CHAPTER 12 Urinary Elimination 639

• 12-10 Administering a Continuous Closed Bladder Irrigation

Indwelling catheters sometimes require continuous irrigation, or flushing, with solution to restore or
maintain the patency of the drainage system. Sediment or debris, as well as blood clots, might

block the catheter, preventing the flow of urine out of the catheter. Irrigations might also be used to

instill medications that will act directly on the bladder wall. Irrigating a catheter through a closed
system is preferred to opening the catheter because opening the catheter could lead to contamina-

tion and infection. If the irrigation is to be continuous, a triple-lumen or three-way catheter is

placed to maintain a closed system (Figure 1).

Irrigation bag

Drip chamber

Clamp

Bladder

Tubing to

irrigation port

Port for inflation

of catheter balloon

Drainage

bag

Tubing from
bladder

FIGURE 1. A continuous blad-

der irrigation (CBI) setup.

EQUIPMENT • Sterile irrigating solution (at room temperature or warmed to body temperature)
• Sterile tubing with drip chamber and clamp for connection to irrigating solution

• IV pole

• IV pump (if bladder is being irrigated with a solution containing medication)

• Three-way indwelling catheter in place in patient’s bladder

• Indwelling catheter drainage setup (tubing and collection bag)

• Alcohol swabs

• Bath blanket
• Disposable gloves

• Additional PPE, as indicated

(continued)

 ‫ﻊ ﻊ ﺾ‬ ‫ﻊﺑ‬ ‫ﻊﺈ‬

‫ع‬ ‫ﻊ‬ ‫ﻊ ﻰ‬ ‫ﻊ‬ ‫ﻊ‬ ‫‪L‬‬

‫‪2‬‬
‫ع ﻊ‬ ‫ع‬ ‫ع ﻉﺿ ﻊ ﺈع‬ ‫ﺾ‬ ‫ﻊ ع‬ ‫ﻊ ﻉﺿ ﻊ‬ ‫ﻉ عع ع‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬
‫ﻊ ﻊ‬ ‫ﻉ عﻊ‬ ‫ﻊ‬ ‫ﻊ ﺾ‬ ‫ﺃ‬ ‫ع‬ ‫ﻊ‬ ‫ع ﻊ ﺾ‬ ‫ﻊ‬ ‫ﺿ‬ ‫ع‬ ‫ﻉﺿ ﻊ‬ ‫ﻊ ﺿﻊ‬
‫ب ﺃﻯ‬ ‫ﺃ ﻯﻊ‬ ‫ع ﻰ‬ ‫ﻊ‬ ‫ﺈ‬ ‫ﻊ ﻊ ع‬ ‫ع‬ ‫ﻊب ﺿ ﻊ‬ ‫ﻰ‬
‫ﺈع‬ ‫ع ع‬ ‫ﻊ‬ ‫ﻊ ﺾ ﺄ ﻉﺿ‬ ‫ﺿ‬ ‫ﻊ‬ ‫ﻊ ع ﻊ‬ ‫ﻊ ﺾ ﺿﻊ ﺿ‬ ‫ﺽ‬ ‫ﻊ‬
‫ﻊ‬ ‫ع ﻰ‬

