Bladder Irrigation Procedure-1.docx

PROCEDURE ON BLADDER IRRIGATION

SUBMITTED TO: Mr. EKE Lama Tamang HOD Med Surg Nursing SUBMITTED BY: Sneha Sehrawat MSc Nursing Rufaida College of Nursing

DEFINITION Bladder irrigation can be defined as a process of flushing out or washing out the urinary bladder. OR Bladder irrigation is a technique used to flush blood clots or debris from the bladder by pushing water solution into the bladder and immediately draining.

PURPOSE  To cleanse the bladder from decomposed urine, bacteria, excess mucous, pus and blood clots.  To relieve congestion and pain in the case of inflammation.  To promote healing.  To prevent clot formation in case of bladder surgeries.  To flush out clots & debris out f bladder.  To instill medication to bladder lining.  To restore patency of the catheter.  To prevent or treat infection.  To arrest bleeding

EXPECTED OUTCOMES •The urinary catheter remains patent and urine is able to drain freely via the indwelling catheter (IDC) •The patients comfort is maintained •Clot formation within the bladder or IDC is prevented or minimised •The patient’s risk of Urinary Tract Infection is minimised, through use of aseptic technique when connecting bladder irrigation to IDC

EQUIPMENT FOR WARD BASED CONTINUOUS BLADDER IRRIGATION

•3way catheter •0.9% sodium Chloride irrigation bags as per facility policy •Continuous bladder irrigation set and closed urinary drainage bag with antireflux valve. •Alcohol wipes •Non sterile gloves •Personal protective equipment.

METHODS

1. OPEN METHOD Open irrigation means that the closed drainage system must be opened to the environment in order to do the bladder irrigation. Every time the catheter is disconnected from the drainage tubing to do the procedure, there is a great risk of introducing bacterial contamination into the urinary bladder. There are also increased chances of introducing air.

2. CLOSE METHOD To avoid the hazard of bacterial contamination present in the open system of bladder irrigation, the closed system of bladder irrigation is practiced at present. Closed system of irrigation is the continuous system of irrigation or an intermittent irrigation.

GENERAL INSTRUCTIONS  The bladder irrigation not to be done without a specific order. As far as possible the bladder irrigation are to be avoided for the fear of introducing infection and trauma to the urinary system.  Patient’s with indwelling catheters should be kept separate because there is a great risk of microbial transmission between catheterized patients.  Vigorous irrigation or introducing fluids with great force will destroy the mucus lining of the bladder.  Practice strict aseptic techniques. All the articles that are used for the irrigation must be sterile and great care must be taken to prevent introduction of infection into the bladder.  Wash hands before and after the procedure.  Maintain an accurate record of the amount of fluid used for irrigation and the total amount of urinary drainage. Irrigation is carried out until the return flow is clear. The color of the drainage should be checked and recorded.

ARTICLES

a) Disposable gloves b) Mackintosh c) Three way retention catheter d) Sterile drainage tubing and bag in place e) Sterile antiseptic swab f) Sterile receptacle g) Sterile irrigation solution warmed or at room temperature. h) Normal saline i) Distilled water j) Solution as prescribed by physician k) Infusion tubing l) IV Stand m) Kidney tray n) Paper bag

PROCEDURE

1) Check the physicians order for amount and strength of irrigating fluid and reason for irrigation.

2) Preparatory phase : a) Explain the procedure and purpose to the client to reduce anxiety. b) Provide privacy and drape the client. c) Empty, measure and record the amount and appearance of urine present in the urinary bag.

3) Prepare the equipments: a) Wash hands to reduce transmission of microorganism. b) Connect the irrigation infusion tubing to the irrigating solution and flush the tubing with solution to remove air. c) Connect the irrigation tubing to the input port of the 3-way catheter. Connect the drainage bag and tubing to the urinary drainage port if not already in place.

4) Irrigate bladder a) Intermittent irrigation  Instill the prescribed amount of irrigant. If specific amount is not ordered, fill up to 150ml of irrigant.  Clamp the irrigant tubing to prevent further filling of irrigant.

 If physician has ordered the irrigant to remain in the bladder for a measured length of time, clamp the drainage tube and wait for the prescribed length of time.  Open the drainage tube (the clamp) and monitor the drainage bag. b) Continuous bladder irrigation  Adjust the clamp on the irrigation tube to allow the prescribed rate of irrigation to flow into the catheter and bladder.  Monitor the color, clarity, debris and volume as it flows back into the drainage bag.

5) Tape the catheter securely on the thigh to prevent catheter from dislodging. 6) Assess the patient’s condition and tolerance of procedure.

7) Discard all used disposable articles, clean and replace reusable articles.

8) Wash hands to prevent cross infection.

Record the procedure.

NURSING CARE OF A PATIENT

Maintaining the patency of the catheter: a) Frequent checking of the urinary drainage. b) Secure the catheter safely to prevent accidental dislodgement. c) See that the patient is not lying over the catheter or tubing to obstruct the urinary flow. d) The catheter should never be left even for the short period because it may lead to retention. Prevention of infection a) Practice strict aseptic techniques. Everything that touches the urinary tract should be sterile namely the fluids, catheter, tubing’s and other equipments. b) Practice thorough hand washing before and after the procedure. c) Cleaning the catheter that is lying outside the urethra reduces the chances of urinary tract infection. d) Increase the fluid intake. e) Every patient and his relatives should be taught about the catheter care. Maintain the comfort and safety of patient a) Teach the client how to move in bed with catheters in place. b) Instruct the patient to take plenty of fluids. c) Use restraints for those patients who are irrational and are continuously pulling out the catheter. d) Proper fixation of the catheter may be added to the comfort of the patient.

Restoring the normal bladder functions When the bladder is continuously drained with an indwelling catheter, the bladder becomes increasing flaccid, it loses its tone. It gives rise to retention of urine on removal of catheter. One way to avoid this is establishing a bladder training program. The catheter is clamped for increasing lengths of time and then released at specific specified intervals to allow the drainage of urine. By this way the bladder is alternatively stretched and allowed to be empty thus restoring its normal function.

COMPLICATION RELATED TO BLADDER IRRIGATION:

 Clot formation  The catheter becomes blocked requiring Manual bladder irrigation or catheter replacement  The patient experiences discomfort as a result of urinary retention secondary to catheter blockage and if urinary retention is not resolved quickly, the patient may become diaphrenic, tachycardic, hypotensive and experience vaso-vagal episodes.  The patient develops urinary tract infection as a result of technique during the procedure.