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CBI Flashcards

1
Q

what are the two types of catheter irrigation

A

closed and open irigation

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2
Q

what does closed irrigation involve

A

• Closed = intermittent or cont of urinary caether w/o disrupting sterile connection b/t catheter + drainage sys

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3
Q

what does intermittent irrigation entail

A

• Intermittent – insertion of sterile catheter into catheter port to irrigate a bolus of fluid

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4
Q

what is CBI

A

• Continuous Bladder (CBI) = continuous infusion of sterile soln into bladder, usually using 3-way irrigation sys w triple=lumen cath; used post GU sx to keep bladder clear + free of clots

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5
Q

can you do open cath irrigation continuously

what is it

A

no
• Open = only used when intermittent. Involves breaking or opening closed drainage sys at connection b/t cath + drainage sys.

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6
Q

should open irrigation be practied routinely even if no evidence of obstr

A

This should be avoided unless irrigation needed to relieve or prevent obstr; strict asepsis to prevent UTI,

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7
Q

aside from removing clots why might closed or open irrigation be used

A

to infuse meds

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8
Q

would single, double or triple lumens be used with open or continuous

A

triple=continuous or intermittent. continuous could also be double lumen
double or single=open

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9
Q

what to check in medical record before starting procedure

A

• Verify order: method (cont or intermit), type (NS or medication soln) + amount of irrigant; type of catheter in place

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10
Q

what to physically assess before starting procedure

A
  • Palpate bladder for distension + tenderness (to see if blocked)
  • Abd pains + spasms, sensation of fullness in bladder or cath bypassing (leaking) – shows if blockage, gets baseline to see tx effectiveness
  • Urine for colour, amount, clarity, presence of mucus, clots, sediment (shows if pt bleeding or sloughing, requiring inc irrigation rate
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11
Q

IF CBI

should pt have higher input or ouptut. why? what to check?

A

output.

if input isnt > than input suspect cath obstr (clots, kinked tubing), irrigation stopped, prescriber notified

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12
Q

what would expected outcomes or goals of care be

A
  • Urine output greater than irrigating soln instilled (if CBI)
  • Pt reports relief from bladder pain/spasm
  • Urine output dec w absence of blood clots + sediment (urine will be bloody following sx, gradually lighter + blood tinged in 2-3d)
  • Absence of fever, lower abd pain, clour or foul-smelling urine
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13
Q

when closed irrigation and fresh post op how often miht you empty bag

A

1-2hrs

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14
Q

closed irrigation. what determines how fast you make the flow rate

A

the color of the output.

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15
Q

if output is red with clots what do you do (from closed continuous irrigation)

A

inc rate until pink

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16
Q

closed continuous irrigation procedure

A

a. Hang bag of irrigating soln to IV pole, prime
b. Connect to drainage port of Y-connector on cath
c. Adjust clamp to desired rate (if bright red irrigation, inc rate until pink)
d. Observe for outflow, ensure no bladder distension; Empty drainage bag as needed

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17
Q

supplies nec for closed intermittent irrigation

A

sterile container
sterile 30-60ml irrigation syringe
syringe to access system
screw clamp or rubber band (to occlude cath)

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18
Q

supplies for closed continuous irigation

A

irrigtion tubin w clamp to reg flow rate
y connector (optional)
IV pole

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19
Q

supplies for open intermittent

A

disposable sterile irrigation kit that has soln container, collection basin, drape, sterile gloves, 30-60ml irrigation syringe
sterile cath plug
sterile gloves

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20
Q

closed intermittent irrigation procedure

A

a. Pour prescribed sterile irrigation into container
b. Draw prescribed amount (usually 30-50ml) into syringe using aseptic technique. Place sterile cap on top of syringe
c. Clamp cath below soft injection port w screw clamp (or fold + secure w rubber band) – allows irrigation soln to enter cath
d. Clean cath port (specimen port) with antiseptic swab
e. Inject soln using even pressure – minimize trauma to baldder mucosa
f. Remove syringe + open up clamped tubing - some may be required to remain in bladder for prescribed time (such as medications)
i. Do not leave clamped cath unattended

