DIRECTORATE OF NURSING AFFAIRS GENERAL NURSING PROCEDURES SECTION 3 BLADDER WASHOUT 1 - 1 BLADDER LAVAGE BLADDER LAVAGEBLADDER LAVAGE BLADDER LAVAGE BLADDER WASHOUT IN A CATHETERIZED PATIENT DEFINITION Washing out the bladder with sterile fluid INDICATION 1. Clear an obstructed catheter 2. To remove the potential sources of obstruction of blood clots or sedimentation from infections. EQUIPMENT 1. Sterile dressing pack 2. Bladder syringe bowls 3. Sterile jug/bowl 4. Antiseptic solution 5. Clamp 6. New catheter bag 7. Receiver 8. Sterile solution for lavage 9. Lab. Container for specimen 10. Xylocaine jell 11. Sterile towel 12. Sterile gloves 13. Incontinent sheet PROCEDURE SN Action Rationale 1. Check the physician’s order, progress notes, and nursing care plan. To obtain specific instructions/information 2. Identify the patient. Check identification against physician’s order. To fulfil legal requirements and hospital policies. To ensure that the right procedure is performed to the right patient. DIRECTORATE OF NURSING AFFAIRS GENERAL NURSING PROCEDURES SECTION 3 BLADDER WASHOUT 1 - 2 SN Action Rationale 3. Explain the procedure to the patient. Allow patient to ask questions. To allay fears and gain patients confidence and cooperation. To promote patient education. 4. Ensure that the patient is in a comfortable position allowing access to the catheter. For the patient privacy and to reduce the risk of cross infection. 5. Perform the procedure using aseptic technique. To prevent infection. 6. Draw up solution using 60 ml syringe. Cap the syringe and place it in a clean receiver. It is easier to draw up solution in a clinical area than at the bedside. 7. Take the trolley to the bedside, open the packing and put them on the upper shelf of the trolley. 8. Pour lavage solution in a sterile jug. 9. Wash and dry hands (see Hand washing procedure) Don sterile gloves. To minimize risk of infection. 10. Clamp the catheter. Place a sterile towel under the junction of the catheter and the tubing of the drainage bag and disconnect them To prevent leakage when the catheter is disconnected. If a patient has a three way catheter the drainage bag will not need disconnecting as the washout fluid is injected through the side arm of the catheter. This should be aspirated off after use and the fluid remaining in the bladder will drain into the catheter bag. 11. Clean gloved hands with an alcohol-based hand wash solution. Clean around the end of the catheter with sterile cotton wool and an antiseptic solution. To remove surface organisms from gloves and catheter and thus reduce the risk of introducing infection into the catheter. 12. Draw up the irrigating fluid into the bladder syringe and insert the nozzle into the end of the catheter. 13. Release the clamp on the catheter and gently inject the contents of the syringe into the bladder, trying not to inject air. Rapid injection of fluid could be uncomfortable for the patient. Large volumes of air in the bladder cause distension and discomfort. DIRECTORATE OF NURSING AFFAIRS GENERAL NURSING PROCEDURES SECTION 3 BLADDER WASHOUT 1 - 3 SN Action Rationale 15. Repeat steps. 13 and 14 of the procedure until the washout is complete or the returning fluid is clear. 16. If the fluid does not return naturally, aspirate gently with the syringe. Gentle suction is sometimes required to remove obstructive material from the catheter. 17. Connect a new catheter bag or sterile spigot of a three-way catheter is in place, and allow the remaining fluid to drain out. A closed drainage system must be re- established as soon as possible to reduce the risk of bacterial invasion through the catheter. 18. If the solution is to remain in the bladder, the catheter should be clamped when all the fluid has been injected and the clamp released after the desired period. 19. Measure the volume of washout fluid returned and compare it with the volume of fluid injected. Record any discrepancies of volume in the appropriate documents. To keep an accurate record of urinary output and to observe for catheter obstruction. 20. Make the patient comfortable, remove equipment and clean the trolley. 21. Wash and dry hands. To prevent cross-infection. 22. Document the procedure appropriately Report any abnormal findings immediately. Note As an alternative to the use of bladder syringe and irrigating solution, a pre-packed filled reservoir with sterile catheter-adapter called Uro-tainer is now available. Kennedy [1984] found that the use Uro-tainer compared with traditional saline washout procedure produce a reduced incidence of urinary infection.