‫ﻊ‬

‫ع‬ ‫ﺁﺃ‬

‫ﻊ‬

‫ع‬

‫ﻉع‬
‫ع ﻊ‬

‫ع‬
‫عﺾ ﻊ‬

‫ع‬ ‫ﺄﻊ‬

‫ﻉع‬
‫ع‬

‫)‬ ‫ﻊ‬ ‫ﻊ ﻊ‬

‫‪S‬‬
‫ﻊ‬ ‫ﻊ‬ ‫ﻊ ﻊ ﻰ ﺃ ﻉﺿ ﻊﺃ‬ ‫ﺾ‬ ‫‪L‬‬ ‫ﻊ‬
‫ﺾ ﻊ‬ ‫ﺾ‬ ‫ع‬ ‫ﺿﻊ‬ ‫ﺁﺃ ﻊ‬ ‫‪L‬ﻉع‬
‫‪ L‬ﻊ عﻊ‬
‫ﺿﻊ‬ ‫ﺾ‬ ‫ﺾ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫)‬ ‫‪L‬‬
‫ﻊ‬ ‫ع‬ ‫ﺃ‬ ‫ع ع‬ ‫ﻊ‬ ‫ع‬ ‫‪L‬‬
‫ﺿ‬ ‫ﻉع‬ ‫ﻊ ع‬ ‫ﺄﻊ‬ ‫ﻊ‬ ‫‪L‬‬
‫ﻊ ﺾ‬ ‫ع‬ ‫‪L‬‬
‫ع‬ ‫ع‬ ‫‪L‬‬
‫ع‬ ‫ﻊ‬ ‫‪ L‬ﺈع ﻊ‬
‫ع ﺾ‬ ‫ﻊﺑ عﺃ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫‪L‬‬

‫‪or‬‬ ‫ﺿﻊ‬


640 UNIT II Promoting Healthy Physiologic Responses

• 12-10 Administering a Continuous Closed Bladder Irrigation continued

ASSESSMENT Verify the order in the medical record for continuous bladder irrigation, including type and amount
of irrigant. Assess the catheter to ensure that it has an irrigation port (if the patient has an indwelling

catheter already in place). Assess the characteristics of urine present in tubing and drainage bag.

Review the patient’s medical record for, and ask the patient about, any allergies to medications.
Before performing the procedure, assess the bladder for fullness either by palpation or with a hand-

held bladder ultrasound device. Assess for signs of adverse effects, which may include pain, bladder

spasm, bladder distension/fullness, or lack of drainage from the catheter.

NURSING DIAGNOSIS Determine related factors for the nursing diagnosis based on the patient’s current status. Appropri-
ate nursing diagnoses may include:

• Impaired Urinary Elimination

• Risk for Infection

OUTCOME The expected outcome to achieve is that the patient exhibits free-flowing urine through the catheter.

IDENTIFICATION Initially, clots or debris may be noted. These should decrease over time, with the patient ultimately

AND PLANNING exhibiting urine that is free of clots or debris. Other outcomes may include the following: the con-
tinuous bladder irrigation continues without adverse effect; drainage is greater than the hourly

amount of irrigation solution being placed in bladder; and the patient exhibits no signs and symp-

toms of infection.

IMPLEMENTATION

ACTION R AT I O N A L E

1. Confirm the order for catheter irrigation in the medical record. Verifying the medical order ensures that the correct intervention is
Calculate the drip rate via gravity infusion for the prescribed administered to the right patient. Solution must be administered

infusion rate. via gravity at the appropriate rate as prescribed.

2. Bring necessary equipment to the bedside. Bringing everything to the bedside conserves time and energy.

Arranging items nearby is convenient, saves time, and avoids

unnecessary stretching and twisting of muscles on the part of

the nurse.

3. Perform hand hygiene and put on PPE, if Hand hygiene and PPE prevent the spread of microorganisms.

indicated. PPE is required based on transmission precautions.

4. Identify the patient. Identifying the patient ensures the right patient receives the inter-

vention and helps prevent errors.

5. Close curtains around the bed and close the door to the room, This ensures the patient’s privacy. This discussion promotes reas-

if possible. Discuss the procedure with patient. surance and provides knowledge about the procedure. Dialogue
encourages patient participation and allows for individualized

nursing care.

6. Adjust bed to comfortable working height, usually elbow Having the bed at the proper height prevents back and muscle

height of the caregiver (VISN 8 Patient Safety Center, strain.

2009).

7. Empty the catheter drainage bag and measure the amount of Emptying the drainage bag allows for accurate assessment of

urine, noting the amount and characteristics of the urine. drainage after the irrigation solution is instilled. Assessment of

urine provides baseline for future comparison.

8. Assist patient to comfortable position and expose the irriga- This provides adequate visualization. Waterproof pad protects the
tion port on the catheter setup. Place waterproof pad under the patient and bed from leakage.

catheter and aspiration port.