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21
Q

open intermittent irrigation method

A

a. May need sterile gloves
b. Prep sterile tray
c. Sterile drape under cath
d. Aspirate soln into syringe (usually 60mL)
e. Move sterile collection basin close to pt thigh
f. Wipe connection port b/t cath + drainage tubing before disconnecting
g. Disconnect cath from drainage tube. Cover open end of drainage tube w sterile protective cap + pos tubing so coiled on top of bed w end on sterile drape
h. Instill soln
i. Remove syringe + allow soln to drain into collection basin ; if ordered repeat instillation until drainage clear of clots + sediment
j. Clean end of drainage tubing + reinsert into cath

heidi says no one drains it into basins

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22
Q

what might you remove at the start of cath irrigation that you would reapply after

A

possibly the cath securement device

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23
Q

to irrigate do you use push pause
much force
continuous P?
what to do if firm resistanc

A

gentle pressure to prevent trauma to bladder

dont force. the cath may be completely ocluded and need to be changed

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24
Q

how to det urine output

A

• Meaures urine output (total vol drained – total instilled)

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25
Q

what do you eval after bladder irrigation

A
  • Meaures urine output (total vol drained – total instilled)
  • Review I+O sheet
  • Inspect urine for blood clots + sediment, ensure tubing not clogged or kinkede
  • Eval pt comfort level
  • Signs + symptoms of infect
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26
Q

how much oral intake should pt have (unless contra)

A

2l

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27
Q

how long do you expect bright red tinged urine postop

A

48hrs

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28
Q

what to do if Irrigating soln does not return (intermittent) or is not flowing at prescribing rate (CBI)

A

Examine tube for clots, sediment, kinks

Notify HCP if irrigant does not flow freely from bladder, pt complains of pain, or bladder distension occurs

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29
Q

Drainage output < irrigation infused

what to do?

A

Examine tube for clots, sediment, kinks
Inspect urine for presence of or inc of blood clots + sediment
Eval pt for pain + distended bladder
Notify HCP

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30
Q

Bright-red bleeding with irrigation (CBI) infusion wide open what to do

A

Assess for shock

Leave wide open + notify HCP

31
Q

Pt experiences pain w irrigation what to do?

A

Examine for occlusion
Eval urine for clots
Eval distended bladder
Notify HCP

32
Q

pt presents with signs of infect what to do?

A

Notify HCP, monitor vitals + characteristics of urine

33
Q

post trans urethral resection of the prostate what med might they give to help keep cath patent

A

• Lasix may be prescribed to promote urine flow + prevent obstruction

34
Q

what is the danger with cath obstr and TURP

A

• After TURP, obstructed cath = distension of prostatic capsule + hem

35
Q

what colour shift indicates reduced bleeding post TURP

A

from pink to amber

36
Q

what is a major risk for TURP pt and what do you consequently monitor

A

hemorrhage

monitor for HoTN, reg shock stuff

37
Q

if pt complains of pain post TURP what to do

A

check tubing, check pt, irrigate (ensuring you get the same amount backt hat you put in

38
Q

why is it bad to let bladder overdistend

A

it can induce 2’ hemorrhage by stretching the coagulated blood vessels in the prostatic capsule

39
Q

why does pt still get urge to void with cath in

A

from presence of cath and from bladder spasms

40
Q

do you infuse 60 x 2??

A

yes. the first is a cushion (see later)

41
Q

how many L are irigation bags

hang just one for CBI?

A

3l

have two running at same rate

42
Q

do you run CBI through the pump?

