Time Specific objective

Content Teaching learning activity

Evaluation

3mins Give an introduction regarding urinary diversion

A urinary diversion is a surgical procedure in which the normal pathway of urine elimination is altered.The ureters are rerouted from a diseased or damaged urinary system to a new outlet,called a stoma,created surgically in the client’s abdomen.The diversion may be permanent(cancerous condition) or temprorary(severe chronic UTI).

3mins Define bladder irrigation

Definition

Bladder irrigation is the washing out of the urinary bladder ,by directing a stream of solution into the bladder ,through the urinary meatus by means of catheter.It is the flushing of the mucous lining of the bladder to remove the sediments decomposed urine and to

Student teacher will define bladder irrigation with help of ppt.

What is bladder irrigation?

treat inflammation .4mins List out the

purposes of bladder irrigation

PurposesThe nurse performs bladder irrigation in order to:

Aviod retention of blood in the bladder. Prevent blood clots from forming. Flush out purulent,stagnant urine and other sediment

from building up in the urinary bladder. Avoid bladder distension . To ensure patency of the urinary drainage system. To relieve congestion and pain in inflammatory

conditions. To promote healing . To medicate the lining of the bladder. To prepare the bladder for surgery as pre-operative

measure.

Student teacher will list out the purpose of bladder irrigation with the help of ppt.

What are the purposes of bladder irrigation?

5mins To explain the type of irrigation

Types of irrigation procedures

Open metho d :It is done with an asepto syringe in which fluid is introduced into the urinary bladder and drained out simultaneously.

Closed method : This provides for frequent intermittent or continuous irrigation without disruption of the sterile catheter system.

Contiuous method : it is a continuous infusion of a sterile solution in to the bladder, usually by using a three-way irrigation closed system with a triple-lumen catheter. One lumen is used to drain urine;

Student teacher will explain the types of irrigation procedure with help of o.h.p.

What are the type of irrigation procedure?

another is used to inflate the catheter balloon, and the final lumen carries the irrigation solution. CBI is primarily used following genitourinary surgery to keep the bladder clear and free of blood clots or sediment.

General instructions Maintain strict aseptic tecnique. Administer only after obtaining doctor’s order . Maintain an accurate record of the fluid used for

irrigation . Fluid should be instilled gently and allowed to

drain back by gravity .Preliminary assessment

Assess functioning of the catheter drainage system. Type of catheter in place. Length of time/duration of catheter . Colour and consistency of urine in tubing and

drainage bag . Bladder distension.

2mins List out the common solutions used

Common solutions used

Weak aqueous solutions to be used for irrigationSolutions Rationale

Distilled water Normal saline

To avoid irritation of the sensitive mucous lining of the bladder.

Sodium nitrate To prevent clot

Student teacher will list out the common solutions used with help of charts.

Which are the solutions used for bladder irrigation.

1:8000 formation. Boric acid 2% Potassium

permanganate 1: 10000

Acriflavin 1 in 10000

Mildly antiseptic and non-irritating.

Silver nitrate 1:5000

Acetic acid 1in 400

Betadine 1:200

Astringent To treat pseudomonas

infection . Antimicrobial

10min Explain the closed system used to irrigate bladder.

Irrigating the catheter using the closed system

Articles required 1. Sterile basin or container2. Waterproof drape 3. Gauze squares or cotton balls with disinfectant or

alcohol swabs4. 30 ml to 50 ml syringe with 18 gauze needle5. Sterile irrigating solution (at room temperature or

warmed to body temperature)6. Bath blanket

Student teacher will explain with the help of ppt.

How the closed system is used to irrigate bladder?

Steps of procedure

Action Rationale Assemble equipments.wash Organization facilitates

your hands.explain the procedure and its purpose to the client .

performance of task .hand washing deter spread of microorganisms.an explanation encourages client cooperation and reduces apprehension.

Provide for privacy by closing the curtains or door &draping the client with the bath blanket.

The procedure may be embarrassing for the client .

Assist the client to a comfortable position and expose the aspiration port on the catheter set-up .place the waterproof drape under the catheter and aspiration port .

This provides for adequate visualization .the drape protects the client and the bed from leakage .

Open the sterile supplies. Pour sterile solution into the sterile basin .aspirate irrigant(30ml to 50 ml)into the sterile syringe and attach the capped sterile needle .

This prevents the spread of microorganisms.

Disinfect the aspiration port with alcohol swabs or gauze square with antiseptic solution .

This prevents the spread of microorganisms.

