Continuous Bladder Irrigation Flashcards
CBI
continuous infusion of sterile solution into bladder, usually using a three-way irrigation closed system with a triple-lumen catheter
risk with irrigation
risk for UTI; must be done maintaining a closed urinary drainage system
example of when irrigation might be needed
after GU surgery where there is a high risk for catheter occlusion for blood clots
nursing diagnoses
RAID and risk for THF risk for infection acute pain impaired urinary elimination deficient knowledge
risk for tur syndrome
risk for hemorrhage
risk for fluid deficit
expected outcomes
- With CBI: urine output is greater than volume of irrigating solution instilled
- Pt reports relief of bladder pain or spasms
- Urine output has decreased with an absence of blood clots and sediment
- Absence of fever, lower abdominal pain, cloudy and/or foul-smelling urine
- Pt can explain purpose of procedure and what to expect
what is expected with urine output?
it will be bloody following bladder/urethral surgery, but will slowly become lighter and blood tinged in 2-3 days
how should patient be positioned during irrigation?
supine
if air enters the tubing what can it cause?
bladder spasms
what can occur from overdistention of the bladder when bladder irrigant cannot properly flow from bladder?
Discomfort, bladder distention, and possible injury can occur
how often may bag need to be emptied?
q1-2h
how much irrigant do you flush through catheter?
30-50mL
why do you occlude tubing in closed intermittent irrigation?
allows irrigating solution to enter catheter and flow into bladder
what is a key step to perform when doing closed intermittent irrigation?
occlude tubing below port of injection
rationale for pushing fluids slowly with even pressure
Gentle instillation minimizes trauma to bladder mucosa
if we instill medicated irrigants, what must we remember?
may need to dwell in bladder for prescribed period in order to be absorbed by lining of bladder; will need to clamp catheter temporarily
evaluation
- Measure actual urine output by subtracting total amount of irrigation fluid infused from total volume drained into basin.
- Look at I&O sheet to verify that hourly output into drainage bag is in appropriate proportion to irrigating solution entering bladder.
- Inspect urine for blood clots and sediment and be sure that tubing is not kinked or occluded.
- Evaluate pt’s comfort level
- Monitor for s&s of infection
unexpected outcomes
- Irrigating solution does not return (closed intermittent irrigation) or is not flowing at prescribed rate (CBI)
- Drainage output is less than amount of irrigation solution infused
- Bright red bleeding with the irrigation (CBI) infusion wide open
- Patient experiences pain with irrigation
what interventions will you perform if the irrigating solution does not return or is not flowing at prescribed rate?
- Examine tubing for clots, sediments, kinks
* Notify hcp if irrigant doesn’t flow freely from bladder, pt complains of pain, or bladder distention occurs
what interventions will you perform if drainage output is less than amount of irrigant solution infused?
• Examine drainage tubing for clots, sediments, kinks
• Inspect urine for presence of or increase in blood clots and sediment
Evaluate pt for pain and distended bladder
what interventions will you perform if there is bright red bleeding with the irrigation wide open?
• Assess for hypovolemic shock
Leave irrigation infusion wide open and notify hcp
what interventions will you perform if the pt experiences pain with CBI?
- Examine drainage tubing for clots, sediments, kinks
- Inspect urine for presence of or increase in blood clots and sediment
- Evaluate for distended bladder
- Notify hcp
what is patient teaching you will do?
- Instruct pt and fc to observe urine daily for changes in colour, presence of mucus or blood, and odor
- Inform pts that bleeding is common after many urologic procedures and to expect bright red-tinged urine during first 48h after surgery, followed by a change in urine ranging from pink-tinged to clear
- Instruct pt to maintain adequate oral intake of 2L/day
- assure pt that the urge to void results from the presence of the catheter and from bladder spasms
- caution pt not to pull on the catheter, as this causes bleeding and subsequent catheter blockage
recording and reporting
record:
- irrigation method
- amount
- type of irrigation solution
- amount returned as drainage
- characteristics of output
- urine output
- pt tolerance
- adverse outcomes
- I&O
- pt learning
what are the lumens used for in CBI?
one lumen to introduce sterile irrigation fluid into the bladder, one lumen for the balloon, and another for urinary drainage
purpose of CBI
to keep the bladder free of blood clots or sediment
what are some nursing assessments that should be completed when you have a pt on CBI?
assessment for:
- blood clots
- hemorrhage
- bladder spasms
- infection
- f/e imbalances
- adequate urinary output
what can an obstructed catheter lead to?
produces distention of the prostatic capsule and can cause hemorrhage
what med may be prescribed for a pt on CBI and why?
Furosemide (Lasix); to promote urination and initiate post-op diuresis
what change in VS and what s&s does the nurse observe for?
- BP, pulse, and resps are monitored and compared with baseline preop VS to detect hypoTN
- restlessness, cold sweats, pallor, any drop in BP, and an increasing pulse rate
how does an overdistended bladder present?
distinct, rounded swelling above the pubis
where is the bag taped to?
inner thigh
is a cystostomy catheter is in place, where is it taped to?
the abdomen
rule of thumb with fluid amount
amount of fluid recovered in the drainage bag must be equal to the amount of fluid injected
what indicates reduced bleeding?
a change in colour from pink to amber