 ‫ﻊ‬ ‫ﺾﺾ‬ ‫ﻊﺈ‬ ‫عع‬ ‫ﻊ‬ ‫ﻊ ع‬ ‫ﻊﺾ‬

‫ع‬
‫ﺿﻊ‬
‫ﻊ‪23‬‬ ‫ﻊ ﻰ‬ ‫ﻊ‬ ‫ﻊ‬ ‫‪L‬‬

‫ﻉ ع‬ ‫ﻋ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺾ ﺿ‬ ‫عﺃ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊب ﺃ ﻊ‬ ‫ﺏ‬

‫ﺃ‬ ‫ﻊ ﺾ ﻊ ﺾ ﺾ‬ ‫ع‬ ‫ع ع عﺈ‬ ‫ع ﺃ‬ ‫ﻊ‬ ‫ﻊ ع‬ ‫ﺈ‬ ‫ﺾ‬
‫ﻊ‬ ‫ﻊ ﻊ‬ ‫ﺐ ﺿ‬ ‫ع‬ ‫ﻉ‬ ‫ﺿﻊ ﻋ ﻊ‬ ‫ﻊ‬ ‫ﻊ ﻊ‬ ‫ﺿﻊ‬ ‫ﻊب ع‬
‫ع ﻊﺒ ع ﻊ‬ ‫ع‬ ‫ﺾ‬ ‫ع ﻊ ﺾ ع ﺃﺾ ﻊ ﺾ ﻊ‬ ‫ﻊ‬ ‫ﻉﺿ ع‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ ع‬
‫ﻊ‬ ‫ﺄ‬ ‫ﻊ‬ ‫ﻉﺿ‬ ‫ﻊ ع‬ ‫ﻊ‬ ‫ﺿﻊ ﺈع‬ ‫ﻊ ع‬ ‫ﺿ‬ ‫ﻊب‬ ‫ﺿﻊ‬

‫ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ ع‬ ‫ﻊ‬ ‫ع‬ ‫ع‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ ﺾﻊ‬ ‫ﻊ‬ ‫ﻊ‬
‫ع‬ ‫ع‬ ‫ﻊ‬
‫ﺃ ﻊ ﺾ‬ ‫‪L‬‬
‫ﻊ ﺿ‬ ‫‪L‬‬

‫ع‬ ‫ع ﻉﺿ ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺃ ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺾ‬ ‫ﻉ ﻊ‬ ‫ع‬ ‫ﺾ‬ ‫ﻊ‬ ‫ﺿﻊ‬ ‫ﺇ‬
‫ﻊ ع‬ ‫ع‬ ‫ﻉﺿ ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ع ع‬ ‫ﺾ‬ ‫ع‬ ‫ﺃ ﻊ‬ ‫ﻊ‬ ‫ﺿ ﻊﺾ‬ ‫ﺈ‬ ‫ﻉ‬ ‫ﻯ‬
‫ﻊ ﺾ ﺾ ﺃ‬ ‫ع‬ ‫ع‬ ‫ﺾ ﻊ‬ ‫ﻉ‬ ‫ع ﻊ‬
‫ﺿ‬
‫ﻋ‬ ‫ع ﺿ‬
‫ع ﺿﻉ ﻊ‬ ‫ﻉ‬
‫ﻊ‬ ‫ﻊ‬
‫ﻊ‬
‫ع‬
‫ﺿ‬ ‫ع‬
‫ﻊب‬
‫ﻊ‬
‫‪doozy‬‬
‫ﻊ‬

‫ب‬

‫ﻉﻉ‬ ‫ﻊ‬ ‫ﻉ‬

‫ﻊ‪A‬‬ ‫ﻉعﻉعﻊ‬ ‫ﻉﻉ‬
‫‪To‬‬
‫ﻉعﻉعﻊ‬

‫ﻯ ﺾ‬ ‫ﻊ‬ ‫ﻉ ﻊ‬ ‫ﻊ‬ ‫ﻊب‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺃ ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﻋ‬
‫ع‬ ‫ﻊ ع‬ ‫ﺾ‬ ‫ﻊ ﻊ‬ ‫ﻉ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ع ع‬ ‫ﻊ‬
‫ﺾ‬ ‫ﺾﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬
‫ﺿﻊ ع‬ ‫ﺾﺃ ﻊ ﺾ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ع ﻊ‬
‫ﺿﻊ ﺾﻊ ﺁ‬ ‫ﻊ‬ ‫ﺿ‬ ‫ع ﺿ ﺾﺃ ﻊ ﺾ‬ ‫ﻉ ﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬
‫ﻊ‬ ‫ع‬ ‫ﺿ‬ ‫ﻊ‬

