Video Assignment 3- Continuous Bladder Irrigation PDF

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SKILL: CBI

Written by Jonathan Marcel

Nursing Lab Skills II

NURSING SKILL: CONTINUOUS BLADDER IRRIGATION (CBI) LEARNING OBJECTIVES: After the successful completion of this lesson plan, the learner will be able to: 1. Determine the purpose and the expected goal of CBI. 2. Identify the indications and contraindications of CBI. 3. Discuss the appropriate patient teaching needed before the placement of the catheter. 4. State and identify the materials needed for CBI. 5. Outline the general administration of the 3-lumen catheter. 6. Describe disease prevention techniques used during the CBI procedure. 7. Identify the relevant information to document once this nursing intervention is completed. 8. Describe the practices to ensure safe and continuous irrigation. PURPOSE This therapeutic treatment is done through the utilization of a three-way irrigation system that involves a triple-lumen catheter by constantly infusing a sterile solution into the bladder. A triple lumen catheter has three different and separated openings. One opening, or “lumen,” is used for the removal of urine and the irrigation solution (antibacterial rinse). The second lumen is used to inflate the catheter balloon. The last lumen is used to transport the irrigation solution into the bladder. CBI is used a way to remove and prevent possible blood clots in the bladder. This is done because the formed blood clots prevent the free flow of urine from a patient’s catheter. The obstructed urine is then collected in the bladder, which ultimately, causes an increasingly painful sensation as the bladder fills. Continuous bladder irrigation removes debris and blood cots that block then the bladder from voiding easily. Continuous bladder irrigation is indicated for the following reasons: a) To help maintain catheter patency by preventing urinary obstruction through the constant flushing of small blood clots formed after prostate or bladder surgery and after chemotherapy or radiation. b) To help prevent possible venous hemorrhage through the establishment of a mild tamponade. c) To give therapeutic relieve and to treat an irritated, inflamed, or infected bladder lining. CONTRA-INDICATIONS  Known or suspected urethral injury (such as a pelvic injury or scarring around the urethral organs)  Injury, recent wound or obstruction due to increase perforation risk  Following gynaecological surgery or radiotherapy (increase perforation risk)  Known bladder tumour.  Small fibrotic bladders  Prosthetic device within the lower abdomen GOAL  The patency of the indwelling urinary catheter is maintained.  Urine drains freely with the absence of any obstruction via the indwelling catheter.

SKILL: CBI

Written by Jonathan Marcel

Nursing Lab Skills II

 The formation of blood clots is minimized or prevented.  The risk of a Urinary Tract infection is reduced by using the aseptic technique when connecting the bladder irrigation catheter to the indwelling catheter. GENERAL ADMINISTRATION FOR CONTINUOUS BLADDER IRRIGATION Materials: 1) Antiseptic swab; 2) Sterile irrigation solution; 3) Correct PPE; 4) Under-pad and bath blanket 5) Irrigation tubing and clamp 6) IV pole 7) 3-way foley Catheter kit PROCEDURE (ASSESS YOUR KNOWDLEGE------REMEMBER 3 CHECKS AND 10 RIGHTS) 1. Verify the order for CBI. Bring necessary equipment to the bedside stand or overbed table. 2. Assess the physician’s order for continuous bladder irrigation to determine if the type of irrigation and irrigation solution on the order is indicated for the patient. 3. Identify the patient with 2 unique indicators and perform hand hygiene. 4. Assess the colour, amount, and for the presence of mucus or sediment for the urine. 5. Determine the patency of the drainage tubing. 6. Explain what you are going to do and why you are going to do it to the patient. Discuss what will happen during the procedure. Explain to them that the initial urine will be bloody and contain blood clots within it. Ask the patient for consent to perform the procedure. Close curtains around the bed and close door to room if possible. Then fold back covers to expose the catheter and cover the patient’s upper torso with the bath. 7. Perform hand hygiene and put on PPE, if indicated. Then assess the lower abdomen for bladder distension and position the in the dorsal recumbent or supine position. 8. Using aseptic technique, insert the tip of the sterile irrigation tubing into the bag of sterile irrigating solution. 9. Close the clamp on the tubing and hang the bag of solution on the intravenous pole. 10. Open the clamp, and allow solution to flow through tubing, keeping the end of tubing sterile. Close the clamp. 11. Wipe off the irrigation port of the triple-lumen catheter or attach a sterile Y connector to the double-lumen catheter, and then attach to irrigation tubing. 12. Be sure that the drainage bag and tubing are securely connected to drainage port of the triple-lumen catheter or other arm of the Y connector. 13. For intermittent flow, clamp the tubing on the drainage system, open the clamp on the irrigation tubing, and allow the prescribed amount of fluid to enter the bladder (100 mL is normal for adults). Close the irrigation clamp and then open the drainage tubing clamp. (Optional: Leave the clamp closed for 20 to 30 minutes if ordered.) 14. For continuous drainage, calculate the drip rate, and adjust the clamp on the irrigation tubing accordingly. Ensure that the clamp on the drainage tubing is open and check the volume of drainage in the drainage bag. Ensure that drainage tubing is patent and avoid kinks. 15. Re-anchor the catheter to the patient with tape or an elastic tube holder. 16. Assist the patient to a comfortable position. 17. Lower the bed to the lowest position. Put the side rails up if appropriate. 18. Dispose of contaminated supplies, remove gloves, and perform hand hygiene. 19. Calculate the amount of fluid used to irrigate the bladder and subtract from total output. 20. Assess characteristics of output: viscosity, colour, and presence of matter (e.g., sediment, clots, blood). 21. Record type and amount of irrigation solution used, amount returned as drainage, and the character of drainage. 22. Record and report any findings such as complaints of bladder spasms, inability to instill fluid into bladder, or presence of blood clots.

SKILL: CBI

Written by Jonathan Marcel

Nursing Lab Skills II

SUGGESTIONS FOR SAFE AND CONTINUOUS IRRIGATION: (1) Make sure to have a second container of irrigant available to replace the one that is almost empty. (2) Verify the inflow and outflow lines regularly for bends, to ensure the irrigant is running easily. (3) Measure the outflow volume correctly. (a) Outflow volume = or slightly > inflow volume. (b) Inflow volume > outflow volume - Possible bladder rupture or renal damage - Notify the Practitioner. (4) Determine if the outflow has changed appearance or if you see blood clots. (5) Make sure drainage collection bags are disposed continuously,

SKILL: CBI

Written by Jonathan Marcel

Nursing Lab Skills II

References: Potter, P. A., Perry, A.G., Stockert, P.A., & Hall, A.M. (Eds.). (2019). Canadian fundamentals of nursing (5th Cdn. ed.) (J. C. Ross-Kerr, M. J. Wood, B. J. Astle & W. Duggleby, Cdn. Adapt.). Toronto, ON: Elsevier Canada SHR Nursing Practice Committee. (2017). Bladder Irrigation-Continuous. Retrieved April 05, 2021, from https://www.saskatoonhealthregion.ca/about/NursingManual/1022.pdf Taylor, C. (2011). Skill checklists for fundamentals of nursing: The art and science of nursing care, seventh edition. Philadelphia, PA: Lippincott Williams & Wilkins.

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