Urology – Catheter Insertion and Management, Bladder Irrigation, Nephrectomy and Trans Urethral Prostatectomy (turp)
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- 10.2 Manual Bladder Irrigation
Section 10 – Bladder Irrigation10.1 Continuous Bladder IrrigationContinuous Bladder Irrigation (CBI) is the continuous flushing and draining of the bladder designed to prevent the formation and retention of blood clots following transurethral resection of the prostate or where blood clot retention of the bladder occurs To instil continuous bladder irrigation via a three-way IDC for the purpose of: Providing bladder washout to remove any residual urine and/or bladder sediment to ensure IDC patency Removing blood clots that may develop post bladder, kidney or prostate surgery Ensuring debris removal from an infected or diseased bladder Introducing medicated irrigation to soothe an irritated bladder so as to promote healing, and/ or to treat disease
Dressing Trolley Sterile dish x two Plain stickers to label consecutive irrigation bags Foleys Statlock Device-Not for Dr Chan’s patients Jugs x two 50ml Bladder Syringes x two Y-type CBI tubing (closed system where available) Three-way indwelling catheter Gloves: two pairs x sterile, one box clean gloves 500ml bottle of 0.9% Sodium Chloride (at room temperature) 2000mls 0.9% Sodium Chloride irrigation fluid bags x four or five bags (at room temperature) Procedure under pads (small and large) e.g. Smart Barrier Touch Dry absorbent pad Safety goggles or shield and gown Portable, adjustable IV pole Cytotoxic Spill Kit where EPIRUBICIN or where patient is receiving Cytotoxic treatment Cytotoxic Bin where Cytotoxic precautions are required
Check patients clinical record for any medical orders Maintain privacy and explain the procedure to the patient Place patient supine and ensure comfort and dignity Where Chemotherapy precautions are actioned, don non-permeable gown, and gloves. Please refer to Chemotherapy Care of the Adult Patient eviQ Clinical Procedure Don safety goggles or eye shield and gown Place procedure under pad beneath patient Place small procedure under pad across patients thighs to prevent fluid leaks whilst connecting the irrigation fluid Commence irrigation and maintain a steady flow rate
Label and number each bag when commencing Maintain strict Bladder Irrigation Chart and Urine Output records. Prior to commencing next irrigation fluid bag, completely empty the current IV irrigation fluid bag into the urinary drainage bag so as to calculate and record the urine output. Empty the urinary drainage bag. Subtract two litre irrigation fluids from amount of fluid in the urinary drainage bag to calculate urine output Do not rest urinary drainage bag on the floor at any time Record the number of irrigation bags used and urine output on the bladder irrigation chart and urine output on fluid balance chart at each bag change Ensure that the patient’s fluid input and urine output is measured and documented accurately Adjust the Patient Accountability and Care Plan to indicate Bladder Irrigation Monitor the patient with fourth hourly general observations by nursing staff whilst the indwelling catheter is insitu for signs of sepsis Regular and frequent Perineal toilets must attended whilst indwelling catheter is in situ- the frequency of which will be documented in the Patient Accountability and Care Plan In the event of a genitourinary tract infection, infection control will collate and present data for reporting purposes
Removing blood clots or blockage that may develop to maintain patency of an IDC Equipment: Dressing Trolley Sterile dish x two Jugs x two 50ml Bladder Syringes x two Gloves: two pairs of sterile, one box clean gloves 500ml bottle of 0.9% Sodium Chloride (at room temperature) Procedure under pads (small and large) e.g. Kylie Where Chemotherapy precautions are actioned, don appropriate PPE Safety glasses, goggles or shield General waste receptacle Clinical waste receptacle Procedure: Maintain privacy and explain the procedure to the patient Provide adequate and appropriate analgesia Place patient supine and ensure comfort Where Chemotherapy precautions are actioned, don appropriate PPE Don personal protective equipment (PPE) includes safety goggles or shield and gown Place procedure under pad beneath patient Place small procedure under pad across patients thighs to prevent fluid leaks whilst connecting the irrigation fluid Prepare Sterile dish with approx 200mls 0.9% Sodium Chloride or open 500ml bottle of 0.9% Sodium Chloride Have jug ready at the IDC site Open syringe Turn off irrigation Disconnect tubing from Statlock device if present Attend hand hygiene by either washing or using ABHR and don sterile gloves Using aseptic technique, detach the drainage bag from the IDC and attach syringe filled with 0.9% Sodium Chloride and flush into bladder Apply suction to the IDC to clear clots from the IDC Disconnect syringe and fill with a further 40mls of 0.9% Sodium Chloride, reconnect to IDC and flush bladder Continue this procedure until return is clear and free of clots and/ or debris Where closed system is in use, do not disconnect indwelling catheter to manually irrigate Clamp the tubing below the bulb Firmly squeeze the bulb to commence manual irrigation Repeat process until clear urine is flowing at a steady rate If no urine return after manually irrigating IDC, contact medical officer Repeat the above steps until urine is flowing at a steady rate Reconnect the IDC to the drainage bag and reset the irrigation fluid Secure tubing with appropriately placed Statlock device (Attachment A) to prevent movement and urethral traction unless contraindicated (as per Dr Chan’s orders) Attend Perineal toilet-The patient will have regular and frequent Perineal toilets attended whilst indwelling catheter is in situ, the frequency of which will be documented in the Nursing Care Plan Discard equipment Where Chemotherapy precautions are actioned, dispose of urinary output directly into the Cytotoxic bin Leave the patient comfortable with call bell within reach Document in patients clinical record: The patient's response to the procedure The urine output on the Bladder Irrigation Chart & fluid balance chart The amount, size and frequency of irrigated clot The patient's indwelling catheter is patent with no complication during and following irrigation The urinary drainage system is maintained as a sterile drainage system The patient's indwelling catheter is irrigated as prescribed by the medical officer according to the patient's clinical management needs with minimal discomfort and no complications Intake and output are balanced The patient is to be monitored with fourth hourly general observations by nursing staff whilst the indwelling catheter is insitu for signs of sepsis The patient is to be monitored for signs of suprapubic distension or discomfort indicating fluid retention The patient’s fluid input and urine output is measured and documented accurately Adjust the Patient Accountability and Care Plan to indicate Bladder Irrigation In the event of a genitourinary tract infection, infection control will collate and present data for reporting purposes
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