Continuous Bladder Irrigation

Aka: Continuous Bladder Irrigation

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II. Indications

  1. Maintain catheter patency
  2. Clear Urinary Catheter obstruction (e.g. blood clots)
    1. Manual irrigation is often used as first step in clearing clots
    2. Follow manual irrigation with Continuous Bladder Irrigation if Gross Hematuria is still significant

III. Contraindications

  1. Complete catheter obstruction (typically with sediment)
    1. Exchange the Urinary Catheter

IV. Preparation

  1. Normal Saline irrigant (3 Liter bags)
  2. Irrigation tubing set (dual bag)
  3. Large capacity Foley Catheter bag (4 Liter)
  4. Intravenous pole that can support large IV bags
  5. Antiseptic cleaner (e.g. Chlorhexidine, Alcohol)
  6. Personal Protective Equipment (gloves, Eye Protection or Face Mask)
  7. Triple lumen Urinary Catheter (lumens: in, out and balloon)
    1. Use as large of catheter as possible (24 fr or larger)
    2. Three lumens in one catheter results in each lumen having a small caliber
      1. Maximizing the overall catheter size allows for larger lumens to pass clots

V. Technique: Continuous Bladder Irrigation

  1. Preparation
    1. Close all clamps on irrigation tubing
    2. Hang spiked irrigation bags on intravenous pole
    3. Fill drip chamber half-way by squeezing
    4. Prime the tubing by opening the clamps and allowing fluid to fill tubing, then reapply clamps
    5. Apply antiseptic to the inflow port on the triple lumen Urinary Catheter
    6. Remove the plug on the inflow port and attach the irrigation tubing (without any short tubing segments at end)
    7. Connect the large drainage bag, after first applying antiseptic to its attachments
  2. Continuous Irrigation
    1. Open the roller clamp start Bladder infusion
    2. Increase the infusion rate after 15 minutes if Urine Color is dark red, and decrease rate if light pink
    3. Check bag status frequently (several times per hour)
      1. Replace irrigation bags as needed
      2. Empty drainage bags as needed
    4. Inflow infusion rates should be similar to outflow drainage rates
    5. Observe patient frequently for signs of obstruction
      1. Stop continuous infusion, and switch to Manual Bladder Irrigation if obstruction
  3. Completion
    1. Continuous infusion is complete when urine is clear at low flow rates
    2. Place sterile catheter plug in inflow port
    3. Re-attach catheter to drainage system
  4. Troubleshooting
    1. See Urinary Catheter

VI. References

  1. Werner and Long (2023) Continuous Bladder Irrigation, EM:Rap 23(11)

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