Bladder irrigation

bladder irrigation means flushing or rinsing out the urinary bladder with a solution.

1. A patient who is a known case of Cerebrovascular Accident (CVA), was brought in the emergency department with complaints of abdominal distention. Patient is unable to talk, has 14Fr urinary foleys catheter and ryles tube in situ. The relative explains the doctor that she has noticed very scanty amount of urine in the urobag since yesterday. She further gives the history that the catheter was changed in the last week. On assessment patient’s vital signs are stable. Patient has bladder distention. What treatment physician is likely to suggest for the patient?

2. BLADDER IRRIGATION BY MISS ADITI SAWANT DESSAI FIRST YEAR MSC NURSING MCON, MAHE MANIPAL

3. Objectives Introduction Definition Purposes Types Articles Preliminary assessment Procedure Nursing responsibility complications

4. Introduction

5. Definition It is washing out of the urinary bladder, by directing a stream of solution into the bladder, through the urinary meatus by means of the catheter.

6. Purposes To ensure patency of the urinary drainage system. To relieve congestion and pain in inflammatory conditions. To promote healing. To mediate the lining of the bladder. To arrest bleeding. To prepare the bladder for surgery as a preoperative measure.

7. To cleanse the bladder from stagnant urine, bacteria, excess mucus, pus and blood clots .

8. “Efficacy of bladder irrigation in preventing urinary tract infections associated with short -term catheterization in comatose patients: A randomized controlled clinical trial ”

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10. Types

11. DOUBLE LUMEN TRIPLE LUMEN

12. Articles required A sterile tray containing: Artery forceps Gallipots or sterile bowl (02) Gauze pieces

13. A clean tray containing Clean gloves Sterile gloves Antiseptic solution

14. Asepto syringe Irrigating solution IV drip set

15. Mackintosh Kidney tray

16. Preliminary assessment

17. Performing intermittent catheter irrigation

18. Adjust the bed to a comfortable working height. Put on gloves. Remove the tape anchoring catheter to the patient’s thigh .

19. Cleanse the access port on the catheter with antimicrobial swab. Clamp or fold the catheter tubing below the access port. Attach the syringe to the access port on the catheter using a twisting motion. Gently instill the solution into the catheter. Check for dwell time. Remove the syringe from the access port. Unclamp or unfold tubing and allow irrigant and urine to flow into the drainage bag.

20. Remove gloves. Secure catheter tubing to the patient’s inner thigh with anchoring device or tape. Assist the patient to the comfortable position. Cover the patient with bed linen. Secure drainage bag below the level of the bladder.

21. Performing a continuos closed bladder irrigation . Clearly label the solution as “bladder irrigation”. Include the date & time on the label. Hang bag on an IV pole 2.5 to 3 feet above the level of the patient’s bladder. Secure the tubing clamp and insert the sterile tubing with drip chamber to the container using aseptic technique.

22. Release the clamp and remove the protective cover on the end of the tubing without contaminating it. Rinse the tubing with fluid. Clamp the tubing and replace end cover. Cleanse the irrigation port on the catheter with an alcohol swab. Using aseptic technique, attach irrigation tubing to the irrigation port of the threeway indwelling catheter.

23. Bladder irrigation solution

24. Citric Acid and Magnesium Carbonate bladder irrigation.

25. Signs and symptoms of high magnesium

26. Valrubicin bladder irrigation solution Valrubicin is a chemotherapy drug. It is used to treat bladder cancer. Side effects Allergic reactions like skin rash Itching or hives Swelling of the face, lips, or tongue blood in the urine Breathing problems fever or chills, sore throat flu-like symptoms.

27. A comparative study on the activity of three antiseptics used as bladder irrigants in the treatment of urinary tract infection in patients with indwelling catheters concluded that phenoxyethanol (2' 4 % v / v) proved to be highly bactericidal against urine-grown cells of all the common urinary pathogens tested.

28. Contact with noxythiolin for periods of at least 1- 2 hrs was necessary before extensive bactericidal activity was detected. These results provide an explanation of the poor clinical performance of noxythiolin that we have observed.

29. “Increasing the volume of bladder irrigations decreases the incidence of bladder calculi formation in enterocystoplasties . ” (A study done by Douglas Husman )

30. NURSING MANAGEMENT

31. Complications Infection Tissue trauma Uretheral irritation Bladder spasm

32. Conclusion Bladder irrigation is a procedure that involves flushing out the urinary bladder with a liquid which helps remove and prevent blood clots in the bladder. Closed bladder irrigation is preferred as it minimises the chances of infection. Bladder irrigation is not a routine procedure. It is done to maintain the patency of catheter and in certain postoperative cases.

33. Bibliography Black, J. M. (2009). Medical Surgical Nursing. India: Elsevier. Citric acid and magnesium carbonate bladder irrigation. (2017, January 19). Retrieved from Clinical key: www.clinicalkey.com Hussman , D. (2007). Increasing the volume of bladder irrigations decreases the incidence of bladder calculi formation in enterocystoplasties . Mayo clinic. Retrieved from www. Jones, M. P. (2017).Genito urinary procedures. USA: Elseveir . K, S. (2015, August 11). Open Prospective study on reduction of bacteriuria following bladder irrigation with chlorhexidine. Retrieved from Clinical key: http://www,clinicalkey.com

34. Lewis. (2004). Medical Surgical Nursing. Canada: Robin Carter. Lynn, T. L. (2015). Fundamentals of Nursing . New Delhi: Wolters Kluwer Pvt Ltd. Perry, P. (2013). Fundamentals of Nursing. New Delhi: Reed Elseveir India Pvt Ltd. Ramezani , F. (2018). Efficacy of bladder irrigation in preventing urinary tract infections associated with short term catheterisation in comatose patients: A randomised control clinical trial. American Journal of Infection Control. RN Adult Medical Surgical Nursing (edition 9th ed.). (2013). Content Mastery Series.

35. Timbey , B. K. (2016). Fundamental Nursing skills & concepts (11th ed.). London: Wolters Kluwer. timby , b. k., & Smith, N. E. (2010). introductory Medical Surgical Nursing (10th edition ed.). London: Wolters Kluwer. Williams, L. S., & Hopper, P. D. (2007). Understanding Medical Surgical Nursing (3rd edition ed.). F.A.Davis company

36. Prepare a list of all the solutions (minimum 5) used in bladder irrigation including the name of the solution, the percentage and the action.

37. Area Marks Neatness 02 Organisation 02 Language 02 Content 02 Refernce 01 Timely submission 01 TOTAL 10