Clamp or fold the catheter tubing distal to the aspiration port .

This directs the irrigating solution into the bladder .

Remove the cap and insert the needle into the port .gently instill solution into the catheter .

Gentle irrigation prevents damage to the lining of the bladder .

Remove the needle from the port . unclamp the tubing and allow irrigant and urine to drain .repeat the procedure as necessary.

Gravity aids drainage of urine and irrigant from the bladder .

Assess the client’s response to the procedure and the quality and amount of drainage.document on the client’s chart.

This provides accurate documentation of the procedure .

Record the amount of irrigant used on the intake and output record.subtract this from the urinary output when totaled.

Subtracting irrigant total from drainage in urine collection bag provides accurate recording of urine output .

Remove equipment and discard uncapped needle and syringe in appropriate receptacle.wash your hands.make client comfortable.

Handwashing deters the spread of microorganisms.proper disposal of needle prevents the nurse accidentally puncturing self.

10 mins Describe the open system used for irrigating bladder.

Irrigating the catheter using the open system

Articles required 1. Sterile irrigation tray with sterile container and basin 2. Sterile Asepto or Toomey syringe3. Disposable gloves4. Gauze squares or cotton balls with disinfectant or

alcohol swabs5. Sterile irrigating solution(at room temperature or

warmed to body temperature)6. Bath blanket 7. Sterile cover for tip of drainage tubing

Student teacher will explain with help of ppt.

What is open system method?

Steps of procedure

Action Rationale Collect articles ,wash hands &explain the procedure to patient.

Saves time,prevents infection and to get cooperation.

Provide privacy to the client.

Avoid uneccesary exposure

Assist the client to a comfortable position and expose the connection between the catheter and the drainage tubing. Position a waterproof drape

This provide for adequate visualization.the drape protects the client and the bed from leakage .

under the catheter . Open the sterile supplies. Pour sterile solution into the sterile container .remove the tip from the Asepto syringe and aspirate irrigate (30ml)into the syringe .

This prevents the spreads of microorganisms.

Cleanse the catheter junction with a gauze pad and disinfectant or alcohol swab.

This prevents the spread of microorganisms into bladder tissue.

Disconnect the cathter and drainage tube .place the sterile cover over the drainage tip and secure drainage tubing on the bed .hold catheter tubing 2.5cm (1inch) from its open end .

This avoids contaminating the sterile drainage system with microorganisms.

Position the sterile basin beneath the catheter .insert the tip of the Asepto syringe into the catheter and gently irrigate with solution .

Gentle irrigation is less traumatic to the lining of the bladder .

Remove the syringe keeping the bulb

Gravity aids the drainage of urine and irrigant from the

compressed ,and allow drainage to return by gravity flow into the basin ,if there is no return ,gently aspirate the solution from the catheter.continue with irrigation as ordered by the physician.

bladder .irrigation maintains patency of the urinary drainage system .

Reattach the drainage tube to the catheter ,being careful not to contaminate the system .secure with tape or a Velcro leg strap.

This prevents entry of microorganisms .the tape or the Velcro leg strap discourages separation of the catheter and the tubing .

Document the client’s response to the procedure and the quality and amount of drainage on the client’s chart.

This provides accurate documentation of the procedure.

Remove the equipment and make the client comfortable .wash your hands.

Hand washing deters the spread of microorganisms.

10mins Describe continuous bladder irrigation method

Giving continuous bladder irrigation

Articles required1. Sterile irrigating solution (at room temperature or

warmed to body temperature ), usually 2000ml size

Student teacher will describe with the help of ppt.

What are the steps of continuous bladder irrigation?

bags.2. Sterile tubing with drip chamber and clamp for

connection to irrigating solution3. IV pole 4. Three –way Foley catheter in place in client’s bladder 5. Foley’s drainage set-up(tubing and collection bag )6. Bath bag

Steps of procedure

Action Rationale Explain the procedure and its purpose to the client .

An explanation encourages client cooperation and reduces apprehension.

Assemble the equipment . Organization facilities performance of tasks.

Wash your hands. Handwashing deters the spread of microorganisms.

Provide for privacy The procedure may be embarrassing for the client.

Prepare the sterile irrigation bag for use as directed by the manufacturer .secure the clamp and attach the sterile tubing with drip chamber to the container.hang the bag on IV pole 2.5 to 3 feet above the level of the client’s

Irrigation solution continuously bathes the lining of the bladder and keeps the catheter patent .flushing the tubing prior to irrigation clears air from the tubing that might cause bladder distention.

bladder .release the clamp and remove the protective cover on the end of the tubing without contaminating it.allow the solution to flush the tubing and remove air .reclamp.Using sterile technique ,attach the irrigation tubing to the irrigation port of the three- way Foley catheter. If a closed system is used ,tubing may already be connected to the irrigation port on the catheter .

