Bladder irrigation

foundation procedure

1. BLADDER IRRIGATION Mr. Melvin Jacob MSc (N)

2. Definition Bladder irrigation means to flush out the urinary bladder with a liquid

3. Purpose To cleans the bladder from decomposed urine, bacteria, excess of mucus, pus and blood clots. To maintain the patency of the urinary catheter. To relieve congestion and pain in case of inflammatory conditions by the application of heat. cont ….

4. To promote healing. To prevent the clot formation in case of bladder surgeries. To prevent and treat infections. To arrest bleeding

5. Types Manual bladder irrigation Continuous bladder irrigation

6. Manual BI Manual bladder irrigation is used for clearing clot retention Catheter blockage is a very common complication in long term catheter users. Up to 50% of long term catheters are changed prematurely due to catheter blockages

7. Signs of a blocked catheter No urine flow from the catheter Patient complaining of suprapubic pain, becoming more pronounced as the bladder fills If unrelieved vaso-vagal symptoms may develop ie sweating ,tachycardia and hypotension Bypassing around the catheter

8. Equipments Dressing pack x1 Catheter tip 50ml syringe x1 Chlorhexidine swabs 70% alcohol Blue under sheet Unsterile jug 500ml bottle Normal Saline PPE ie sterile gloves, goggles and apron

9. Procedure Explain to patient Maintain asepsis (this is done as an aseptic procedure to prevent a UTI as the closed urinary drainage system is being broken) Place blue sheet under the catheter and drainage bag connection Prepare sterile setup with 500ml N/S in kidney dish Place unsterile jug on bottom of trolley PPE and sterile gloves cont….

10. Place sterile towel under site where urinary catheter and drainage bag attached Clean catheter and drainage bag connection with chlorhexidine wipes, disconnect and wrap the drainage bag end in a chlorhexidine swab and if possible give to the patient to hold. If not keep the end wrapped in clean packaging or gauze cont….

11. Using 50ml volumes of normal saline, irrigate the catheter by flushing in and drawing back to evacuate any clot or debris. If resistance is encountered reasonable pressure can be used, (except following renal transplant or bladder surgery). Empty each returned syringe directly into the unsterile jug on the bottom of the trolley Cont….

12. Continue to irrigate with 50ml volumes until you achieve a clear or clot free return Reconnect catheter to drainage bag without contaminating either Calculate the difference between volume infused and volume returned and record on the fluid balance chart.

13. CBI PURPOSE To prevent blood clot formation, allow free flow of urine and maintain patency, by continuously irrigating the bladder with Normal Saline

14. Articles 3way catheter 0.9% sodium Chloride irrigation bags as per facility policy Continuous bladder irrigation set and closed urinary drainage bag with anti-reflux valve. Alcohol wipes Non sterile gloves Personal protective equipment (PPE) Under pad IV pole

15. Procedure Explain procedure to the patient and ensure patient privacy Position the patient for easy access to the catheter whilst maintaining patient comfort Ensure that the patient has a three-way urinary catheter. Hang irrigation flasks on IV pole and prime irrigation set maintaining asepsis of irrigation set. Cont….

16. Don goggles and impervious gown , place under pad underneath catheter connection Attend hand wash and don non-sterile gloves Swab IDC irrigation and catheter ports with alcohol swabs and allow to dry Open the irrigation lumen of the catheter Cont…..

17. Connect the irrigation set to the irrigation lumen of the catheter, maintaining clean procedure Ensure urine is draining freely before commencing continuous irrigation. Unclamp the irrigation flask that was used to prime the irrigation set and set the rate of administration by adjusting the roller clamp. Cont…..

18. Documentation Record in the progress notes a) Date and time of procedure b) Indication for the manual irrigation including the patients clinical symptoms c) Result of irrigation ie volume of return, describe output/clots/debris and also colour of urine d) On the fluid balance chart record volume infused, volume returned and the difference being urine volume

19. General instructions Should not be done without written order. As far as possible, bladder irrigation are to be avoided . The safest and most effective means of irrigating the urinary system is by “internal irrigation” The fluid should be instilled gently and allowed to drain back by gravity . Cont ….

20. If the fluid flows easily into the bladder but fails to return , there is a clot over the eye of the catheter In such situation no more fluid is introduced into the bladder but try to dislodge the clot by milking the tubing . All the articles that are used for the irrigation must be sterile. Cont …..

21. Nurses responsibility Before Check for order Inform the patient Arrange articles Comfortable position Privacy Hand washing Expose only the area

22. During Maintain aseptic technique Follow all the steps Use only recommended solutions Arrange the flow rate for CBI Make sure that the fluid is coming back

23. After Clean the area Replace the articles Regular catheter care should be given to CBI pt. Watch for any contraindications Record and report the procedure

24. Complications Infection : urinary tract offer a favourable environment for the multiplication of bacteria because it is dark, moist & warm . Injury to the mucosa of the bladder leads to growth of the bacteria in bladder. Changing the pH value of urine by medication .force of the flow cause injury . Cont…

25. Tissue trauma : during the insertion of the catheter & procedures applied to the bladder , tissue trauma may take place .even the slight movement of the catheter can cause tissue trauma & breakdown. cont……

26. Urethral irritation : symptoms include burning sensation & pain at urethral meatus will be experienced especially by the male pt. due to indwelling catheter cont….

27. Bladder spasm : bladder spasm may occur due to the balloon of an indwelling catheter resting directly on the bladder neck . Forcing fluid more than what is tolerable by the pt. will lead to muscle spasm & pain

28. Thank you