BLADDER IRRIGATION
2. Gather equipment
Definition: continuous washing out of the bladder with
sterile fluid
Assessment
 Determine rationale for irrigation. – To test and
maintain the patency of the retention catheter
 Note rate of urine flow from bladder, color of urine,
presence of clots or debris.
 Assess for distended bladder.
 Assess for bladder discomfort
 Note client’s I&O balance
Objectives
 To remove blood clots from client’s bladder
 To ensure patency of drainage system
 To relieve bladder spasms
Procedures: 3 Types of Bladder Irrigation
1. Irrigating by Opening a Closed System
2. Irrigating a Closed System
3. Maintaining Continuous Bladder Irrigation
Expected Outcomes
 Blood clots are removed from client’s bladder
 Continuous flow of solution is maintained to evacuate
clots and prevent catheter obstruction
 Catheter remains patent and unobstructed by clots or
sediments
 Net urine output is determined
3 KINDS OF BLADDER IRRIGATION
1. IRRIGATING BY OPENING A
CLOSED SYSTEM
Equipment:
Clean gloves
Catheter tipped syringe/ asepto syringe
Irrigating solution
Catch basin
Sterile bowl/ basin
Antiseptic swab
Absorbent pad
Pain or antispasmodic medication
Preparation:
1. Check physician’s order for system irrigation and
client care plan.
Bladder Irrigation
3. Check client’s identaband
4. Explain procedure and rationale to client.
5. Wash your hands.
6. Premedicate client as indicated. Rationale: Manual
irrigation causes painful bladder spasms.
7. Provide privacy, and place client in a comfortable
position. The dorsal-recumbent position is most
convenient if client can tolerate this position. Raise
bed, and lower side rails if needed.
Procedure:
1. Fanfold linen to expose catheter.
2. Palpate client’s bladder to check for distention.
3. Open sterile container on bed or on over-bed table.
Maintain sterility of inside of the container.
4. Don clean gloves
5. Place an absorbent pad under connection of tubing and
catheter. Rationale: This will form a working field for
irrigating catheter.
6. Pour irrigant into solution container.
7. Place catheter tipped syringe in container. Do not
contaminate syringe tip.
8. Place catch basin on pad to form working field.
(Always keep syringe tip and irrigant uncontaminated).
9. Disconnect catheter from drainage tube. Place sterile
protective cap over the end of the drainage tube.
Rationale: This will prevent contaminating tip of tubing.
Carefully remove sealing Disconnect catheter from
tape to access catheter drainage tubing; cover tubing
catheter. end with sterile cap
10. Coil tubing on bed.
11. Place catheter over edge of catch basin. Rationale: If
end of catheter touches covers, underpad, exposed
skin surfaces, or drainage tube, it will be
contaminated.
12. Insert irrigating syringe into catheter and attempt to
aspirate any obstructing debris, Rationale: If
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 irrigation is performed without removing debris, it
can be forced into bladder and result in infection.
13. Withdraw irrigating solution into syringe.
14. Instill 30-50 ml of irrigant into catheter with gentle
but firm pressure.
a. Remove syringe and allow solution to drain.
b. Lower catch basin to facilitate solution return
via gravity or aspirate instilled solution.
c. Continue to irrigate client’s bladder with 30-50
ml of irrigant until fluid returns are clear or clots
removed.
15. Remove the protective cap from drainage tube and
wipe it with an antiseptic swab.
16. Wipe end of catheter with an antiseptic sponge, and
connect the catheter to the drainage tube.
17. Ensure straight line from tubing to drainage bag. Curl
excess tubing loosely on bed and secure tubing to linen.
18. Tape catheter to inner thigh for a female and abdomen
for male.
Instill 30-50 ml of irrigant reconnect catheter to
into catheter using aseptic drainage tubing
technique
19. Lower bed and raise side rails.
20. Discard equipment and remove gloves.
21. Make sure client is clean and comfortable. Place call
light within easy reach.
22. Wash your hands.
23. Measure amount of return. Subtract any irrigation
solution used to irrigate from the client’s I & O record
Bladder Irrigation
2. IRRIGATING A CLOSED SYSTEM
Equipment
Irrigation set
30-ml syringe with needleless cannula
Alcohol or povidone – iodine (Betadine) swab
Ordered irrigating solution (normal saline)
Clamp for drainage tubing
Clean gloves
Prepared pain medication, if ordered
Preparation
1. Check physician’s order and client care plan.
2. Gather equipment
3. Check client’s identaband. Explain procedure and
rationale to client.
4. Wash hands
5. Provide privacy, and place client in dorsal –
recumbent position, if tolerated.
6. Raise bed, and lower side rail on working side of bed.
7. Don clean gloves.
8. Premedicate client if ordered.
9. Empty client’s urinary drainage and record amount.
Procedure:
1. Open sterile container, Maintain sterility on inside of
the container.
2. Place absorbent pad under end of catheter to form a
working field.
