Always keep syringe tip and irrigant uncontaminated).9. Disconnect catheter from drainage tube. Place sterile

protective cap over the end of the drainage tube. Rationale: This will prevent contaminating tip of tubing.

Carefully remove sealing Disconnect catheter fromtape to access catheter drainage tubing; cover tubingcatheter. end with sterile cap

10. Coil tubing on bed.11. Place catheter over edge of catch basin. Rationale: If

end of catheter touches covers, underpad, exposed skin surfaces, or drainage tube, it will be contaminated.

12. Insert irrigating syringe into catheter and attempt to aspirate any obstructing debris, Rationale: If

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irrigation is performed without removing debris, it can be forced into bladder and result in infection.

13. Withdraw irrigating solution into syringe.14. Instill 30-50 ml of irrigant into catheter with gentle

but firm pressure.a. Remove syringe and allow solution to drain.b. Lower catch basin to facilitate solution return

via gravity or aspirate instilled solution.c. Continue to irrigate client’s bladder with 30-50

ml of irrigant until fluid returns are clear or clots removed.

15. Remove the protective cap from drainage tube and wipe it with an antiseptic swab.

16. Wipe end of catheter with an antiseptic sponge, and connect the catheter to the drainage tube.

17. Ensure straight line from tubing to drainage bag. Curl excess tubing loosely on bed and secure tubing to linen.

18. Tape catheter to inner thigh for a female and abdomen for male.

Instill 30-50 ml of irrigant reconnect catheter to into catheter using aseptic drainage tubing

technique

19. Lower bed and raise side rails.20. Discard equipment and remove gloves.21. Make sure client is clean and comfortable. Place call

light within easy reach.22. Wash your hands.23. Measure amount of return. Subtract any irrigation

solution used to irrigate from the client’s I & O record

2. IRRIGATING A CLOSED SYSTEMEquipment

Irrigation set30-ml syringe with needleless cannulaAlcohol or povidone – iodine (Betadine) swabOrdered irrigating solution (normal saline)Clamp for drainage tubingClean glovesPrepared pain medication, if ordered

Preparation1. Check physician’s order and client care plan.2. Gather equipment3. Check client’s identaband. Explain procedure and

rationale to client.4. Wash hands5. Provide privacy, and place client in dorsal –

recumbent position, if tolerated.6. Raise bed, and lower side rail on working side of bed.7. Don clean gloves.8. Premedicate client if ordered.9. Empty client’s urinary drainage and record amount.

Procedure:1. Open sterile container, Maintain sterility on inside of

the container.2. Place absorbent pad under end of catheter to form a

working field.3. Pour irrigant into solution container.4. Clamp tubing just distal to injection port. 5. Swab tubing injection port with alcohol or Betadine

solution 6. Insert the needleless cannula into tubing injection port7. Attempt to aspirate obstructing clot or debris.

Rationale: Irrigation without first attempting removal of debris can force it into bladder, resulting in infection

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8. Withdraw irrigating solution into syringe.9. Swab injection port again.10. Inject solution slowly into port. Rationale: To

prevent back pressure in urinary drainage system.11. Remove syringe from injection port.12. Unclamp drainage tube, and lower catheter.

Rationale: This facilitates drainage.13. Repeat irrigation steps until return is free of clots and

debris.14. Lower bed and raise side rail.15. Dispose of equipment and remove gloves16. Wash your hands.17. Measure amount of return. Subtract the irrigating

solution from the client’s I&O record.

3. MAINTAINING CONTINOUS BLADDER IRRIGATION (CYSTOCLYSIS)

Equipment Irrigating solution IV tubing with roller clamp IV pole Alcohol or povidone – iodine (Betadine) swab Clean gloves

Procedure 1. Check physician’s order and client care plan.2. Note if client has triple lumen indwelling catheter

and drainage bag.3. Place label on irrigating bag. Include client’s name,

date, room number, type of solution, and additives.4. Check client’s identaband.5. Explain procedure to client and provide privacy.6. Wash your hands and don clean gloves.7. Remove protective covering from spike on tubing,

and insert spike into insertion port of solution container. Use aseptic technique.

8. Hang irrigating solution container on IV pole and prime tubing. Height of pole is usually 24 - 36 inches above bladder.

a. Remove protective cover from end of tubing using aseptic technique.

b. Open roller clamp, and allow irrigating solution to run through tubing until all air is expelled. Rationale: This prevents air from entering bladder and causing discomfort.

c. Close roller clamp.9. Connect tubing to catheter irrigating (indwell) lumen

using aseptic technique.

10. Removes gloves.11. Adjust drip rate irrigating solution by adjusting the

clamp on the tubing to increase or decrease based on urine out – flow color.

a. Infuse continuously to keep urine drainage pink to clear.

b. When drainage is dark red or contains blood clots, increase drip rate. Rationale: Increased drip rate will clear the drainage and flush out clots.

c. Change irrigation solution bottle using aseptic technique.

12. Check for bladder distention or abdominal pain; note urine color.

13. Monitor urine output at least every hour to observe patency of system.

14. Empty drainage bag as recorded. Subtract amount of irrigant infused from total output to obtain urine output and record.

15. Maintain catheter traction if taped to thigh. Rationale: This promotes venous hemostasis.

16. Remove gloves and wash hands.

Note: Procedure is done to flush clots and debris from bladder following prostatic surgery, and to prevent catheter obstruction and promote patency.

DOCUMENTATION FOR BLADDER IRRIGATION Type and amount of solution administered for

irrigation. Rate of administration of irrigating solution Description of urinary output, including color and

presence of clots or debris Any signs of discomfort or cramping Medication given for pain Amount of actual urine output (total urine output

minus amount of irrigant instilled).

Critical Thinking Application

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UNEXPECTED OUTCOMES CRITICAL THINKING OPTIONS

Irrigation flow is not infusing as prescribed rate * May need to raise or lower IV standard with attached irrigation bag to assist in regulating flow using gravity.

* Move the flow adjuster clamp to a new site on the tubing if flow is slower than ordered. Tubing may be collapsed due to

constant pressure from clamp.* If infusion rate slows, may indicate clots are blocking flow.

Irrigate catheter following physician’s orders.

Irrigation solution is not returned because of an * Follow these steps to obtain irrigation solution:obstruction in the system a) Check tubing for kinks

b) Have client change position c) Aspirate the solution from the catheter, using moderate “pull back” pressure.

d) If the irrigant does not return, palpate the client’s bladder and instill 30 – 50 ml of irrigating solution to

agitate and clear any clots. e) If irrigant does not return, reconnect urinary system and observe for 30 minutes. Bladder spasms can block the flow of urine through the system .

f) If irrigant still does not return after performing the above procedures, notify physician for further orders.

Client experiences excessive bladder spasms. * Notify physician to obtain an order for urinary antispasmodic * Assist client to change position

Bright red drainage continues even when * Notify physician immediatelysolution flow rate is increased. * Obtain vital signs and continuously monitor

* Continue to infuse solution at a rapid rate to flush client’s bladder until you obtain physician’s orders * Do not allow client to cough * Keep client’s catheter—taped leg straight to maintain traction

on catheter inflation bulb

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