NUR 142: SKILL 33-3 PERFORMING CATHETER IRRIGATION
PERFORMING CATHETER IRRIGATION - INTRODUCTION Urinary catheter irrigations are performed on an intermittent or a continuous basis to maintain catheter patency. There are two types of irrigation: closed catheter irrigation and open irrigation. Closed catheter irrigation provides intermittent or continuous irrigation of a urinary catheter without disrupting the sterile connection between the catheter and the drainage system. Intermittent irrigation involves insertion of a sterile catheter into a catheter port to irrigate a bolus of fluid. Continuous bladder irrigation is a continuous infusion of a sterile solution into the bladder, usually using a three-way irrigation system with a triple-lumen catheter. It is often used after genitourinary surgery to keep the bladder clear and free of blood clots or sediment.
ASSESSMENT 1. Verified order for irrigation method, type, and amount of irrigant, as well as type of catheter in place. 2. Palpated bladder for distention and tenderness. 3. Assessed patient for abdominal pain or spasms, sensation of bladder fullness, or catheter bypassing. (leaking). 4. Observed urine for color, amount, clarity, and presence of mucus, clots or sediment. 5. Monitor I & O. 6. Assessed patient’s knowledge regarding purpose of performing a catheter irrigation.
PLANNING 1. Identified expected outcomes With CBI: ( Continuous bladder irrigation): Urine output is greater than volume of irrigating solution instilled. Patient reports relief of bladder pain or spasms Urine output has decreased with an absence of blood clots and sediment (Note: Urine will be bloody following bladder/urethral surgery, gradually becoming lighter and blood tinged in 2 to 3 days). Absence of fever, lower abdominal pain, cloudy and/or foul-smelling urine Patient can explain purpose of procedure and what to expect. 2. Explained procedure to the patient
IMPLEMENTATION 1. Identify patient using two identifiers 2. Perform hand hygiene 3. Provide privacy by closing room door and bedside curtain. 4. Raise the bed to the appropriate working height. If side rails are raised, lower side rail on working side. 5. Position patient supine and expose catheter junction (catheter and drainage tubing). 6. Remove catheter securement device. 7. Organize supplies according to type of irrigation prescribed. Apply clean gloves.
IMPLEMENTATION – CONT’D 8. CLOSED CONTINUOUS IRRIGATION : A. Close clamp on new irrigation tubing and hang bag on irrigating solution on IV pole. Insert (spike) tip of sterile irrigation tubing into designated port of irrigation solution bag using aseptic technique. B. Fill drip chamber half full by squeezing chamber; then open clamp and allow the solution to flow (prime) through tubing, keeping end of tubing stile. Once fluid has completely filled tubing, close clamp and recap end of tubing. C. Using aseptic technique, connect tubing securely to drainage port of Y- connector on double/triple-lumen catheter.
IMPLEMENTATION – CONT’D D. Adjust the clamp on irrigation tubing to begin flow of solution into bladder. If set volume rate is ordered, calculate drip rate and adjust rate at roller clamp. If urine is bright red or has clots, increase irrigation rate until drainage appears pink (according to ordered rate or agency protocol). E. Observe for outflow of fluid into drainage bag. Empty catheter drainage bag as needed.
IMPLEMENTATION – CONT’D 9. Closed Intermittent Irrigation: A. Pour prescribed sterile irrigation solution into sterile container. B. Draw prescribed volume of irrigant (usually 30 to 50 mL) into syringe using aseptic technique. Place sterile cap on tip of needleless syringe. C. Clamp catheter tubing below soft injection port with screw clamp (or fold catheter tubing onto itself and secure with rubber band). D. Using circular motion, clean catheter port (specimen port) with antiseptic swab. E. Insert tip of needleless syringe using twisting motion into port. F. Inject solution using slow, even pressure. G. Remove syringe and remove clamp (or rubber band) allowing solution to drain into urinary drainage bag. (Note: Some medicated irrigants may need to dwell in bladder for prescribed period, requiring catheter to be clamped temporarily before being allowed to drain).