‫ﻊ‬ ‫ع‬ ‫ع ﻊ ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺿ‬ ‫عﺃ ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊﺾ ع‬ ‫ﻊ‬ ‫ﺿﻊ‬ ‫ﺄﻊ‬
‫ﻊ‬ ‫ع ع‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ ﻊ‬ ‫ﺾ‬ ‫ﻊب‬

‫ع‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻉ‬ ‫ﻊ‬ ‫ﺾ‬ ‫ﻊ‬ ‫ﻊ‬

‫‪G‬‬ ‫‪EA‬‬ ‫ع‬ ‫ﻊب‬ ‫ع‬ ‫ﺿ‬
‫‪an‬‬

‫‪C‬‬ ‫ﻊﻊ ع‬ ‫ﻊ‬ ‫ﺾ‬ ‫ﻊ‬ ‫ﻊﺑ ﻊ‬ ‫ع‬ ‫ﻉ‬ ‫ﻊﻰ ﺃ‬ ‫ع‬ ‫ﺿﻉﺁ‬ ‫ﺾ ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﺇ ﻉﺁ‬
‫ع‬ ‫ﻯ‬ ‫ﺿ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ ﺾﻊ‬ ‫ﺾ ﻊﺑ ﻊ‬ ‫ﺃ‬ ‫ﺿ ﺾﺃ ﻊ‬ ‫ﻊ‬
‫‪C‬‬ ‫ﺃ‬

‫ﺿﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ ﺈع‬ ‫ﺿ ﺾ ﻊ‬ ‫ﺾ ﻊ ﺈع ﻊ ﺾ‬ ‫ع‬ ‫ﻯ ﺿ ع‬ ‫ﻊ‬ ‫ﻊ ﺈع ﻊ‬ ‫ﻊ‬ ‫ﻊ‬

‫ﻉ‬ ‫)‬ ‫ﺎ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬

‫ﻌ ﻊ‬ ‫ﻊ‬ ‫ﻯ ﺈ ﺂ‬ ‫ﻊ ﺾ‬ ‫ﺿ ع‬ ‫ﺄﻊ‬ ‫ﺃ ﻊى‬

‫ع‬ ‫ﻊب ع‬ ‫ﻊ ﺾ‬ ‫ﺾﺃ‬ ‫ﺾ ﻊ‬ ‫ﺁ‬ ‫ﻊ‬ ‫ﻊ ﺾ‬ ‫ع‬ ‫ﺿ‬
‫ﻊ‬
‫ع‬ ‫عﺿ‬ ‫ﺿ ع‬ ‫ﺾ ﻊ عﺃ‬ ‫ﻊ ﺾﺃ ﻊ‬ ‫ﻊ ﻊ‬ ‫ﺄ ﺈ ﻊ‬ ‫ﻯﺿ‬ ‫ﺃ ﺿ‬ ‫ﻊ‬ ‫ع‬ ‫ﺎ‬
‫ﻊ‬ ‫ﺿﻊ‬ ‫ﻊ‬ ‫ﺈ‬ ‫ﺿ ﺈ ﻊ‬ ‫ﻊ‬ ‫ع‬ ‫عﺿ‬ ‫ﺿ ع‬


CHAPTER 12 Urinary Elimination 641

ACTION R AT I O N A L E

9. Prepare sterile irrigation bag for use as directed by manufac- Proper labeling provides accurate information for caregivers. Ster-

turer. Clearly label the solution as ‘Bladder Irrigant.’ Include ile solution not used within 24 hours of opening should be dis-
the date and time on the label. Hang bag on IV pole 2.5 to carded. Aseptic technique prevents contamination of solution

3 feet above the level of the patient’s bladder. Secure tubing irrigation system. Priming the tubing before attaching irrigation

clamp and insert sterile tubing with drip chamber to container clears air from the tubing that might cause bladder distention.
using aseptic technique (Figure 2). Release clamp and remove

protective cover on end of tubing without contaminating it.

Allow solution to flush tubing and remove air (Figure 3).

Clamp tubing and replace end cover.

FIGURE 2. Inserting tubing into solution bag. FIGURE 3. Removing air from irrigation tubing.