Sterile technique prevents the spread of microorganisms into the bladder .

Release the clamp on the irrigation tubing and regulate the flow according to the physician’s order.

This allow for continual gentle irrigation without causing discomfort to the client .

As irrigation is completed ,clamp the tubing .do not allow the drip chamber to empty .disconnect the empty bag and attach a full irrigation bag.continue as ordered by the physician.

This eliminates the need to separate tubing from the catheter and clear air from the tubing .opening the drainage system provides access for introduction of microorganisms.

Assess the client’s response to the procedure and the quality and amount of drainage .document on the client’s chart .

This provides accurate documentation of the procedure.

Record the amount of irrigant used on the intake and output record.empty the drainage collection bag as each new container is hung and record .

This ensures accurate recording of urine output .

Wash your hands It prevents spread of microorganisms.

Patient’s teaching ;- Explain the need for the patient to drink fluid.- Identify the possible side-effect and explain the need

to report them immediately.

After –care of the client and articles: Make the client comfortable . Clean the other equipment and return it to its usual

place. Wash hands Record treatment on the client’s chart and the nurse’s

record note book with:I. Date and time

II. Purpose of the irrigation III. Name and amount of solutions used

IV. Amount of drainage and colour of drainage from the bladder

V. Type of bladder irrigation done Report any complication to the ward sister and

doctor.

Sample charting/recordingDate time Bladder irrigation performed with 200ml

normal saline at room temperature using 30ml at a time .230ml returned .30ml of

urine recorded on output record .urine return had several small dark red clots.

Flow was slow and constant .client tolerated procedure well.informed

to ward sister. Signature

3mins To enlist the complications of bladder irrigation.

Complication of bladder irrigation Infection Tissue trauma Urethral irritation –presence of catheter may lead to

urinary infection .Muscular spasms-forcing fluid more than what is tolerable by the client will cause musle spasm and pain.

Student teacher will enlist the complications with help of charts.

What are the complications of bladder irrigation ?

9mins Describe the scientific principles involved in bladder

Scientific principles Anatomy & physiology The urinary system consists of two kidneys,two ureters ,the cystic bladder and the urethra.The bladder is hollow muscular organ that serves as a

Student teacher will describe the scientific principles with help of ppt.

What are the scientific principles involved in bladder

irrigation. reservoir for urine and by contraction expels it from the body through the urethra.The bladder is lined with mucous membrane that is continuous into the urethra,the ureters,and the kidneys.The musculature of the bladder is capable of great distention to hold the urine that slowly and constantly accumulates in it.The desire to empty the bladder occurs when about 300ml.the usual daily amount of urine secreted by a normal adult is from 1200ml to 1500ml.The desire to urinate is due to sensory stimulation in the bladder itself caused by the pressure of urine and reflex stimulation.

Microbiology The urinary tract offers a favourable location for the multiplication of germs because it is dark ,moist and warm.The commonest organism causing urinary infections is the colon bacillus .other bacteria responsible for bladder infections are the staphylococci,streptococci, gonococci,the typhoid bacilli and the tubercle bacilli.Bacteria may be introduced into the bladder by an unsterile catheter.

Physics The muscles of the bladder possess a certain amount of tone.As the bladder fills ,the pressure may rise a little.Pascal’s principle states that increases in pressure on any portion of confined liquid is transmitted undiminished to all parts of the liquid .If a large quantity of urine collects

irrigation?

in the bladder,pressure on the adjacent organs may be great enough to cause pain.

Psychology Certain psychic states greatly increases the tonicity of the muscles of the bladder whereby internal pressure and the desire for urination are increased.Excitement and fear may cause frequent urination.These procedure usually cause the patient some embarrassment at having another person concerned over normal activities of his body.The nurse can do much by her attitude of helpfulness to change the patient’s feeling towards these services.

1min Summary

Bladder irrigation is washing out the urinary bladder with sterile irrigating solution ,and it should be performed under sterile condition to prevent introducing micro-organism into the urinary tract.its of 3 type i.e. open and closed method&

continuous method.in open method ,fluid is introduced into urinary bladder and drained out simultaneously.in closed method,there is frequent intermittent or continuous irrigation without disruption of the sterile catheter system.

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