II. Definitions
- Bladder Irrigation
- Infusion of fluid into Bladder typically to clear obstruction
III. Indications
- Maintain catheter patency
- Clear Urinary Catheter obstruction (e.g. blood clots)
- Manual irrigation is often used as first step in clearing clots
- Follow manual irrigation with Continuous Bladder Irrigation if Gross Hematuria is still significant
IV. Contraindications
- Complete catheter obstruction (typically with sediment)
- Exchange the Urinary Catheter
V. Preparation
- Normal Saline irrigant (500 ml bottles)
- Antiseptic cleaner (e.g. Chlorhexidine, Alcohol)
- Large syringe (e.g. 60 ml)
- Sterile bowl for irrigation fluid
- Disposable absorbant underpads (e.g. Chucks Pads) placed under patient and tubing
- Disposal container for removed irrigation fluid
- Personal Protective Equipment (gloves, Eye Protection or Face Mask)
- Sterile catheter plug
VI. Technique: Manual Irrigation
- Preparation
- Detach the attachment seal and securement device from the catheter
- Apply sterile gloves
- Clean the catheter attachment site and surrounding tubing with antiseptic (e.g. Chlorhexidine)
- Disconnect the foley bag from the catheter and pinch off the catheter tube end to prevent leakage
- Apply the sterile catheter plug to the drainage tubing
- Irrigate
- Draw up saline into large syringe (e.g. 60 ml) and inject into catheter port
- Use drainage port if using a triple lumen catheter
- Aspirate and dispose of infused fluid
- Consider bedside Bladder Ultrasound (POCUS) if instillation or aspiration is difficult
- Demonstrates catheter balloon position, amount of retained urine and echogenic blood or sediment
- If fluid cannot be aspirated after instilling easily, catheter balloon may be lodged in Bladder neck
- Apply antiseptic to catheter at Urethra, deflate catheter balloon, advance catheter a few inches, re-inflate
- Re-attempt fluid aspiration after catheter repositioning
- Consider bedside Bladder Ultrasound (POCUS) if instillation or aspiration is difficult
- May use push-pull with syringe in cycles to break up clot within Bladder
- Repeat cycles of irrigation and aspiration until the fluid is clear and flows easily out drainage port
- Continue for additional 1000 ml
- Draw up saline into large syringe (e.g. 60 ml) and inject into catheter port
- Completion
- Re-attach catheter to drainage system
- Consider following with Continuous Bladder Irrigation if persistent Gross Hematuria
- Troubleshooting
- See Urinary Catheter
VII. References
- Werner and Long (2023) Continuous Bladder Irrigation, EM:Rap 23(11)