Fundamental Patterns Knowing in Nursing

Cystoclysis

Description: Bladder irrigation is the process of flushing the bladder with normal saline to prevent or treat clot formation. Bladder irrigation may also be used to instill medications such as antibiotics for treating bladder infections. This is done over a period of time, and runs continuously. A special catheter is used for the above procedure.

Purpose:
To prevent blood clot formation, allow free flow of urine and maintain IDC patency, by continuously irrigating the bladder with Normal Saline.

Materials/ Equipment Needed:

3 way catheter
0.9% sodium chloride irrigation bags as per facility policy
continous bladder irrigation set and closed urinary drainage bag with anti-reflux valve.
Chlorhexidane 0.5% with 70% alcohol wipes
Non sterile gloves
Personal protective equipment
Underpad (bluey)
IV pole

Procedure:
1. Explain procedure to the patient and ensure patient privacy
2. Position the patient for easy access to the catheter whilst maintaining patient comfort
3. Ensure that the patient has a three-way urinary catheter. If not, a three-way catheter needs to be inserted
4. Hang irrigation flasks on IV pole and prime irrigation set maintaining asepsis of irrigation set.
Note: Only one of the irrigation flask clamps should be open when priming the irrigation set otherwise the fluid can run from one flask to another. After priming the irrigation set ensure that all clamps on the irrigation set are closed.
5. Don goggles and impervious gown , place underpad underneath catheter connection
6. Attend hand wash and don non sterile gloves
7. Swab IDC irrigation and catheter ports with chlorhexidine swabs and allow drying
8. Remove the spigot from the irrigation lumen of the catheter using sterile gauze and discard spigot 9. Connect the irrigation set to the irrigation lumen of the catheter, maintaining clean procedure
10. Remove spigot or old drainage bag from the catheter lumen using sterile gauze and apply catheter drainage bag maintaining clean procedure.
Note: Do not commence Bladder Irrigation until urine is draining freely
11. Unclamp the irrigation flask that was used to prime the irrigation set and set the rate of administration by adjusting the roller clamp
Note: The aim of the bladder irrigation is to keep the urine rose’ coloured and free from clots.

Diagram/ Illustrations:
Nursing Responsibilities:
 Saline flasks for bladder irrigation do not need to be ordered by a Medical Officer
 Continue irrigation as necessary depending on the degree of hematuria (ensure adequate supply of irrigant nearby)
 After each flask is complete, empty urine drainage bag and record urine output on the fluid balance chart, prior to commencement of the next irrigation flask
 Regular catheter care is required in order to minimise the risk of catheter related urinary tract infection
 Catheter care provided should be documented in the progress notes and nursing care plan including patient comfort, urine colour/degree of hematuria and urine output. Also presence of clots if any and if manual bladder washout was necessary.