How to Flush Continuous Bladder Irrigation
Medically Reviewed By Matt Coward, MD, FACS
People who live with a catheter may also require bladder irrigation, particularly when there is blood in the urine or a blockage of the catheter.
This article will talk about how bladder irrigation works, and the different methods clinicians use. It will also cover what to expect during bladder irrigation and after the procedure.
What is bladder irrigation?
A bladder irrigation procedure involves instilling fluid into the bladder and draining it. This happens through a catheter, which is a thin, flexible tube that a healthcare professional inserts into the urethra up to the bladder.
The bladder irrigation fluid can be sterile saline or a medication, usually an antibiotic.
What are the reasons for bladder irrigation?
Health professionals use bladder irrigation to prevent the buildup of mucus or blood in the bladder or urethra. This buildup can be a risk after surgery on the bladder or prostate gland, particularly when doctors perform the procedure through the urethra.
Blood clots or mucus could block a urinary catheter and prevent urine from draining. Should this occur, urine can back up into the kidneys, causing damage to these organs.
Doctors may also use bladder irrigation to administer medication directly to the bladder. These treatments include:
- antibiotics, to treat or prevent urinary tract infections (UTIs) when oral antibiotics are not effective
- chemotherapy, most commonly mitomycin, to treat bladder cancer
- immunotherapy, most often Bacillus Calmette-Guerin (BCG), which uses the body's immune system to target cancer cells
Bladder irrigation can also help reduce irritation and inflammation of the bladder or remove bladder stones.
Who performs bladder irrigation?
In the hospital, a nurse will likely perform bladder irrigation. However, doctors may discharge patients home to continue bladder irrigations. In this case, you will learn to perform the procedure yourself before going home.
How is bladder irrigation performed?
The steps of a bladder irrigation procedure depend on the type of irrigation method your care team uses.
- Continuous bladder irrigation:This method constantly flushes the bladder with fluid using a three-way catheter. This catheter allows fluid to flow in and out of the bladder at the same time. The bladder irrigation fluid flows from a bag similar to an IV, or intravenous, fluid set.
- Intermittent bladder irrigation:This method rinses the bladder as necessary throughout the day. It uses a pump and a port on a two-way urinary catheter set. You or a clinician will hook the fluid up to the port when flushing is necessary. A pump instills the fluid while a clamp keeps the outflow shut. After a certain amount of time, you open the clamp and let the fluid and any debris flow out of the bladder.
- Manual bladder irrigation: This method is also a periodic rinsing of the bladder. However, it does not use a pump. Instead, it uses a syringe to instill the fluid through a catheter. A healthcare professional may perform manual bladder irrigation, or you may receive instructions on how to do it yourself.
The frequency of manual and intermittent irrigation varies based on a few factors. These include the volume and color of urine a person produces and any symptoms they experience.
After surgery, it may be necessary to irrigate the bladder every few hours. The frequency may decrease as the bladder heals. For irrigation with medications, the frequency will depend on the dosing of the medication.
What can I expect during bladder irrigation?
Bladder irrigation occurs through a flexible catheter placed into your bladder through your urethra. You may feel some discomfort while a healthcare professional places the catheter. You may also feel like your bladder is full, and you need to urinate after the catheter is in your bladder.
Your procedure takes place in a hospital, where a nurse will set up and perform the irrigation. However, you will likely not require an overnight stay.
If you live with a catheter and require ongoing bladder irrigations, your care team may teach you how to perform them at home. Your clinician will provide detailed instructions, but you will generally follow these steps:
- Wash your hands.
- Using sterile technique (you will be taught this at the hospital), draw the saline or medication into the syringe. In some cases, you will use pre-filled syringes.
- Close the clamp on the catheter.
- Disconnect the catheter from the urine collection bag.
- Place the tip of the syringe into the catheter.
- Open the clamp on the catheter.
- Gently instill the solution into the bladder through the catheter.
- Close the clamp.
- Let the fluid remain in the bladder for the recommended time.
- Gently withdraw the fluid with the syringe or let it drain as prescribed.
- Repeat as directed.
- Disconnect the syringe and attach a new urine collection bag.
- Clean the equipment as directed.
Your care team will also discuss what to do if you encounter resistance when draining the fluid. They will also discuss what to do if you experience other problems or side effects.
What are the risks and potential complications of bladder irrigation?
Bladder irrigation can help your bladder heal, but complications are possible. Risks and potential complications of bladder irrigation include:
- bladder spasms or pain
- bladder trauma
- dehydration
- overdistention of the bladder
- UTI due to contamination during the irrigation procedure
Reducing your risk of complications
You can reduce your risk of certain complications by:
- applying gentle pressure when instilling or withdrawing the irrigation fluid to avoid bladder trauma
- drinking plenty of fluids, about 2 liters a day, and avoiding caffeine to stay hydrated
- maintaining sterile technique during bladder irrigation
- notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
- using room temperature irrigation fluid to reduce spasms and pain
What can I expect after bladder irrigation?
After the bladder irrigation is complete and a professional removes the catheter, you may still notice irritation in your bladder or urethra. You may also have difficulty urinating the first time without the catheter.
Will I feel pain?
Some people have discomfort during bladder irrigation. If you are performing bladder irrigation yourself, it can help to ensure the irrigation fluid is at room temperature when you instill it. Contact your doctor if pain or discomfort persists.
How long will bladder irrigation last?
Each person is different in how long they will need bladder irrigation. Bladder irrigation may be part of care in the postoperative period after prostate or bladder surgery. Other people who live with a catheter may require ongoing bladder irrigation, such as those with certain chronic conditions.
In general, doctors will recommend bladder irrigation if urine appears dark due to the presence of blood or if there are signs of blockage in a catheter. Signs of a blocked catheter include:
- decreased urine output
- lower abdominal pain
- swelling in the bladder to the point that you can feel it from outside the body
- urine bypassing or leaking around the catheter
When should I call my doctor?
Keep all follow-up appointments with your doctor. Between appointments, call your doctor right away or seek immediate medical care if:
- There is resistance when you try to instill the irrigation fluid into the bladder.
- Urine is darkening in color, cloudy, or foul smelling.
- There does not appear to be any clearing of a blocked catheter.
- You are having persistent pain or discomfort during your irrigations.
- You require more frequent irrigations to keep the catheter draining.
- You develop symptoms such as high heart rate, excessive sweating, or low blood pressure.
- You become confused or disoriented.
Summary
Bladder irrigation is a procedure that involves inserting fluid into the bladder through a catheter, then letting that fluid drain. Doctors and health professionals often use bladder irrigation to clear blood clots from the bladder or urethra.
Nurses and other health clinicians often perform bladder irrigation as an outpatient procedure in a hospital. However, you may be able to perform manual bladder irrigation yourself at home.
Talk with your doctor about options for bladder irrigation, including when to contact your health team for any symptoms or concerns.
Source: https://www.healthgrades.com/right-care/kidneys-and-the-urinary-system/bladder-irrigation
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