II. Definitions

  1. Bladder Irrigation
    1. Infusion of fluid into Bladder typically to clear obstruction

III. 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

IV. Contraindications

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

V. Preparation

  1. Normal Saline irrigant (500 ml bottles)
  2. Antiseptic cleaner (e.g. Chlorhexidine, Alcohol)
  3. Large syringe (e.g. 60 ml)
  4. Sterile bowl for irrigation fluid
  5. Disposable absorbant underpads (e.g. Chucks Pads) placed under patient and tubing
  6. Disposal container for removed irrigation fluid
  7. Personal Protective Equipment (gloves, Eye Protection or Face Mask)
  8. Sterile catheter plug

VI. Technique: Manual Irrigation

  1. Preparation
    1. Detach the attachment seal and securement device from the catheter
    2. Apply sterile gloves
    3. Clean the catheter attachment site and surrounding tubing with antiseptic (e.g. Chlorhexidine)
    4. Disconnect the foley bag from the catheter and pinch off the catheter tube end to prevent leakage
    5. Apply the sterile catheter plug to the drainage tubing
  2. Irrigate
    1. Draw up saline into large syringe (e.g. 60 ml) and inject into catheter port
      1. Use drainage port if using a triple lumen catheter
    2. Aspirate and dispose of infused fluid
      1. Consider bedside Bladder Ultrasound (POCUS) if instillation or aspiration is difficult
        1. Demonstrates catheter balloon position, amount of retained urine and echogenic blood or sediment
      2. If fluid cannot be aspirated after instilling easily, catheter balloon may be lodged in Bladder neck
        1. Apply antiseptic to catheter at Urethra, deflate catheter balloon, advance catheter a few inches, re-inflate
        2. Re-attempt fluid aspiration after catheter repositioning
    3. May use push-pull with syringe in cycles to break up clot within Bladder
    4. Repeat cycles of irrigation and aspiration until the fluid is clear and flows easily out drainage port
      1. Continue for additional 1000 ml
  3. Completion
    1. Re-attach catheter to drainage system
    2. Consider following with Continuous Bladder Irrigation if persistent Gross Hematuria
  4. Troubleshooting
    1. See Urinary Catheter

VII. References

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

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