A

reg with clamp?? acording to handout

43
Q

t or f your returns are unequal in your CBI setup. You should check the pt for bladder distention and then manually irrigate

A

F always check the tubing and system before breaking the system as this opens them up to infection

44
Q

CBI

how often to palpate abd/bladder and when to do this more often

A

q1-2h and if bleeding then more often

45
Q

stopped page 2 of handout now ppt

indicatiosn for CBI

A

To prevent formation of and to remove blood clots in the patient’s bladder
To instill medication (eg for severe bladder infection)
To prevent venous hemorrhage following genitourinary surgery
Continuous irrigation can also be used to treat an irritated, inflamed or infected bladder lining.

-post GU sx eg TUPR removal of bladder tumour

46
Q

who inserts triple lumen cath and how much are they gen inflated with

A

surgeon in OR does it and often uses 30ml to inflate

47
Q

when the urine is what color can the CBI be removed

who can do this

what might be done before removal and why

A

rose colored output. still require order

nurse can remove

Prior to discontinuing a triple lumen catheter often you will see that the Dr. will order to clamp the CBI for a few hours while the nurse is to observe the patients urine. Doing so allows the nurse to see if the patient begins to bleed without the irrigation of the CBI fluid running (which would cause catheter obstruction).
When the urine is light pink to clear it is a good sign. when clamped for an hr and then opened ad the new drainage darkens to mod sanguineous tinge recommence CBI and clamp again in 1hr

48
Q

what type of bleeding requires traction post TURP. what fx does this serve

A

arterial bleed which is bright red and has clots. venous gen doesnt need traction.

it prevents hemorrhage

49
Q

pt requires traction post TURP how is this done and

A

If bleeding occurs the catheter is applied with traction (usually adhered to the upper thigh in some way) so that the catheter remains in the prostatic fossa (the area that had prostate and is now empty).

To apply traction the specialized nurse firmly grasps the catheter approximately 6 inches above the 3-way junction (with a Dr.’s order) and pulls firmly until catheter is taut. The catheter is then taped.

50
Q

with traction during TURP what are your concerns

A

Once traction is placed, blood pressure and pulse will be taken regularly. The effectiveness of the traction will be assessed.
Check policy for frequency of these assessments. Traction time is limited as traction can cause necrosis of tissue

51
Q

pt is fresh post op with CBI going when do you dec the freq of your checks. what freq do you use initially

how freq do you check output

A

Assess drainage system q30 minutes until flow is consistently pink to clear in color, then q4H for duration of CBI

Assess urinary & irrigant output q2h
Returns - irrigant used = urinary output

52
Q

beyond assessing output and the char of drainage what are you assessing and how regularly (if no abn)

A

Assess Q4H & PRN:
VS q4H
Patient comfort r/t instillation of fluid
Patency of systems

Assess q8H &amp; PRN:
For fluid leaking around the catheter
Condition of urinary meatus 
Inflow obstruction/outflow obstruction
Bladder distension
53
Q

what are the potential problems of CBI

A

Over-distension of the Bladder – Due to clot formation and obstruction of drainage system. May lead to increased bleeding/pain/rupture of bladder
Bleeding and Hemorrhage – Related to surgical process. Can be caused by over-distension of bladder
Pain – Meatal trauma due to tension on catheter. Bladder spasm related to over-distension
Infection – Nosocomial infections

54
Q

how clear should the returns be

A

clear enough to see your finger through the tubing

55
Q

if you see old red returns what do you do

A

irrigation might be nec

56
Q

. If flow does not return after irrigating with 30-50mls what to do

A

may need to aspirate for clots

57
Q

what is nec to dec pain

A

cath MUST be taped in place with stat lock device
antispasmodics…opioids

make sure bladder doesnt overdistend

58
Q

what is TUR syndrome

A

direct result of either absorption of irrigating fluid used during the sx procedure through venous sinuses opened by the resecion of prostate tissue and sometimes as a result of breaching of the prostatic capsule w fluid ollecting in the retroperitoneal space and absorbed from there

59
Q

how much vol of fluids is absorbed in TUR syndrome

why does this happen

A

10-30 ml per minute irrigating soln’ can be absorbed.

