Continuous bladder irrigation can help prevent urinary tract obstruction by flushing out small blood clots that form after prostate or bladder surgery. It may also be used to treat an irritated, inflamed, or infected bladder lining.
This procedure requires placement of a triple-lumen catheter. One lumen controls balloon inflation, one allows irrigant inflow, and one allows irrigant outflow. The continuous flow of irrigating solution through the bladder also creates a mild tamponade that may help prevent venous hemorrhage. (See Setup for continuous bladder irrigation.)
One 4-L container or two 2-L containers of irrigating solution (usually normal saline solution) or the prescribed amount of medicated solution 
Y-type tubing made specifically for bladder irrigation alcohol or povidone-iodine pad intravenous (I.V.) pole.
Before starting continuous bladder irrigation, double-check the irrigating solution against the doctor's order. If the solution contains an antibiotic, check the patient's chart to make sure he isn't allergic to the drug.
- Identify the patient using two patient identifiers. Perform hand hygiene. Assemble all equipment at the patient's bedside. Explain the procedure to the patient and provide privacy.
- Hang the bag of irrigating solution on I.V. pole. Insert the spike of the Y-type tubing into the container of irrigating solution. (If you have a two-container system, insert one spike into each container.)
- Squeeze the drip chamber on the spike of the tubing until drip chamber is half full.
- Open the flow clamp and flush the tubing to remove air, which could cause bladder distention. Then close the clamp.
Hanging out
- Use standard precautions. To begin, hang the bag of irrigating solution on the I.V. pole.
- Clean the opening to the inflow lumen of the catheter with the alcohol or povidone-iodine pad.
- Insert the distal end of the Y-type tubing securely into the inflow lumen (third port) of the catheter. Take care not to attach to the balloon inflation port; this will cause balloon rupture.
- Make sure the catheter's outflow lumen is securely attached to the drainage bag tubing and is unclamped.
- Open the flow clamp under the container of irrigating solution and set the drip rate as ordered.
- To prevent air from entering the system, don't let the primary container empty completely before replacing it.
Close this, open that
- If you have a two-container system, simultaneously close the flow clamp under the nearly empty container and open the flow clamp under the reserve container. This prevents reflux of irrigating solution from the reserve container into the nearly empty one. Hang a new reserve container on the I.V. pole and insert the tubing, maintaining asepsis.
- Empty the drainage bag about every 4 hours or as often as needed. Use sterile technique to avoid the risk of contamination.
- 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.
Go all out—measure and assess
- Measure the outflow volume accurately. It should equal or, allowing for urine production, slightly exceed inflow volume. If inflow volume exceeds outflow volume postoperatively, suspect bladder rupture at the suture lines or renal damage and notify the doctor immediately.
- Also assess outflow for changes in appearance and for blood clots, especially if irrigation is being performed postoperatively to control bleeding. If drainage is bright red, irrigating solution should usually be infused rapidly with the clamp wide open until drainage clears. Notify the doctor at once if you suspect hemorrhage. If drainage is clear, the solution is usually given at a rate of 40 to 60 drops/minute. The doctor typically specifies the rate for antibiotic solutions. (See Documenting continuous bladder irrigation.)
Outline