A patient with a history of stroke was brought to the emergency department with abdominal distention. The patient has a urinary catheter that is producing very little urine. On examination, the patient's vital signs were stable but the bladder was distended. The physician is likely to suggest bladder irrigation to relieve the distention and ensure the urinary drainage system remains clear.

2. A patient who is a known case of Cerebrovascular Accident (CVA), was brought
in the emergency department with complaints of abdominal distention. Patient is
unable to talk, has 14Fr urinary foleys catheter and ryles tube in situ. The relative
explains the doctor that she has noticed very scanty amount of urine in the urobag
since yesterday. She further gives the history that the catheter was changed in the
last week.
On assessment patient’s vital signs are stable. Patient has bladder distention.
What treatment physician is likely to suggest for the patient?

3. BLADDER
IRRIGATION
BY
MISS ADITI SAWANT DESSAI
FIRST YEAR MSC NURSING
MCON, MAHE
MANIPAL

4. Objectives
Introduction
Definition
Purposes
Types
Articles
Preliminary assessment
Procedure
Nursing responsibility
complications

5. Introduction
The flushing of a tube, canal, or area with solution is called
irrigation.
A bladder irrigation rinses out the bladder and can also instil
medication that acts directly on the bladder wall.
Continuous or frequent irrigations may be ordered when a
blood clot or other debris threatens to block the catheter.

6. Definition
It is washing out of the urinary bladder, by
directing a stream of solution into the bladder,
through the urinary meatus by means of the
catheter.

7. Purposes
To ensure patency of the urinary drainage system.
To relieve congestion and pain in inflammatory conditions.
To promote healing.
To mediate the lining of the bladder.
To arrest bleeding.
To prepare the bladder for surgery as a preoperative measure.

8. To cleanse the bladder from stagnant urine, bacteria,
excess mucus, pus and blood clots.

9. “Efficacy of bladder irrigation in
preventing urinary tract infections
associated with short -term
catheterization in comatose
patients: A randomized controlled
clinical trial ”

10. /
Overall, the trial’s findings suggest that bladder irrigation was successful in
preventing CAUTI in short -term catheterization of critically ill, comatose
patients.
The irrigation protocol consisted of holding 50 - 60 cc povidone -iodine
solution in the bladder for 10 -13 minutes, done on every alternate day, which
was found to be highly effective in reducing the incidence of bacteriuria.
Significant improvements were also observed in patients who received
bladder irrigation, using 450 cc NS, once a day, over a 3 -day period.

11. Significant improvements were also found for 3
secondary outcomes; specifically urine appearance,
urinary RBC and WBC deposits, and erythrocyte
sedimentation rates.
The findings supported the benefits of bladder
irrigation in preventing recurrent UTIs and in
reducing the incidence of calculi formation.
Bladder irrigation with NS, done once a day, could be
considered a promising, easy to implement, and cost-
effective intervention for preventing CAUTI in
critical care settings.

12. Types
OPEN METHOD CLOSED METHOD

14. DOUBLE LUMEN TRIPLE LUMEN

16. Intermittent
bladder irrigation
Continuos bladder
irrigation

17. Articles required
A sterile tray containing:
Artery forceps
Gallipots or sterile bowl (02)
Gauze pieces

18. A clean tray containing
Clean gloves
Sterile gloves
Antiseptic solution

19. Asepto syringe
Irrigating solution
IV drip set

20. Mackintosh Kidney tray

21. Preliminary assessment
Assess functioning of
the catheter drainage
system.
Type of catheter in
place.
Length of
time/duration of
catheter.
Colour and
consistency of urine
in tubing and
drainage bag.
Assess for bladder
distention.

22. Performing intermittent catheter
irrigation
Confirm the order
for catheter
irrigation.
Gather equipment.
Perform hand
hygiene and put
on PPE, if
indicated.
Identify the
patient.
Provide privacy.
Explain the
procedure to the
patient.

23. Adjust the bed to a comfortable working height.
Put on gloves.
Remove the tape anchoring catheter to the
patient’s thigh.

27. Open supplies, using aseptic technique.
Open
Pour the sterile solution into the sterile basin.
Pour
Put on gloves.
Put on

32. Cleanse the access port on the catheter with
antimicrobial swab.
Clamp or fold the catheter tubing below the access
port.
Attach the syringe to the access port on the catheter
using a twisting motion.
Gently instill the solution into the catheter.
Check for dwell time.
Remove the syringe from the access port.
Unclamp or unfold tubing and allow irrigant and
urine to flow into the drainage bag.

33. Remove gloves.
Secure catheter tubing to the patient’s inner thigh
with anchoring device or tape.
Assist the patient to the comfortable position.
Cover the patient with bed linen.
Secure drainage bag below the level of the
bladder.

34. Remove equipment and discard syringe in
appropriate receptacle.
Remove
Remove gloves and additional PPE, if used.
Remove
Perform hand hygiene.
Perform
Document baseline assessment of the patient.
Document

35. Document the amount and type of irrigation solution used and the
amount and characteristics of drainage returned after the procedure.
Urine output = total amount of fluid in the urobag - the irrigant amount.

36. Performing a continuos closed
bladder irrigation.
Clearly label the solution as “bladder irrigation”.
Include the date & time on the label.
Hang bag on an IV pole 2.5 to 3 feet above the level
of the patient’s bladder.
Secure the tubing clamp and insert the sterile tubing
with drip chamber to the container using aseptic
technique.

38. Release the clamp and remove the protective
cover on the end of the tubing without
contaminating it.
Rinse the tubing with fluid.
Clamp the tubing and replace end cover.
Cleanse the irrigation port on the catheter with an
alcohol swab.
Using aseptic technique, attach irrigation tubing
to the irrigation port of the threeway indwelling
catheter.