R/T prolonged resection time, increased volume of irrigation fluid, larger resected amount of prostatic tissue & elevation of height of irrigation bag

60
Q

early signs and symptoms of TUR syndrome

late mnfts

A 
Uneasy/vague apprehension
Headache &amp; dizziness
N &amp; V, abdominal distension
Hypertension
Bradycardia
Lethargic

late: Hypotension, Angina, Dyspnea, Hypoxia, Cardiovascular collapse, Neuromuscular disturbances, transient blindness, cerebral edema & coma.

61
Q

what should be reported to dr

A

1 Urine output is less than 30ml/hr over 2 consecutive hours
2 Dislodged urinary catheter (may need to be reinserted by surgeon)
3 Catheter obstruction (could be from a large clot) Try and clear catheter first by irrigating it (if orders permit) prior to calling physician
4 Excessive leakage around catheter
5 Unresolved bladder distension (could indicate clot blocking urine flow in catheter)
6 Onset of chills, shaking (could indicate hemorrhage, shock)
7 Severe, continuous bladder spasms
8 Neurological changes in lower extremities
9 If irrigant does not return
10 Bright red drainage continues with increased flow rate
11 Sudden change in color of urine
12 Abdominal pain
13 Change in VS

62
Q

what might excess leakage around cath indicate

A

(could indicate clot blocking urine flow in catheter)
spasm
obstr

63
Q

why might pt have continuous bladder spasms

A

(surgery to the lower abdominal area may weaken the bladder or pelvic floor muscles, or cause damage to the nerves that control the bladder.

  Bladder surgery (a common cause of bladder spasms in both children and adults)
  Prostatectomy (prostate removal)
  Other lower abdominal surgery
64
Q

how should bed be for pt if CBI

A

highest position to promote drainage

65
Q

what to document after irrigation

A 
Time irrigation started
Amount and type of irrigating solution
Character and changes in character of urinary returns
I&amp;O 
Urinary returns – irrigant = urinary output
Tolerance of procedure
Bladder spasms
Pain
,
66
Q

disharge teaching at home

A

Monitor for Complications at Home:
Infection:
Fever, chills, diaphoresis, myalgia, dysuria, urinary frequency & urgency
Bladder distension R/T spasms, UTI, clots:
Abdominal pain & bladder spasms, changes in urinary flow, dysuria.

67
Q

pg 2 handout

when getting a pt back from OR what do you assess in relation to CBI

what may not have been switched in OR

A

BAD
bag–make sure NS and not glycine. if glycine switch right away and fill out incident report.
abdm–palpate for distention
drainage–want to see fingers through tubing

68
Q

what does it mean to provide a cushion according to VIHa policy

A

instill 60ml, pinch off, instill 60more then withdraw 60…likely someone infused 60 then tried to withdraw from empty bladder and got some tissue caught. now we provide cushion toprevent this

69
Q

what is a challenge and when is this done

what happens

A

When catheter drainage light pink to clear clamp for 1 hour. Open clamp and if drainage light pink d/c and attach catheter to straight drainage bag.
o If drainage darkens to moderate sanguineous tinge recommence CBI and clamp again in 1 hour

70
Q

symptoms of bladder spasm

A 
sudden urge to void
o bearing down sensation
o catheter bypassing
o urge to have BM
o low abd/bladder discomfort
o penile discomfort
71
Q

pts with which sx require extreme caution for hand irrigating, you should consult w urologist befrehand

A

transurethral resection of bladder tumour–> might perforate the bladder

72
Q

irrigation bags should never be >___ above pt

A

3ft (higher can contribute to TUR syndrome)

73
Q

what PPE would you need? other supplies?

A

gloves, gown, face shield

alcohol swabs for between irrigating and accessing
waterproof pad for under pt
sterile basin and syringe
250ml or so sterile NS
sterile drape for under catheter (not sure if it comes in package)
sterile cap for the catheter bag that you disconnect when irigating
clamp

? maybe more

234342 (11 decks)

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