10. Put on gloves. Cleanse the irrigation port on the catheter Aseptic technique prevents the spread of microorganisms into the

with an alcohol swab. Using aseptic technique, attach irri- bladder.

gation tubing to irrigation port of three-way indwelling

catheter (Figure 4).

11. Check the drainage tubing to make sure clamp, if present, is An open clamp prevents accumulation of solution in the bladder.
open.

12. Release clamp on irrigation tubing and regulate flow at This allows for continual gentle irrigation without causing dis-

determined drip rate, according to the ordered rate (Fig- comfort to the patient. An electronic infusion device regulates

ure 5). If the bladder irrigation is to be done with a medicated the flow of the medication.
solution, use an electronic infusion device to regulate the flow.

FIGURE 4. Attaching irrigation tubing to irrigation port on FIGURE 5. Regulating irrigation flow rate using flow clamp.

catheter.

(continued)

 ‫ﻊ ﻊ ﺾ‬ ‫ﻊﺑ‬ ‫ﻊﺈ‬

‫ﻉﻉ‬ ‫ﻊ‬ ‫ﻉ‬

‫ﻊ‪L‬‬ ‫ﻉعﻉعﻊ‬ ‫ﻉﻉ‬ ‫ﻉعﻉعﻊ‬

‫ﺿ‬ ‫ﻊ ع‬ ‫ﺾ ع‬ ‫ع‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﺾﺃ ﺿ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﺾ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬
‫ﻊﺈ ﻯ‬ ‫ع‬ ‫ﺾ ﻊ ﺄﻊ‬ ‫ﻊ‬ ‫ﺿﻊ ﺾ‬ ‫ﻊ ع‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬
‫ﺾ ﺾ‬ ‫ﻊ‬ ‫ع‬
‫ﺾ‬ ‫ﻊب ﺾ‬ ‫ﺾ‬ ‫ع‬ ‫ع ﻊ‬ ‫ﺾ‬ ‫ﻊ‬ ‫ﺾ‬ ‫ﺃﺾ‬ ‫ﻉ ﻊ‬ ‫ﺇ‬ ‫ﻊﺾ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬
‫ﺃ ﻊ ﺈع ﻊ ع‬ ‫ﻊب ﺾ ﻊ‬ ‫ﻊ ﺾﻊ‬ ‫ﻊ‬ ‫ﺁﺃ‬ ‫ﻊ ﻉع‬ ‫ﺿ‬ ‫ﻊب ع‬ ‫ﻊ‬ ‫ﻋ‬ ‫ع ﻊ‬
‫ﻌﻊ‬ ‫ﺿ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫عﺿ ع‬ ‫ع‬
‫ﻉع‬ ‫ﻊﻊ‬ ‫ﺈﺾ‬ ‫ﻯ‬ ‫ﺾ‬ ‫ﺿ‬ ‫ع ﻊب ﺾ‬ ‫ﻊ ﻰ ع ﻊ ﺾﻊ‬
‫ﺃ‬ ‫ﻊ ﻊﻰ ع ﻊ‬ ‫ﺿﻊ‬ ‫ﻉ ﺾ ﻊ‬ ‫ﺿﻊ ﺾﻊ ﻊﺑ ﻊ ﻊ‬

‫ﻊ‬ ‫ﻉع‬ ‫ﻊ ﺾﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺾ‬ ‫ﻊ‬ ‫ﺃ‬ ‫ع ﻊب ﺾ‬ ‫ﻊ‬

‫ﺃ‬ ‫ﻊ‬ ‫ع‬ ‫ع ﻊ ع‬ ‫ﻊ‬ ‫ﻊ‬

‫ع‬
‫ﻊ‪sotherm‬‬ ‫ع‬
‫ع‬
‫ﻊ‬ ‫ﺏ‬ ‫ع ﻊ‬
‫ﻊﺏ‬
‫ﻊ‬
‫ﻊ‬ ‫ﺎﺍ‬
‫ﺐ ﻌ ﺍعﺑ ﻉ ع‬
‫ﻊ ﻊ ﺈع ﻊ‬
‫ﻊ ﺏ‬ ‫ﺏ‬
‫ﺄ‬ ‫ﻊ‬ ‫عﻯع‬ ‫ﻊ‬