39. Release the clamp on the irrigation tubing.
Regulate the flow at the determined drip rate.
As irrigation fluid container nears empty,
clamp the administration tubing.
Do not allow the drip chamber to empty.
Disconnect the empty bag and attach a new
full irrigation solution bag.

40. Bladder
irrigation
solution

41. Citric Acid
and
Magnesium
Carbonate
bladder
irrigation.
It is used to treat some types of bladder
stones by making the urine more acidic.
This medicine may also be used to keep
urinary catheter lines free from blockages.
Side effects: allergic reactions like skin rash,
itching or hives, swelling of the face, lips, or
tongue.

42. Signs and symptoms of high magnesium
Nausea Confusion
Shortness of
breath
Weakness or
tired
Dizziness
Loss of muscle
reflexes

43. Valrubicin
bladder
irrigation
solution
Valrubicin is a chemotherapy drug.
It is used to treat bladder cancer.
Side effects
Allergic reactions like skin rash
Itching or hives
Swelling of the face, lips, or tongue blood
in the urine
Breathing problems fever or chills, sore
throat flu-like symptoms.

44. A comparative study on the activity of
three antiseptics used as bladder irrigants
in the treatment of urinary tract infection
in patients with indwelling catheters
concluded that phenoxyethanol (2' 4 %
v / v) proved to be highly bactericidal
against urine-grown cells of all the
common urinary pathogens tested.

45. Chlorhexidine (200 p.g/ml) was active against
Escherichia coli and produced significant
reductions in the viability of Klebsiella
pneumoniae, Proteus mirabilis and
Pseudomonas aeruginosa but failed to
eradicate Providencia stuartii.
Exposure to noxythiolin (2'5% v/v) for 20
min had little effect on any of the bacteria,
even though all strains tested had been
recorded as noxythiolin-sensitive by
conventional plate sensitivity tests.

46. Contact with noxythiolin for periods of at
least 1- 2 hrs was necessary before
extensive bactericidal activity was detected.
These results provide an explanation of
the poor clinical performance of
noxythiolin that we have observed.

47. “Increasing the volume of bladder
irrigations decreases the incidence of
bladder calculi formation in
enterocystoplasties. ”
(A study done by Douglas Husman)

48. This study was performed to determine if altering the volume of daily bladder
irrigations could affect the incidence of calculi formation as during long term follow -
up of patients with enterocystoplasties up to 45% developed a bladder calculus.
All patients within this study had an enteric cystoplasty in situ and were catheterizing
via an abdominal stoma with a 12e14 French catheter.
At initiation of the study the patients were noted to be stone free by radiographic
evaluations. Patients were randomly chosen to irrigate daily with 30, 60 or 250 cc of
normal saline.

49. All patients were followed via radiologic evaluations
at a minimum of yearly intervals.
A minimum follow -up of 5 yrs was necessary to be
included within the study.
The study concluded that daily bladder irrigation with
250 cc of normal saline can significantly decrease the
incidence of bladder calculi formation in
enterocystoplasties .

50. NURSING
MANAGEMENT

51. Complications
Infection
Tissue trauma
Uretheral irritation
Bladder spasm

52. Conclusion
Bladder irrigation is a procedure that involves
flushing out the urinary bladder with a liquid
which helps remove and prevent blood clots in the
bladder. Closed bladder irrigation is preferred as it
minimises the chances of infection. Bladder
irrigation is not a routine procedure. It is done to
maintain the patency of catheter and in certain
postoperative cases.

54. Bibliography
Black, J. M. (2009). Medical Surgical Nursing. India: Elsevier.
Citric acid and magnesium carbonate bladder irrigation. (2017, January 19). Retrieved from
Clinical key: www.clinicalkey.com
Hussman, D. (2007). Increasing the volume of bladder irrigations decreases the incidence of
bladder calculi formation in enterocystoplasties. Mayo clinic. Retrieved from www.
Jones, M. P. (2017).Genito urinary procedures. USA: Elseveir.
K, S. (2015, August 11). Open Prospective study on reduction of bacteriuria following bladder
irrigation with chlorhexidine. Retrieved from Clinical key: http://www,clinicalkey.com

55. Lewis. (2004). Medical Surgical Nursing. Canada: Robin Carter.
Lynn, T. L. (2015). Fundamentals of Nursing . New Delhi: Wolters Kluwer Pvt Ltd.
Perry, P. (2013). Fundamentals of Nursing. New Delhi: Reed Elseveir India Pvt Ltd.
Ramezani, F. (2018). Efficacy of bladder irrigation in preventing urinary tract infections
associated with short term catheterisation in comatose patients: A randomised control clinical
trial. American Journal of Infection Control.
RN Adult Medical Surgical Nursing (edition 9th ed.). (2013). Content Mastery Series.

56. Timbey, B. K. (2016). Fundamental Nursing skills & concepts (11th ed.). London: Wolters
Kluwer.
timby, b. k., & Smith, N. E. (2010). introductory Medical Surgical Nursing (10th edition ed.).
London: Wolters Kluwer.
Williams, L. S., & Hopper, P. D. (2007). Understanding Medical Surgical Nursing (3rd edition ed.).
F.A.Davis company

57. Prepare a list of all the
solutions (minimum 5) used in
bladder irrigation including the
name of the solution, the
percentage and the action.

58. Area Marks
Neatness 02
Organisation 02
Language 02
Content 02
Refernce 01
Timely submission 01
TOTAL 10