3. Pour irrigant into solution container.
4. Clamp tubing just distal to injection port.
5. Swab tubing injection port with alcohol or Betadine
solution
6. Insert the needleless cannula into tubing injection port
7. Attempt to aspirate obstructing clot or debris.
Rationale: Irrigation without first attempting removal
of debris can force it into bladder, resulting in
infection
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8. Withdraw irrigating solution into syringe.
9. Swab injection port again.
10. Inject solution slowly into port. Rationale: To
prevent back pressure in urinary drainage system.
11. Remove syringe from injection port.
12. Unclamp drainage tube, and lower catheter.
Rationale: This facilitates drainage.
13. Repeat irrigation steps until return is free of clots and
debris.
14. Lower bed and raise side rail.
15. Dispose of equipment and remove gloves
16. Wash your hands.
17. Measure amount of return. Subtract the irrigating
solution from the client’s I&O record.
3. MAINTAINING CONTINOUS BLADDER
IRRIGATION (CYSTOCLYSIS)
Equipment
 Irrigating solution
 IV tubing with roller clamp
 IV pole
 Alcohol or povidone – iodine (Betadine) swab
 Clean gloves
Procedure
1. Check physician’s order and client care plan.
2. Note if client has triple lumen indwelling catheter
and drainage bag.
3. Place label on irrigating bag. Include client’s name,
date, room number, type of solution, and additives.
4. Check client’s identaband.
5. Explain procedure to client and provide privacy.
6. Wash your hands and don clean gloves.
7. Remove protective covering from spike on tubing,
and insert spike into insertion port of solution
container. Use aseptic technique.
8. Hang irrigating solution container on IV pole and prime
tubing. Height of pole is usually 24 - 36 inches above
bladder.
a. Remove protective cover from end of tubing
using aseptic technique.
b. Open roller clamp, and allow irrigating solution
to run through tubing until all air is expelled.
Rationale: This prevents air from entering
bladder and causing discomfort.
c. Close roller clamp.
9. Connect tubing to catheter irrigating (indwell) lumen
using aseptic technique.
Bladder Irrigation
10. Removes gloves.
11. Adjust drip rate irrigating solution by adjusting the
clamp on the tubing to increase or decrease based on
urine out – flow color.
a. Infuse continuously to keep urine drainage pink
to clear.
b. When drainage is dark red or contains blood
clots, increase drip rate. Rationale: Increased
drip rate will clear the drainage and flush out
clots.
c. Change irrigation solution bottle using aseptic
technique.
12. Check for bladder distention or abdominal pain;
note urine color.
13. Monitor urine output at least every hour to observe
patency of system.
14. Empty drainage bag as recorded. Subtract amount of
irrigant infused from total output to obtain urine
output and record.
15. Maintain catheter traction if taped to thigh.
Rationale: This promotes venous hemostasis.
16. Remove gloves and wash hands.
Note: Procedure is done to flush clots and debris from
bladder following prostatic surgery, and to prevent
catheter obstruction and promote patency.
DOCUMENTATION FOR BLADDER IRRIGATION
 Type and amount of solution administered for
irrigation.
 Rate of administration of irrigating solution
 Description of urinary output, including color and
presence of clots or debris
 Any signs of discomfort or cramping
 Medication given for pain
 Amount of actual urine output (total urine output
minus amount of irrigant instilled).
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Critical Thinking Application
UNEXPECTED OUTCOMES
Irrigation flow is not infusing as prescribed rate
Irrigation solution is not returned because of an
obstruction in the system
Client experiences excessive bladder spasms.
Bright red drainage continues even when
solution flow rate is increased.
Bladder Irrigation
CRITICAL THINKING OPTIONS
* May need to raise or lower IV standard with attached irrigation
bag to assist in regulating flow using gravity.
* Move the flow adjuster clamp to a new site on the tubing if flow
is slower than ordered. Tubing may be collapsed due to
constant pressure from clamp.
* If infusion rate slows, may indicate clots are blocking flow.
Irrigate catheter following physician’s orders.
* Follow these steps to obtain irrigation solution:
a) Check tubing for kinks
b) Have client change position
c) Aspirate the solution from the catheter, using moderate
“pull back” pressure.
d) If the irrigant does not return, palpate the client’s
bladder and instill 30 – 50 ml of irrigating solution to
agitate and clear any clots.
e) If irrigant does not return, reconnect urinary system
and observe for 30 minutes. Bladder spasms can block
the flow of urine through the system .
f) If irrigant still does not return after performing the above
procedures, notify physician for further orders.
* Notify physician to obtain an order for urinary antispasmodic
* Assist client to change position
* Notify physician immediately
* Obtain vital signs and continuously monitor
* Continue to infuse solution at a rapid rate to flush client’s
bladder until you obtain physician’s orders
* Do not allow client to cough
* Keep client’s catheter—taped leg straight to maintain traction
on catheter inflation bulb
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