IMPLEMENTATION – CONT’D 10. Open intermittent irrigation: A. Sterile gloves may be required (see agency policy). B. Open sterile irrigation tray. Establish sterile field (see Chapter 8) and pour required amount of sterile solution into sterile solution container. Replace cap on large container of solution. Add sterile irrigation syringe (piston type) to sterile field. Have antiseptic wipe open and ready for use. C. Position sterile drape under catheter. D. Aspirate prescribed volume of irrigation solution into irrigating syringe (usually 30 mL). Place syringe in sterile solution container until ready to use. E. Move sterile collection basin close to patient’s thigh. F. Wipe connection point between catheter and drainage tubing with antiseptic wipe before disconnecting.
IMPLEMENTATION – CONT’D G. Disconnect catheter from drainage tubing, allowing any urine to flow into sterile collection basin. Cover open end of drainage tubing with sterile protective cap and position tubing so it stays coiled on top of bed with end resting on sterile drape. H. Insert tip of syringe into lumen of catheter and gently push plunger to instill solution – By adding the fluid in a gentle manner, this type of instillation minimizes the risk of trauma to the bladder. I. Remove syringe, lower catheter, and allow the solution to drain into a collection basin. The amount of drainage solution should be equal to or greater than the amount instilled. If ordered, repeat sequence of instilling solution and drainage until drainage is clear of clots and sediment.
IMPLEMENTATION – CONT’D J. After irrigation is complete, remove protector cap from urinary drainage tubing end, clean end of tubing with antiseptic wipe, and reinsert into lumen of catheter. 11. Anchor catheter with catheter securement device (see Sill 33-1). 12. Help patient to safe and comfortable position. Lower bed and place side rails accordingly. 13. Dispose of all contaminated supplies in appropriate receptacle, remove gloves and perform hand hygiene.
EVALUATION 1. Measure actual urine output by subtracting total amount of irrigation fluid infused from total volume drained into basin. 2. Review I&O flow sheet to verify that hourly output into drainage bag is in appropriate proportion to irrigating solution entering bladder. Expect more output than fluid instilled because of urine production. 3. Inspect urine for blood clots and sediment and be sure that tubing is not kinked or occluded. 4. Evaluate patient’s comfort level. 5. Monitor for signs and symptoms of infection.
UNEXPECTED OUTCOMES 1. Irrigating solution does not return (intermittent irrigation) or is not flowing at prescribed rate. Examine tubing for clots, sediment and kinks Notify health care provider if irrigent does not flow freely from bladder, patient complains of pain, or bladder distention occurs. 2. Drainage output is less than the amount of irrigation solution infused. Examine drainage tubing for clots, sediment, or kinks Inspect urine for presence of or increase in blood clots and sediment Evaluate patient for pain and distended bladder Notify health care provider
UNEXPECTED OUTCOMES – CONT’D 3. Bright-red bleeding with the irrigation (CBI) infusion wide open. Assess for hypovolemic shock (vital signs, skin color and moisture, anxiety level). Leave irrigation infusion wide open and notify health care provider 4. Patient experiences pain with irrigation. Examine drainage tubing for clots, sediment, or kinks. Evaluate urine for presence of or increase in blood clots and sediment Evaluate for distended bladder Notify health care provider 5. Fever; cloudy, foul-smelling urine; abdominal pain; change in mental status, indicating a possible infection. Notify health care provider Monitor vital signs and character of urine.
RECORDING AND REPORTING Record irrigation method, amount of and type of irrigation solution, amount returned as drainage, characteristics of output, urine output, and patient tolerance to procedure in nurses’ notes. Report catheter occlusion, sudden bleeding, infection, or increased pain to health care provider. Record I&O on appropriate flow sheet.
END OF SKILL This is the end of the skill Your book does not provide a video for this skill, but I have picked three out for you on you-tube. Again, I’m not affiliated with the school, so while these videos may be helpful, please remember that I picked them out. 1. Irrigating Foley Catheter by Opening a Closed System 2. Open Bladder Irrigation 3. Demonstration of a Catheter Irrigation : I have provided 3 videos for you to review. Again, watch the videos, if you would like, but in order to pass this skill, you must practice it in the nursing skills lab.