VELEZ COLLEGE – COLLEGE OF NURSING (Nursing Care Management 103 Skills Lab)

SKILLS LABORATORY MODULE NO. 13

CYSTOCLYSIS / CONTINUOUS BLADDER IRRIGATION (CBI)

 Cystoclysis or Continuous Bladder Irrigation (CBI) is a procedure which involves a continuous infusion of
sterile solution into the bladder, usually by using a closed three-way irrigation system.

LEARNING OBJECTIVES:
By the end of the module, the student will be able to:
1. Give the indications of cystoclysis/continuous bladder irrigation (CBI).
2. Identify and assemble the parts of a continuous bladder irrigation (CBI) setup.
3. Describe nursing management of clients on CBI.
4. Discuss how urine output is computed in a client on CBI.
5. Apply the principles of asepsis and infection control throughout the procedure.
6. Explain rationale for each step of the procedure.

 Important Information related to this Module:

A. Indications of Cystoclysis/Continuous Bladder Irrigation:

 Primarily done to encourage hemostasis and flushing of blood _________ & debris out of the
bladder usually after bladder & prostate surgery (e.g., transurethral prostatectomy)
 Also done to instill medicated solution into the bladder

B. Parts of a Continuous Bladder Irrigation (CBI) Setup:

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 Materials/Equipment Needed: [materials/items with an asterisk (*) are the materials the students should
bring during skills laboratory period]

- Sterile gloves*
- Alcohol or povidone-iodine swabs*
- Closed irrigation tubing (a macrodrip set is commonly used)
- Ordered irrigation solution (ideal solution for CBI is normal saline solution)
- _____-_____ _____________ catheter (a triple-lumen catheter allows irrigating solution to flow into
the bladder through one lumen and flow out through another; the third lumen is used to inflate the balloon
that holds the catheter in place)
- IV pole
- Large urine collection bag
- Toomey syringe

 Nursing Skill to Develop in this Module:

A. Assembling & Maintaining a Continuous Bladder Irrigation Setup:
1.Verify physician’s order of prescribed irrigating solution to be used and flow rate.
2.Perform hand hygiene. Assemble all equipment at the patient's bedside. Explain the procedure and
provide privacy.
3.Insert the spike of the irrigation tubing (macrodrip set) into the container of irrigating solution (make
sure tubing is clamped before spiking).
4.Squeeze & fill half of the drip chamber on the spike of the tubing.
5.Open the flow clamp and flush the tubing to remove air, which could cause bladder distention. Then
close the clamp.
6.To begin, hang the bag of irrigating solution on the I.V. pole.
7.Clean the opening to the inflow lumen of the catheter with the alcohol or povidone-iodine swab.
8.Insert the distal end of the irrigation tubing (macrodrip set) securely into the inflow lumen (third port)
of the catheter.
9.Make sure the catheter's outflow lumen is securely attached to the drainage bag tubing.
10. Open the flow clamp under the container of irrigating solution, and set the drip rate as ordered.
11. To prevent air from entering the system, DON’T let the primary container empty completely before
replacing it.
12. Empty the drainage bag about every 4 hours, or as often as needed. Use sterile technique to avoid
the risk of contamination.

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 Special Considerations:
 The insertion of the three-way indwelling catheter is usually done by the surgeon in the operating
room immediately after surgery. Thus, insertion is not a nursing responsibility. However, the nurse
should be aware that 30 mL of sterile water is used to inflate the balloon of a 3-way catheter which is
important to note especially during catheter removal.
 Check the inflow and outflow lines periodically for kinks to make sure the solution is running freely. If the
solution flows rapidly, check the lines frequently.
 As an alternative to flow clamp administration, an infusion pump may be used, requiring the pump
tubing to be primed. Set the flow rate as ordered by the physician.
 Be sure the irrigating solution is at least at room temperature to avoid bladder spasms. Body
temperature is preferable. The solution can be soaked in a water bath prior to use with sterility
maintained at all times.
 Be sure to track the amount of irrigating solution instilled (inflow volume) and the amount of drainage
(outflow volume). The outflow volume must ALWAYS equal or exceed inflow volume.
 To calculate a client’s URINE OUTPUT, get the difference of the outflow volume (‘cysto-out’) and the
inflow volume (‘cysto-in’). [e.g., outflow volume = 300 mL, inflow volume = 200 mL; thus, urine output is
100 mL]. Note that the normal urine output per hour is 30 to 60 mL. A negative urine output must be
reported to the physician immediately for this may indicate bladder rupture at suture lines or renal
damage.
 Also assess outflow for changes in appearance and for blood clots, especially if irrigation is being
performed postoperatively to control bleeding (in this case, outflow is normally light pink or straw-
colored). If drainage is bright red, irrigating solution should usually be infused rapidly with the clamp
wide open until drainage clears. Notify the physician at once if you suspect hemorrhage. If drainage is
clear, the solution is usually given at a rate of 40 to 60 drops/minute or as prescribed.
 A Toomey syringe [see illustration below] should always be placed at client’s bedside. This syringe will be
used by the physician to irrigate the catheter in the event that the CBI system gets clogged or obstructed
with large clots.

 Monitor for transurethral resection syndrome or severe hyponatremia (water intoxication) caused by
the excessive absorption of bladder irrigation during surgery (altered mental status, bradycardia,
increased blood pressure, and confusion).

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 Discontinue CBI and Foley catheter as prescribed, usually 24 to 48 hours after surgery.
 Monitor for continence and urinary retention when the catheter is removed.
 Inform the client that some burning, frequency, and dribbling may occur following catheter removal.
 Inform the client that he should be voiding 150 to 200 mL of clear yellow urine every 3 to 4 hours a day
by 3 days after surgery.
 Inform the client that he may pass small clots and tissue debris for several days.

 Teach the client to AVOID heavy lifting, stressful exercise, driving, Valsalva maneuver, and sexual
intercourse for 2 to 6 weeks to prevent strain and to call the physician if bleeding occurs or there is a
decrease in urinary stream.
 Instruct the client to drink 2400 to 3000 mL of fluid each day, preferably before 8 PM.
 Instruct the client to AVOID alcohol, caffeinated beverages, and spicy foods and to avoid overstimulation
of the bladder.
 Instruct the client that if urine becomes bloody, to rest and increase fluid intake and that if the bleeding
does not subside, to notify the physician.

 References & Suggested Readings:

 Altman, G.B. (2010). Fundamental & advanced nursing skills (3rd ed.). Clifton Park, NY: Delmar Cengage
Learning.
 Nettina, S. & Mills, E.J. (2006). Lippincott manual of nursing practice (8th ed.). Philadelphia, PA:
Lippincott, Williams & Wilkins.
 Schilling-McCann, J. (2009). Lippincott’s nursing procedures (5th ed.). Philadelphia, PA: Lippincott,
Williams & Wilkins.
 Silvestre, L.A. (2005). Saunders comprehensive review for the NCLEX-RN examination (3rd ed.).
Philadelphia: Elsevier Saunders.
 Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010). Brunner & Suddarth’s textbook of medical-
surgical nursing (12th ed.). Philadelphia, PA: Wolter Kluwer Health/Lippincott, Williams & Wilkins.

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