‫ع‬ ‫ﺾ ﺃ ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ ﺈﺾ‬ ‫ﻊ‬ ‫ﺈﺾ‬ ‫ﺿ‬ ‫ﻉ ﻊ‬ ‫ﻋ‬ ‫ﻊ‬ ‫ﻉ ﺾ‬ ‫ﻊﺃ‬

‫ﺃ‬ ‫ﺿ ﻊ‬ ‫ﺄﻊ‬ ‫ﻊ‬ ‫ﻯ‬ ‫ﻊ‬ ‫ﺏ‬ ‫ﻊ‬ ‫ﺍب‬ ‫ﻊ‬ ‫ﺐ‬ ‫ﻊ‬ ‫ﻉع‬ ‫ﻊ‬ ‫ﺇ‬
‫ﻊ ﺿﻊ‬ ‫ﺃ‬ ‫ﺿ‬ ‫ﻊﺑ‬ ‫ع ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺍﺏع‬ ‫ﻊ‬
‫ﺃ‬ ‫ﻊ‬ ‫ﺿ‬ ‫ﻊﺑ‬ ‫ع ﻊ‬ ‫ﺃع‬ ‫ﺾ‬ ‫ع‬ ‫ﻊ‬

‫ﻊﻊ‬ ‫ﺃﺾ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺃﺾ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﺈ ﻊ‬ ‫ﻊ‬ ‫ﻊ ﺾ‬ ‫ﺄ‬ ‫ﻊ‬

‫ﺿﻊ‬


642 UNIT II Promoting Healthy Physiologic Responses

• 12-10 Administering a Continuous Closed Bladder Irrigation continued

ACTION R AT I O N A L E

13. Remove gloves. Assist the patient to a comfortable position. Positioning and covering provide warmth and promote comfort

Cover the patient with bed linens. Place the bed in the lowest and safety.
position.

14. Assess patient’s response to the procedure, and quality and Assessment is necessary to determine effectiveness of intervention

amount of drainage. and detection of adverse effects.

15. Remove equipment. Remove gloves and addi- Proper disposal of equipment prevents transmission of microor-

tional PPE, if used. Perform hand hygiene. ganisms. Removing PPE properly reduces the risk for infection
transmission and contamination of other items. Hand hygiene

prevents the spread of microorganisms.

16. As irrigation fluid container nears empty, clamp the admin- This eliminates the need to separate tubing from the catheter and

istration tubing. Do not allow drip chamber to empty. clear air from the tubing. Opening the drainage system provides
Disconnect empty bag and attach a new full irrigation access for microorganisms.

solution bag.

17. Put on gloves and empty drainage collection bag as each new Gloves protect against exposure to blood, body fluids, and

container is hung and recorded. microorganisms.

EVALUATION The expected outcome is met when urine flows freely through the catheter. Effectiveness of therapy

is determined by the urine characteristics. On completion of the therapy with a continuous bladder

irrigation, the patient should exhibit urine that is clear, without evidence of clots or debris. Other
outcomes would include the following: the continuous bladder irrigation is administered without

adverse effect; drainage is greater than the hourly amount of irrigation solution being instilled in

bladder; and the patient exhibits no signs and symptoms of infection.

DOCUMENTATION

Guidelines Document baseline assessment of patient. Document the amount and type of irrigation solution

used and the patient’s tolerance of the procedure. Record urine amount emptied from the
drainage bag before the procedure and the amount of irrigant used on intake and output

record. Record the amount of urine and irrigant emptied from the drainage bag. Subtract

the amount of irrigant instilled from the total volume of drainage to obtain the volume
of urine output.

Sample Documentation
12/14/12 1330 Foley catheter replaced with 3-way Foley catheter. Bladder nonpalpable.

Continuous bladder irrigation with normal saline initiated at 100 mL/hour. Patient tolerated

procedure without adverse effect. Drainage from bladder slightly cloudy, light cherry col-
ored. No evidence of clots.

—B. Clapp, RN

UNEXPECTED • Continuous bladder irrigation begins and hourly drainage is less than amount of irrigation being
given: Palpate for bladder distention. If patient is lying supine, rolling the patient onto his or her

SITUATIONS AND
side may help increase the amount of drainage. Check to make sure that the tubing is not kinked.
ASSOCIATED

INTERVENTIONS If return flow remains decreased, notify physician.

