CYSTOCLYSIS

Cystoclysis- Is a type of irrigation in which saline solution is introduced into the bladder.
-It is also called as a continuous bladder irrigation.

PURPOSE OF CYSTOCLYSIS
 To restore or maintain the patency of the bladder.- It prevents the obstruction of the
catheter.
 To relieve bladder spasm. –Draining the urine from the bladder can relieve the
spasm
 To irrigate bladder with medication treat infection or bladder irritation.
 To drain the bladder when acute urinary retention is present.
To perform this procedure, you may need:
 3 way catheter
 9% sodium chloride irrigation bags as per facility policy
 continuous bladder irrigation set and closed urinary drainage bag with anti-reflux
valve
 Chlorhexidane 0.5% with 70% alcohol wipes
 Non sterile gloves
 Personal protective equipment
 Underpad (bluey)
  IV pole
TYPES OF IRRIGATING CYSTOCLYSIS
1. Closed bladder irrigation system
- does not require that the system be opened
- for frequent intermittent irrigations or continuous irrigation without
disrupting the sterile alignment of the catheter and drainage system
through use of a three-way catheter
- can be used to instill medication, encourage hemostasis, flush clots and
debris out of the bladder and catheter.

3 ways catheter
 2. Open Irrigation System
- The bladder is drained using a 60-mL syringe.
- opening of the closed drainage system to instill bladder irrigations
- is used when bladder irrigations are required less frequently and there are
no blood clots or large mucous fragments.

INDICATIONS OF IRRIGATING CYSTOCLYSIS

 Acute Urinary Retention- Patients with acute urinary retention is unable to urinate
because nerve dysfunction, constipation, infection, or medication such as anti-
 cholinergics and anti-depressants causing a bladder spasm. We can use this procedure in
order to drain urine out of the bladder therefore relieving bladder spasm.
 Urinary Tract Infection- We can instill medication into the catheter such as antibiotics
in order to drain it into the urinary tract therefore curing Urinary Tract Infection.
 Prostatic Hematuria- Presence of blood in the urine. Cystoclysis can help preventing
formation of clots.
 Post-surgically after prostatectomy / who have had surgery of the urinary tract –
Patients who undergo surgery in the urinary tract are at risk for formation of clots. The
procedure can help by preventing formation of clots that may cause blockage to the
bladder.

CONTRAINDICATIONS OF IRRIGATING CYSTOCLYSIS

 Hypersensitivity to the solution to be used

 Patients with defects in the bladder mucosa or bladder wall – It can cause further
injury to the bladder wall.

NURSING RESPONSIBILITIES
Prior to the procedure:
1. Check physician’s order for type of irrigation and irrigation solution to use, date,
time room and name of the client
2. Explain the procedure to the client. Make sure that the patient understands it well
and you may need to obtain informed consent.
3. Gather the necessary materials
4. Do medical handwashing and provide privacy to the patient.
5. Open the IV tubing then do priming
6. Assess lower abdomen for bladder distention
7. Position the patient dorsal recumbent or supine

During the process:

 During the procedure aseptic technique must be observed. First you must drape the
patient exposing the leg where the catheter is being taped. Then, do gloving and cleanse the
catheter injection port with an antiseptic swab. Remember to maintain sterility at all times and
make sure that you are only exposing the site.
Swab IDC irrigation and catheter ports with chlorhexidine swabs and allow drying. After
that, remove the spigot from the irrigation lumen of the catheter using sterile gauze and discard
the spigot. Connect the irrigation set to the irrigation lumen of the catheter still observing the
aseptic technique. Then remove the spigot or old drainage bag from the catheter lumen using
sterile gauze and apply catheter drainage bag maintaining clean procedure.
Remember not the start bladder irrigation until the urine of the patient is flowing freely. If
it is, then you must unclamp the irrigation flask that was used to prime the irrigation set and set
the rate of administration by adjusting the roller clamp. Regulate the flow well.
We must ensure that there is adequate supply or irrigants nearby as this procedure may be
done continuously and as necessary depending on the degree of the hematuria. After each flask is
complete, empty urine drainage bag and immediately record urine output on the fluid balance
chart, before you begin with next irrigation flask.
After:
1. After care
2. Do proper documentation
- amount of solution used as irrigant, amount returned as drainage, characteristics
of output, calculation
To prevent infection especially those catheter related UTIs, the nurse must ensure that
regular catheter care is given and must be documented in the nurse’s notes as well as NCPs.
Not only should you note the amount of urine output, but the nurse must note the descriptions
such as urine color and degree of hematuria, as well as patient’s comfort.

GUIDELINES INVOLVED IN IRRIGATING CYSTOCLYSIS

 Determine whether the irrigation will be open or close.
- There are two types of irrigating cystoclysis: the open and close irrigation system. Also a
physician’s order is required to perform this operation. The order should include the type of
 solution to be used, the rate of the irrigation and whether the irrigation should be
continuous or intermittent.
 Set up sterile irrigating supplies, maintaining sterile technique per agency protocol.
- It is important to maintain the sterility of equipments. Insertion and maintenance of (three-
way) foley catheter patency involves a closed drainage system and sterile technique. Sterility
and patency of CBI system is maintained to avoid infection and occlusions.
 Use only clearly labeled or prepared solutions for irrigation.
- In irrigating cystoclysis, irrigant solutions are used like sterile normal saline solution so it is
important to use only clearly labeled or prepared solutions to ensure that the right solutions
are used and to prevent committing errors. Also most of Foley catheter insertion are done
with antibiotic solutions so a doctor’s order is needed.
 Flush tubing prior to irrigation.
- To clear air from the tubing that might cause bladder distention and to know patency of
tubing.
 Check for bladder distention.
- Detects whether catheter is malfunctioning or blocking urinary drainage.
 Cleanse site of entry or end of Y-connector with antiseptic/disinfectant.
- To prevent infection
 Saline solution for infusion should be stored and infused at a room temperature.
- Normal Saline Solutions could be irritating to the delicate tissues inside the urethra and
bladder, especially if there’s already some trauma due to the insertion and presence of the
catheter so whatever solution is used should be warm to the body temperature because cold
solution can cause spasms that are very uncomfortable for the patient.
 Strict input and output is recommended for all patients receiving CBI.
- Special attention to frail elderly and /or history of pelvic floor or bladder radiation. These
patients are at high risk for bladder perforation.
 If an obstruction occurs in the catheter, the irrigation should be shut off, and manual irrigation
should be performed to remove obstruction. When manual irrigant flow freely, the irrigation can
be resumed.
 To determine an accurate output during bladder irrigation, subtract the amount of irrigant used
from the amount of drainage obtained. The difference is the patient’s output of urine and blood.
 Date Bottle # Total Time Rate Time Present Amount Total Actual
Volume hooked of Volume Instilled Urine Urine
Flow Solution Output Output
2/20/09 1 1000 ml 2pm titrated 2pm 1,000 - - -
3pm 900 100 240 140
4pm 750 150 240 90
5pm 550 200 300 100
6pm 450 100 170 70
7pm 350 100 60 -40

References:
Kathleen Hoerth Belland.Clinical Nursing Procedures.
Black et al(2001) Medical – Surgical Nursing.6 th edition.Toronto: W.B. Saunders
Perry, A.Potter, P.(2002) Clinical Nursing Skills and Techniques 5 th edition, St. Loius:Mosby
http://nursingfile.com/nurses-notes/medical-surgical-nursing/cystoclysis.html