Week 10 Continuous Bladder Irrigation Flashcards
When does a pt typically require a CBI?
following genitourinary surgery such as a TURP/prostatectomy
What is the purpose of a CBI?
to keep the bladder free of blood clots or sediment
What are the frequent patient assessments you should be doing with a patient with a CBI?
blood clots, haemorrhage, bladder spasms, infection, fluid and electrolyte imbalances, and adequate urinary output
What medication may be prescribed to promote urinary and initiate postop diuresis?
Lasix (furosemide)
What does a nurse observe to ensure that the catheter has not become blocked?
the lower abdomen
What does a over distended bladder present as?
a distinct, rounded, swelling above the pubis
what is examined for bleeding?
the drainage bag, dressings, and incisional site
what does a change in colour of urine from pink to amber indicate?
reduced bleeding
How can drainage of the bladder be accomplished?
by gravity through a closed sterile drainage system
why is genital manual irrigation of the catheter prescribed sometimes?
to remove any obstructing clots
what would you examine if a pt complains of pain?
the tubing
Usually, how much fluid is used to irrigate the catheter?
50 mL
The amount of fluid recovered in the drainage bag MUST BE…..
equal to the amount of fluid injected
What can over distention of the bladder cause?
secondary hemorrhage by stretching the coagulated blood vessels in the prostatic capsule
If a cystotomy catheter is in place, where would it be taped?
to the abdomen
What can pulling on the catheter cause?
urinary retention
What does irrigation pose a risk of causing?
UTI
What is an example of when irrigation is needed?
after GU surgery where there is high risk for catheter occlusion for blood clots
Closed catheter irrigation?
provides intermittent or continuous irrigation of the urinary catheter without disrupting the sterile connection between the catheter and the drainage system.
CBI?
continuous infusion of sterile solution into the bladder, usually using a 3-way irrigation closed system with a triple lumen catheter; frequently used after GU surgery.
What should you verify prior to irrigating the catheter?
Order for irrigation method (if it is continuous or intermittent); type of solution (sterile saline or a medicated solution); amount of irrigant; type of catheter that is in place
When are a single and double lumen catheters used?
with open irrigation
When are triple lumen catheters used?
for both intermittent and continuous closed irrigation
Why do you palpate the bladder before irrigating?
for distention or tenderness or fullness, or catheter bypassing (leaking)
What would bladder distention indicate?
that flow of urine may be blocked from draining
What should you observe urine for?
colour, amount, clarity, and presence of mucous, clots, or sediment
With a CBI, which fluid volume should be greater?
the urine output
if a pt reports relief of bladder pain or spasms, what might it indicate?
indicates bladder emptying.
how long does urine take to get lighter (compared to the blood-tinged colour) after surgery?
2-3 days
When irrigating pts catheter, which position should the pt be in?
supine
During close continuous irrigation, why should you start by closing the clamp?
because it prevents air from entering tubing. Air can cause bladder spasms.
What should you do with if a patients urine is bright red or has blood clots?
Increase irrigation rate until drainage appears pink which helps prevent clotting in presence of active bleeding in bladder and flushes clots out
During closed intermittent irrigation, where do you clamp the catheter?
Tubing below soft injection port so solution can go into bladder
How do you measure actual urine output?
By subtracting total amount of irrigation fluid infused from total volume drained into basin
What should you do if irrigating solution does not return (closed intermittent irrigation) or is not flowing at prescribed rate?
examine tubing for clots, sediments, kinks. Notify HCP if irrigant doesnt flow freely from bladder, pt complains of pain, or bladder distention occurs.
What should you do if drainage output is less than amount of irrigation solution infused?
examine drainage tubing for clots, sediments, kinks. inspect urine for presence or increase in blood clots and sediment. Evaluate pt for pain and distended bladder.
What should you do if you notice bright red bleeding with the irrigation infusion wide open?
Assess for hypovolemic shock. Leave irrigation infusion wide open and notify HCP.
What should you do if the pt experiences pain with irrigation?
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 should you teach a patient to expect that just had a urologic procedure?
bright red-tinged urine during the first 48hr after surgery is normal, followed by a change in urine ranging from pink-tinged to clear
What should you teach a pt to maintain after surgery?
adequate oral intake of 2L/day
Typically how long are CBIs in for?
24 Hours
TURP syndrome?
with CBI of the urinary catheter to prevent its obstruction by. blood clots, fluid may be absorbed through the open surgical site and retained, increasing the risk for excessive fluid retention, fluid imbalance, and water intoxication
