Bladder irrigation is a medical procedure used to clean the urinary bladder and prevent complications associated with catheter use. It can be performed manually or continuously, utilizing sterile techniques and specific equipment to ensure patient safety and efficacy. Potential complications include infection, tissue trauma, urethral irritation, and bladder spasms, which caregivers must monitor closely.

1. BLADDER
IRRIGATION
MA. GLENLEE V. MAGBANUA, RM,RN,MAN

2. Definition
Bladder irrigation means to
flush out the urinary bladder
with a liquid.

3. Purpose
◦ To cleans the bladder from decomposed urine, bacteria, excess of mucus, pus
and blood clots.
◦ To maintain the patency of the urinary catheter.
◦ To relieve congestion and pain in case of inflammatory conditions by the
application of heat.
◦ To promote healing.
◦ To prevent the clot formation in case of bladder surgeries.
◦ To prevent and treat infections.
◦ To arrest bleeding.

4. Types
◦Manual bladder irrigation
◦Continuous bladder irrigation

5. Manual BI
◦Manual bladder irrigation is used for cleaning clot
retention
◦Catheter blockage is a very common complication
in long term catheter users.
◦Up to 50% of long term catheters are changed
prematurely due to catheter blockages

6. Signs of a Blocked Catheter
◦No urine flow from the catheter.
◦Patient complaining of suprapubic pain, becoming
more pronounced as the bladder fills.
◦If unrelieved vaso-vagal symptoms may develop i.e.
sweating, tachycardia and hypotension.
◦Bypassing around the catheter

7. Equipments
◦ Dressing pack x1
◦ Catheter tip 50ml syringe x1
◦ Chlorhexidine swabs 70% alcohol
◦ Blue under sheet
◦ Unsterile jug
◦ 500ml bottle Normal Saline
◦ PPE i.e sterile gloves, goggles and apron

8. Procedure
◦ Explain to patient.
◦ Maintain asepsis (this is done as an aseptic procedure to prevent a UTI as
the closed urinary drainage system is being broken)
◦ Place blue sheet under the catheter and drainage bag connection
◦ Prepare sterile setup with 500ml N/S in kidney dish
◦ Place unsterile jug on bottom of trolley
◦ PPE and sterile gloves

9. ◦ Place sterile towel under site where urinary catheter and drainage bag attached
◦ Clean catheter and drainage bag connection with chlorhexidine wipes,
disconnect and wrap the drainage bag end in a chlorhexidine swab and if
possible, give to the patient to hold. If not keep the end wrapped in clean
packaging or gauze
◦ Using 50ml volumes of normal saline, irrigate the catheter by flushing in and
drawing back to evacuate any clot or debris. If resistance is encountered
reasonable pressure can be used, (except following renal transplant or bladder
surgery). Empty each returned syringe directly into the unsterile jug on the bottom
of the trolley

10. ◦ Continue to irrigate with 50ml volumes until you achieve a clear or
clot free return
◦ Reconnect catheter to drainage bag without contaminating either
◦ Calculate the difference between volume infused and volume
returned and record on the fluid balance unit

12. CBI
◦To prevent blood clot formation, allow free flow of
urine and maintain patency, by continuously
irrigating the bladder with Normal Saline
Purpose

13. Articles
◦ 3 way catheter
◦ 0.9% Sodium Chloride irrigation bags as per facility policy
◦ Continuous bladder irrigation set and closed urinary drainage bag
with anti-reflux valve.
◦ Alcohol wipes
◦ Non sterile gloves
◦ Personal protective equipment (PPE)
◦ Under pad
◦ IV pole

14. Procedure
◦Explain procedure to the patient and ensure patient
privacy
◦Position the patient for easy access to the catheter
whilst maintaining patient comfort
◦Ensure that the patient has a three-way urinary
catheter.
◦Hang irrigation flasks on IV pole and prime irrigation set
maintaining asepsis of irrigation set.

15. ◦ Don goggles and impervious gown, place under pad underneath
catheter connection.
◦ Attend hand wash and don non-sterile gloves.
◦ Swab IDC irrigation and catheter ports with alcohol swabs and allow
to dry.
◦ Open the irrigation lumen of the catheter.
◦ Connect the irrigation set to the irrigation lumen of the catheter,
maintaining clean procedure
◦ Ensure urine is draining freely before commencing continuous
irrigation.
◦ Unclamp the irrigation flask that was used to prime the irrigation set
and set the rate of administration by adjusting the roller clamp.

20. Documentation
◦Record in the progress notes
a) Date and time of procedure
b) Indication for the manual irrigation including the
patients' clinical symptoms
c) Result of irrigation ie volume of return, describe
output/clots/debris and also color of urine
d) On the fluid balance chart record volume infused,
volume returned and the difference being urine volume

21. General Instructions
◦Should not be done without written order.
◦As far as possible, bladder irrigation are to be
avoided.
◦The safest and most effective means of irrigating
the urinary system is by "internal irrigation"
◦The fluid should be instilled gently and allowed to
drain back by gravity.

22. ◦If the fluid flows easily into the bladder but fails to
return, there is a clot over the eye of the catheter
◦In such situation no more fluid is introduced into the
bladder but try to dislodge the clot by milking the
tubing.
◦All the articles that are used for the irrigation must
be sterile.

23. Nurses responsibility
➤Before
◦ Check for order
◦ Inform the patient
◦ Arrange articles
◦ Comfortable position
◦ Privacy
◦ Hand washing
◦ Expose only the area

24. Nurses responsibility
➤ During
◦Maintain aseptic technique
◦Follow all the steps
◦Use only recommended solutions
◦Arrange the flow rate for CBI
◦Make sure that the fluid is coming back

25. Complications
Infection:
urinary tract offer a favorable environment for
the multiplication of bacteria because it is dark,
moist & warm. Injury to the mucosa of the bladder
leads to growth of the bacteria in bladder.
Changing the pH value of urine by medication
force of the flow cause injury.

26. Complications
Tissue Trauma:
during the insertion of the catheter &
procedures applied to the bladder, tissue
trauma may take place even the slight
movement of the catheter can cause tissue
trauma & breakdown

27. Complications
Urethral Irritation:
symptoms include burning sensation &
pain at urethral meatus will be experienced
especially by the male pt. due to indwelling
catheter

28. Complications
Bladder Spasm:
bladder spasm may occur due to the
balloon of an indwelling catheter resting
directly on the bladder neck. Forcing fluid
more than what is tolerable by the pt. will
lead to muscle spasm & pain

29. Thank You!