• Bladder irrigation is not flowing at ordered rate, even with clamp wide open: Check the tubing
for kinks or pressure points. Raise the bag 3 to 6 inches and then check flow of irrigation solu-

tion. Frequently check flow rate of irrigation solution.

 ‫ﻊ‬ ‫ﺾﺾ‬ ‫ﻊﺈ‬ ‫عع‬ ‫ﻊ‬ ‫ﻊ ع‬ ‫ﻊﺾ‬

‫ﺿﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ ﻰ‬ ‫ﻊ‬ ‫ﻊ‬ ‫‪L‬‬

‫ﻊ ﻊ‬ ‫ﺿ‬ ‫ﺿﻊ ﻰ ع ﻊ‬
‫ﻉﻉ‬ ‫ﻉعﻉعﻊ‬‫ﻊ‬ ‫ﻉﻉ‬

‫ﺿﻊ‬
‫‪good‬‬
‫ﺾﺃ ﻊ ﺾ‬
‫ﺿ‬
‫ﻯ‬
‫ﺃ ﻉ‬ ‫ﻊ‬
‫ﺃ ﺿ‬
‫ﻊ‬
‫ﻊ‬ ‫‪ AG‬ع‬
‫ﻋﺁ‬ ‫ﻊ‬
‫ﻉعﻉعﻊ‬

‫ﺈع ﻊ‬
‫ﻊ‬
‫‪gg‬‬
‫ﻰ‬
‫ﻉ‬

‫ﻊ‬ ‫ﺃ ع‬ ‫ﺿ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺿ‬ ‫ﺿﺾ‬ ‫ﺏ ﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬

‫ﻊﺒ ع ﻊ ع‬ ‫ﺄ‬ ‫ﺿﻊ‬
‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊﺾ ع‬ ‫ﻊ‬ ‫ﺿ‬ ‫ﻊ ﺈع ﻊ‬ ‫ﻌﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺇ‬
‫ﺿ‬ ‫ع ﻊ‬ ‫ﻊ‬ ‫ﻯ‬ ‫ﻊ‬ ‫ﻊ ﻊﺾ ع‬ ‫ﻊ‬ ‫عﺃ ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ ﻊ‬ ‫ﻊﺑ عﺃ‬ ‫ﻊ‬
‫"‬ ‫ﻊ‬ ‫ع‬ ‫ع ﻊ ع‬ ‫ﻊ‬ ‫عﺃ ﻊ‬ ‫ﻊب‬ ‫ﻊ ع‬ ‫ﺿ ﺾ‬

‫ﺿ‬ ‫ﻊ‬ ‫ﻊب ع‬ ‫ﺃ‬ ‫ﻊ ﻰ ﻊ ع‬ ‫ﻊﺑ ﻊ‬ ‫ﻉ ﺾ‬ ‫ﺃع ﺁ‬ ‫ﻊ‬ ‫ﺾﻊ‬ ‫عﺿ‬ ‫ع‬
‫ﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﺿ ﺾ ﻊ ع‬ ‫ع ﻊ‬ ‫ﺾﺃ ﺃ ﻯ‬ ‫ﻊب ﺾ‬ ‫ﻊ ﺾﻊ ﻊ‬ ‫ع‬ ‫ﺾ‬ ‫ﻊ ﺈع ى ﺿﻉ ﺃ‬ ‫ﻊ‬ ‫ﺈ ى ﻊﺃ‬ ‫ﺁﺃ ﻊ‬

‫ﺿ‬ ‫ﻊ‬ ‫ﺿ ﺾﻊ‬ ‫ﻊ‬ ‫ﻊ ﺈع ﻊ‬ ‫ﺿ‬ ‫ﻊ ﺈع ﺁ‬ ‫ﻊ‬ ‫ﺿﻉ ع‬ ‫ﻊ ﺈع ﻊ‬ ‫ﻊ‬

‫ﻊ‬ ‫ﻊ ع ع‬ ‫عﺿ‬

‫ﻊ ﺾ‬ ‫ع‬ ‫ﻊ‬ ‫ﺃ ع‬ ‫ﻊ‬ ‫ﻊ ﺾ‬ ‫ﺃ‬ ‫ع‬ ‫ﺾ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺏ‬

