CYSTOCLYSIS

MARIA FILOMENA E. SEMILLA, RN,MSN

CYSTOCLYSIS/BLADDER IRRIGATION

• 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

Purpose: • To drain the bladder when

acute urinary retention is present

• To relieve bladder spasm

• To free blockage in the urinary catheter or tubing

EXPECTED OUTCOMES

1. The urinary catheter remains patent and urine is able to drain freely via the indwelling catheter (IDC)

2. The patients comfort is maintained

EXPECTED OUTCOMES

3. Clot formation within the bladder or IDC is prevented or minimized

4. The patient’s risk of Urinary Tract Infection is minimized, through use of aseptic technique when connecting bladder irrigation to IDC

TYPES OF IRRIGATING CYSTOCLYSIS

1. OPEN BLADDER IRRIGATION SYSTEM

also called MANUAL IRRIGATIONThis is used when bladder

irrigations are required less frequently and there are no blood clots or large mucous fragments

TYPES OF IRRIGATING CYSTOCLYSIS

2. CLOSED BLADDER IRRIGATION SYSTEM involves instilling sterile

irrigation solution into the bladder allowing the fluid to drain out

NOTE: CONTINUOUS BLADDER IRRIGATION should not go beyond in weeksFailure to recognize that the fluid is not draining

can result in severe bladder injury, as large volumes of irrigation solution are typically instilled.

• Example:• 100cc is irrigated + 30cc urine

output/hr=130cc is expected if output is less than NOTIFY THE

PHYSICIAN

MATERIALS/ EQUIPMENT NEEDED

• 3 way catheter• 0.9% sodium chloride

irrigation bags as per facility policy

• continuous bladder irrigation set and closed urinary drainage bag with anti-reflux valve.

MATERIALS/ EQUIPMENT NEEDED

• 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

Procedure:

• 3. Ensure that the patient has a three-way urinary catheter. – If not, a three-way catheter

needs to be inserted

Procedure:

• 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.

Procedure:

• 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

Procedure:

• 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

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

Procedure:

• 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)

Nursing Responsibilities:

• 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 minimize the risk of catheter related urinary tract infection

Nursing Responsibilities:

• Catheter care provided should be documented in the progress notes

• Also the nursing care plan including:– patient comfort– urine colour/degree of hematuria– urine output– Also presence of clots if any and if manual bladder

washout was necessary

QUIZ

• 1-3. purposes of bladder irrigation• 4-5. indication for bladder irrigation• 6-7 nursing responsibilities for patient with

cystoclysis• 8. complication of bladder irrigation• 9-10. types of bladder irrigation

ANSWER• 1-3. To prevent blood clot formation• To drain the bladder when acute urinary retention is

present• To relieve bladder spasm• To free blockage in the urinary catheter or tubing• 4-5. • UTI, Post-genitourinary Surgery, Prostatic Hematuria• 6-7 nursing responsibilities• 8. infection , trauma to the wall of the bladder, bladder

spasm, bladder distention • 9-10 open and closed bladder irrigation system