Irrigation of medication

Nasal/ear/bladder/ Bowel irrigation

1. Flushing out / washing out the urinary bladder with specific solution. 4/28/2013 www.drjayeshpatidar.blogspot.in 2 Bladder Irrigation

2. To flush clots & debris out of the catheter & bladder. To instill medication to bladder lining To restore patency of the catheter. 4/28/2013 www.drjayeshpatidar.blogspot.in 10

3. Disposable gloves Disposable, water resistant, sterile towel/mackintosh Threeway retention catheter Strile drainage tubing & bag in place Sterile antiseptic swab Sterile receptable Sterile irrigating solution warmed or at room temperature Normal saline Distilled water Solution as prescribe by physician Infusion tubing IV pole Kidney basin 4/28/2013 www.drjayeshpatidar.blogspot.in 11

4. Check physician's order & nursing care plan for type, amount & strength of irrigation fluid & reason for irrigation. Prepare the patient Explain the procedure & purpose to the patient Provide for privacy & drape the patient Empty, measure & record the amount & appearance of urine present in the urine bag 4/28/2013 www.drjayeshpatidar.blogspot.in 12

5. Prepare the equipment Wash hand Connect the irrigation infusion tubing to the irrigating solution & flush the tubing with solution Connect the irrigation tubing to the input port of the 3-way catheter. Connect the drainage bag & tubing to the urinary drainage port if not already in place 4/28/2013 www.drjayeshpatidar.blogspot.in 13

6. Irrigate the bladder a. Continuous irrigation Open the flow clamp on the urinary drainage tubing (if present) Open the regulating clamp on the irrigating tubing & adjust the flow rate as prescribed by the physician or to 40- 60 drops/minute if not specified. Assess the drainage for amount, colour & clarity. 4/28/2013 www.drjayeshpatidar.blogspot.in 14

7. b. Intermittent Irrigation I. Determine whether the solution is to remain in the bladder for a specified time. If solution is to remain in the bladder during a bladder irrigation or instillation close the flow clamp on the urinary drainage tubing. Open the flow clamp on the irrigation tubing, allowing the specified amount of solution (75-100 ml) to infuse & then clamp the tubing After retaining the solution for specific period of time, open the drainage tubing flow clamp & allow the bladder to empty 4/28/2013 www.drjayeshpatidar.blogspot.in 15

8. II. If the solution being instilled is to irrigate the catheter, open the flow clamp on the urinary drainage tubing. Assess the patient condition, urinary output, color, odour & clarity of drainage. Discard all used disposable articles, clean & replace reusable articles. Wash hands Record procedure in nurse’s record. 4/28/2013 www.drjayeshpatidar.blogspot.in 16

9. Colonic Irrigation

10. Defin i ti o n Colonic Irrigation or enteroclysis or bowel wash refers to the treatment of washing out the colon with large quantities of a solution in order to clear the colon of faeces

11. Purposes To clean the colon of faeces , gas , excess mucus , barium etc . To dilute & remove any of the toxic agents that may be present in the large intestine T o k e ep the i n d i v i d u al c l e a n i n fa e c a l i n c o nt i n e n c e a n d to check the diarrhoea To supply heat to the colon or to the pelvic & abdominal organs surrounding the large intestine to (to relieve pain & bring about circulatory changes in these organs )

12. Purposes To reduce temperature in hyperpyrexia & heat stroke To apply medications locally To supply the body with fluid & electrolytes that are absorbed from the intestine As a preparation for diagnostic examinations & certain surgeries to cleanse the bowel

13. Solutions used Plain water Cold water Normal saline Sodium bi-carbonate solution 1 to 2 % Antiseptic solution such as silver nitrate 1 : 5000 ; potassium permanganate solutions 1 : 5000 ; thymol 1 : 100 ; alum 1 : 100 ; boric solution 1 to 2 %

14. Amount of solution used : 2 to 3 liter or till the return flow is clear Temperature of the solution : For cleansing purpose 104 ºF ( 40 º C ) For thermal effect 110 to 115 ºF ( 43.3 to 46 ºC) For reducing temperature 80 to 90 ºF ( 27 to 32 ºC )

15. General Instruction A cleansing enema should be given 1 hour before the colon irrigation is started , so that the rectum will be free of faecal matter The bladder should be emptied before a colonic irrigation to reduce the intra-abdominal pressure The temperature of the solution be kept constant throughout the procedure Do not allow the air to enter into the intestine by : Expelling the air from the tube Not letting the fluid into to run in completely from the tube

16. Make sure that the return flow is not blocked Stop the procedure temporarily if the client complaints of pain Use a smooth & flexible rectal tube & lubricate it well to prevent damage to the rectal mucosa Listen to the complaints of the client should not ignore any discomfort however small they may be Stop the treatment if the client shows the signs of fatigue & collapse

17. Allow only 200 to 300 ml of fluid to run into the rectum at a time Then it should be drained out completely before introducing the fluid 2 nd time Regulate the flow of fluid . Do not have the ingoing tube higher than 45 to 60 cm above the bed level & do not have the outgoing tube more than 30 cm below the bed

18. By using funnel & catheter

19. Thank you… 