‫ع‬ ‫ﻉﺿ‬ ‫ع‬ ‫ﺿ ﺾ‬ ‫ﺿ‬ ‫ع‬ ‫ﺾ ﺿﻊ‬ ‫ﻉ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﻊ‬
‫ع‬ ‫ع‬ ‫ﺾ ﻊ‬ ‫ﻉ‬ ‫ع ﻊ‬ ‫ﻋ‬ ‫ع ﺿ‬ ‫ﻊ‬ ‫ﻊ ﻊ‬ ‫ع‬ ‫ﻊب‬ ‫ﻊ ع‬
‫ﺿ‬ ‫ع ﺿﻉ ﻊ‬ ‫ﻉ‬ ‫ﻊ‬ ‫ﺿ‬ ‫ع‬ ‫عﺃ ﻊ‬ ‫ﺁ‬ ‫ﻊ‬

‫ب‬
‫ﻊ ﺾ‬ ‫ﺏ ﻊ‬ ‫ﻊ‬ ‫ﺿ‬ ‫ﻊ‬ ‫ﺾ ﻊ‬ ‫ﺿﺾ‬ ‫ﺾ‬ ‫ﻊب ع‬ ‫ﺾ‬ ‫ع‬ ‫ﻊ‬ ‫ﻊﺏ ﻊ‬
‫ﻊ ﺾ‬ ‫ع‬ ‫ﺾ ﺿﻊ‬ ‫ﻊ‬ ‫ﺃ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊﺑ ﻊ ﺿ‬ ‫ﻊ‬ ‫ﺃ ﻊﺁ ع‬ ‫ﻊ‬
‫ﺇ‬ ‫ﺎ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺃ ﻊﺁ‬ ‫ﻊ‬ ‫ع‬ ‫ﺿﻊ‬
‫ﻊ ع‬ ‫ﻊ‬

‫ب‬ ‫ﻊ‬
‫ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ﺾ‬ ‫ﻊ ع ﺁ‬ ‫ع ع‬ ‫ﻊ‬ ‫ﺃﺾ‬ ‫ﺃﺾ‬ ‫ﻊ‬ ‫ﻊ‬
‫ﺁع‬ ‫ع‬ ‫ﻊ‬ ‫ع ﻊ‬ ‫ﺿ ع‬ ‫ﻊ‬ ‫ﻊ‬ ‫ع‬ ‫ﻉ‬ ‫ع‬ ‫ﺾ‬
‫ع‬ ‫ﺾ‬ ‫ﻊ ﺈع ﻯ‬ ‫ﺾ ﻊ‬

‫‪B‬‬
‫ﻊ‬ ‫ﻉ‬ ‫ع‬ ‫ع‬ ‫ع ﺿ ﺾ ﻊ‬ ‫ﻊ‬ ‫ﻉﻊ‬ ‫‪L‬‬ ‫ﺐ‬ ‫ﺃ‬
‫ع‬ ‫عﺃ‬ ‫ﻉﺿ ع‬ ‫ع‬

‫ﻊب ﺾ‬
‫ﻊ‬

‫ﻊﺃ‬
‫ﻊ‬
‫ﻉ‬

‫ﻊ‬
‫ﻊ ع‬
‫ع‬
‫ﻊ ﺈع‬

‫ﺈﺾ ع‬
‫ﺃ‬
‫ﻊﻊ‬
‫ع‬

‫ﺿ ﺾ ﻊ‬
‫ﺾ‬ ‫ﺁ‬
‫ﻊ ع ﻊ‬
‫ﻉ ﻊب ﺾ‬

‫ﺾ‬
‫ﺈع ﻊ ع‬
‫ﻋ‬

‫ﻊ‬ ‫ﻊ ع ع‬
‫ﻯ ﻊ‬
‫ﻊ‬

‫‪L‬‬
‫‪safe‬‬ ‫ﻊﺐﺎ‬ ‫ﻊ‬

‫ﻊ‬

‫ﺾ ﻊ‬ ‫ﺃ‬ ‫ﻊﺃ‬ ‫ﺾ ع‬ ‫ﻊﺃ ﻊ‬ ‫ﻉﺿ ع ﻊ ﻰ‬ ‫ﺾﻊ ﻊ‬

‫ﺾ ﻊ‬ ‫ﺃ‬