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 clients I&O balance Objectives To remove blood clots from clients bladder To ensure patency of drainage system To relieve bladder spasms

1. Check physicians order for system irrigation and client care plan. 2. 3. 4. 5. 6. Gather equipment Check clients identaband Explain procedure and rationale to client. Wash your hands. 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 clients bladder to check for distention. 3. Open sterile container on bed or on over-bed table. Maintain sterility of inside of the container. Procedures: 3 Types of Bladder Irrigation 4. Don clean gloves 1. Irrigating by Opening a Closed System 5. Place an absorbent pad under connection of tubing and 2. Irrigating a Closed System catheter. Rationale: This will form a working field for 3. Maintaining Continuous Bladder Irrigation irrigating catheter. 6. Pour irrigant into solution container. Expected Outcomes 7. Place catheter tipped syringe in container. Do not Blood clots are removed from clients bladder contaminate syringe tip. Continuous flow of solution is maintained to evacuate 8. Place catch basin on pad to form working field. clots and prevent catheter obstruction (Always keep syringe tip and irrigant uncontaminated). Catheter remains patent and unobstructed by clots or 9. Disconnect catheter from drainage tube. Place sterile sediments protective cap over the end of the drainage tube. Net urine output is determined Rationale: This will prevent contaminating tip of tubing.

3 KINDS OF BLADDER IRRIGATION

1. IRRIGATING BY OPENING A CLOSED SYSTEM Equipment: Clean gloves Catheter tipped syringe/ asepto syringe Irrigating solution Catch basin Sterile bowl/ basin Antiseptic swab Absorbent pad Pain or antispasmodic medication Preparation:

Carefully remove sealing Disconnect catheter from tape to access catheter drainage tubing; cover tubing catheter. 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. Page 1 of 4

Bladder Irrigation

12. Insert irrigating syringe into catheter and attempt to aspirate any obstructing debris, Rationale: If 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 clients bladder with 30-50 ml of irrigant until fluid returns are clear or clots removed. 2. IRRIGATING A CLOSED SYSTEM 15. Remove the protective cap from drainage tube and Equipment wipe it with an antiseptic swab. Irrigation set 16. Wipe end of catheter with an antiseptic sponge, and 30-ml syringe with needleless cannula connect the catheter to the drainage tube. Alcohol or povidone iodine (Betadine) swab 17. Ensure straight line from tubing to drainage bag. Curl Ordered irrigating solution (normal saline) excess tubing loosely on bed and secure tubing to linen. Clamp for drainage tubing 18. Tape catheter to inner thigh for a female and abdomen Clean gloves for male. Prepared pain medication, if ordered Preparation 1. Check physicians order and client care plan. 2. Gather equipment 3. Check clients identaband. Explain procedure and rationale to client. 4. Wash hands 5. 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 clients urinary drainage and record amount.

Instill 30-50 ml of irrigant into catheter using aseptic technique

reconnect catheter to drainage tubing

19. Lower bed and raise side rails. 20. Discard equipment and remove gloves. 21. Make sure client is clean and comfortable. Place call Procedure: light within easy reach. 1. Open sterile container, Maintain sterility on inside of 22. Wash your hands. the container. 23. Measure amount of return. Subtract any irrigation 2. Place absorbent pad under end of catheter to form a solution used to irrigate from the clients I & O record 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 port 7. Attempt to aspirate obstructing clot or debris. Rationale: Irrigation without first attempting removal of debris can force it into bladder, resulting in infection Bladder Irrigation Page 2 of 4

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 gloves 16. Wash your hands. 17. Measure amount of return. Subtract the irrigating solution from the clients 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 physicians order and client care plan. 2. Note if client has triple lumen indwelling catheter and drainage bag. 3. Place label on irrigating bag. Include clients name, date, room number, type of solution, and additives. 4. Check clients 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. Bladder Irrigation

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).

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Critical Thinking Application UNEXPECTED OUTCOMES Irrigation flow is not infusing as prescribed rate

CRITICAL THINKING OPTIONS * 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 physicians orders. * Follow these steps to obtain irrigation solution: 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 clients 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. * Notify physician to obtain an order for urinary antispasmodic * Assist client to change position * Notify physician immediately * Obtain vital signs and continuously monitor * Continue to infuse solution at a rapid rate to flush clients bladder until you obtain physicians orders * Do not allow client to cough * Keep clients cathetertaped leg straight to maintain traction on catheter inflation bulb

Irrigation solution is not returned because of an obstruction in the system

Client experiences excessive bladder spasms. Bright red drainage continues even when solution flow rate is increased.

Bladder Irrigation

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