Written Skills Exam: Irrigating an Indwelling Urinary Catheter or Bladder

What to document for irrigation of closed system

Procedure/amt of urine output -determine the actual urine output by subtracting the amt of irrigation fluid from the total output, or the vol of fluid in the bag.

What equipment is needed for irrigating a closed system?

*Irrigation set *30-mL syringe with needless cannula *Antiseptic swabs *Ordered irrigating solution (sterile saline) *Clamp for drainage tubing *Clean gloves *Prepared pain med, if ordered

Bladder Irrigation: What needs to be documented?

*Type and amt of soln used for irrigation (I&O) *Rate of admin of irrigation soln *Description of urinary output, including color and presence of clots/debris *Any statements of discomfort or cramping *Medication given for pain *Amt of actual urine output (total urine output minus amt of irrigant instilled)

Maintaining Continuous Bladder Irrigation: Preparation

1. Check order, gather equipment, ID patient, explain procedure, hand hygiene

Irrigating by opening a closed system: preparation

1. Check order, gather equipment, ID patient, hand hygiene 2. Consider pre-medicating (avoid bladder spasms) 3. Raise HOB, lower bed rail on working side, position in dorsal recumbent or supine

Steps before touching the patient:

1. Check order, gather equipment, hand hygiene 2. Look for pre-medication order/consideration (with open/closed system not continuous)

Irrigating a Closed System Preparation

1. Check order, gather equipment, identify patient, hand hygiene 2. Consider pre-medicating to prevent bladder spasms 3. Raise HOB, lower bed rail on working side, position pt. dorsal recumbent or supine (helps flow of irrigate into bladder), fanfold linens, provide privacy 4. Palpate the bladder (check for distention). May also bladder scan pt. before/after. 5. Don clean gloves 6. Empty urinary bag, record amt.

Maintaining continuous bladder irrigation: procedure

1. Don clean gloves 2. Remove protective covering from irrigation tubing/insert spike into port on irrigation bag using aseptic technique 3. Hang irrigation soln on IV pole at least 24-26 in above bladder 4. Remove protective cover form end of tubing using aseptic technique. Prime irrigation tubing with irrigation fluid 5. After swabbing cath lumen with antiseptic, connect irrigation tubing, open roller clamp 6. Adjust drip rate of irrigating fluid by moving roller clamp. Increase/decrease rate based on color of urine outflow 7. Remove gloves, wash hands 8. Check pt. frequently for bladder distention, bladder spasms, abd pain 9. Replace irrigation bags as needed using aseptic technique 10. Monitor urine bag q 30 min noting amt, color, patency 11. Empty bag as needed, subtract amt of irrigation infused to determine amt of urine 12. Document urine amt in I&O

Purpose of urinary irrigation:

1. Ensure patency of drainage system 2. Free blockage (blood clot) 3. Relieve bladder spasm discomfort

Irrigating by opening a closed system: procedure:

1. Fanfold linens, provide for privacy 2. Palpate bladder, check for distention 3. Open sterile irrigate container (should be placed on over bed table) 4. Don clean gloves 5. Place absorbent pad under catheter connection site 6. Pour irrigant into sterile soln. container 7. Uncap tip of irrigation syringe/place into soln. 8. Place sterile catch basin in position 9. Disconnect catheter from drainage tube, place catheter tubing into sterile catch basin, cover end of drainage tube with sterile protective cap. 10. Coil caped catheter tubing on bedding 11. Draw up 30-50mL of sterile irrigation soln into syringe and instill into urine catheter 12. Aspirate irrigation, continue to irrigate with 30-50mL until returns are clear 13. Wipe catheter end with antiseptic sponge, remove protective cap from drainage tube and reconnect catheter to drainage bag 14. Secure cath to patient's leg 15. Lower bed, raise rails 16. Discard equipment 17. Measure amt of returns, subtract irrigation amt. 18. Remove gloves, wash hands 19. Document procedure, amt of net returns

Equipment for continuous bladder irrigation

1. Irrigating solution (2000 mL sterile NS, or less than drainage bag volume) as prescribed 2. IV tubing with roller clamp 3. IV pole 4. Antiseptic swabs 5. Clean gloves

What to document for Irrigation by opening a closed system:

1. Procedure 2. Amt of net returns (Measure of amt of returns subtract irrigation amt)

Equipment for Irrigating by opening a closed system:

1. Sterile irrigation set with catheter tip syringe 2. Clean gloves 3. Sterile normal saline irrigant (unless otherwise ordered) 4. Catch basin 5. Antiseptic swab 6. Absorbent pad 7. Sterile protective cap for tubing 8. Pain/antispasmodic medication 9. Tape for securing catheter

Irrigating Closed System Procedure

7. Open sterile container & irrigant, maintain sterility inside of container 8. Place absorbent pad under catheter to form field 9. Pour irrigant into sterile container 10. Clamp drainage tubing distal to injection port 11. Using sterile technique, swab tubing injection port with antiseptic swab 12. Insert needleless cannula into injection port 13. Attempt to aspirate any obstructing debris (irrigating first may force debris into bladder). If unable to withdraw fluid proceed to irrigation. 14. Using sterile technique, draw sterile soln. into syringe. Maintain sterility of syringe and soln. container. Swab injection port. 15. Inject soln. slowly. remove syringe, unclamp drainage tube and lower catheter drainage bag to promote drainage. 16. Repeat until free of clots/debris. 17. Determine the actual urine output by subtracting the amt. of irrigation fluid from the total output, or the vol. of fluid in the bag 18. Lower bed, raise side rail 19. Dispose of equipment, remove gloves, hand hygiene 20. Document procedure/amt of urine output

Is irrigating a closed system a clean or sterile procedure

Aseptic procedure with clean gloves. Maintain sterility once sterile package is opened.

Continuous irrigation: What urine returns would the nurse increase the drip rate:

Increase drip rate for dark red, blood clots, or debris in returns.

Continuous irrigation: What should the desired urine return look like?

Infuse continuously to produce pink to clear returns

How many lumens must a pt. have in order to receive continuous bladder irrigation?

Triple lumen catheter needed for this procedure. One lumen for urine return, one for balloon, third (extra) lumen is for the irrigating soln.

To prevent painful bladder spasms during the manual irrigation procedure, the nurse may consider

pre-medicating