Week 10 Continuous Bladder Irrigation

Question 1

When does a pt typically require a CBI?

Answer 1

following genitourinary surgery such as a TURP/prostatectomy

Question 2

What is the purpose of a CBI?

Answer 2

to keep the bladder free of blood clots or sediment

Question 3

What are the frequent patient assessments you should be doing with a patient with a CBI?

Answer 3

blood clots, haemorrhage, bladder spasms, infection, fluid and electrolyte imbalances, and adequate urinary output

Question 4

What medication may be prescribed to promote urinary and initiate postop diuresis?

Answer 4

Lasix (furosemide)

Question 5

What does a nurse observe to ensure that the catheter has not become blocked?

Answer 5

the lower abdomen

Question 6

What does a over distended bladder present as?

Answer 6

a distinct, rounded, swelling above the pubis

Question 7

what is examined for bleeding?

Answer 7

the drainage bag, dressings, and incisional site

Question 8

what does a change in colour of urine from pink to amber indicate?

Answer 8

reduced bleeding

Question 9

How can drainage of the bladder be accomplished?

Answer 9

by gravity through a closed sterile drainage system

Question 10

why is genital manual irrigation of the catheter prescribed sometimes?

Answer 10

to remove any obstructing clots

Question 11

what would you examine if a pt complains of pain?

Answer 11

the tubing

Question 12

Usually, how much fluid is used to irrigate the catheter?

Answer 12

50 mL

Question 13

The amount of fluid recovered in the drainage bag MUST BE…..

Answer 13

equal to the amount of fluid injected

Question 14

What can over distention of the bladder cause?

Answer 14

secondary hemorrhage by stretching the coagulated blood vessels in the prostatic capsule

Question 15

If a cystotomy catheter is in place, where would it be taped?

Answer 15

to the abdomen

Question 16

What can pulling on the catheter cause?

Answer 16

urinary retention

Question 17

What does irrigation pose a risk of causing?

Answer 17

UTI

Question 18

What is an example of when irrigation is needed?

Answer 18

after GU surgery where there is high risk for catheter occlusion for blood clots

Question 19

Closed catheter irrigation?

Answer 19

provides intermittent or continuous irrigation of the urinary catheter without disrupting the sterile connection between the catheter and the drainage system.

Question 20

CBI?

Answer 20

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.

Question 21

What should you verify prior to irrigating the catheter?

Answer 21

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

Question 22

When are a single and double lumen catheters used?

Answer 22

with open irrigation

Question 23

When are triple lumen catheters used?

Answer 23

for both intermittent and continuous closed irrigation

Question 24

Why do you palpate the bladder before irrigating?

Answer 24

for distention or tenderness or fullness, or catheter bypassing (leaking)

Question 25

What would bladder distention indicate?

Answer 25

that flow of urine may be blocked from draining

Question 26

What should you observe urine for?

Answer 26

colour, amount, clarity, and presence of mucous, clots, or sediment

Question 27

With a CBI, which fluid volume should be greater?

Answer 27

the urine output

Question 28

if a pt reports relief of bladder pain or spasms, what might it indicate?

Answer 28

indicates bladder emptying.

Question 29

how long does urine take to get lighter (compared to the blood-tinged colour) after surgery?

Answer 29

2-3 days

Question 30

When irrigating pts catheter, which position should the pt be in?

Answer 30

supine

Question 31

During close continuous irrigation, why should you start by closing the clamp?

Answer 31

because it prevents air from entering tubing. Air can cause bladder spasms.

Question 32

What should you do with if a patients urine is bright red or has blood clots?

Answer 32

Increase irrigation rate until drainage appears pink which helps prevent clotting in presence of active bleeding in bladder and flushes clots out

Question 33

During closed intermittent irrigation, where do you clamp the catheter?

Answer 33

Tubing below soft injection port so solution can go into bladder

Question 34

How do you measure actual urine output?

Answer 34

By subtracting total amount of irrigation fluid infused from total volume drained into basin

Question 35

What should you do if irrigating solution does not return (closed intermittent irrigation) or is not flowing at prescribed rate?

Answer 35

examine tubing for clots, sediments, kinks. Notify HCP if irrigant doesnt flow freely from bladder, pt complains of pain, or bladder distention occurs.

Question 36

What should you do if drainage output is less than amount of irrigation solution infused?

Answer 36

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.

Question 37

What should you do if you notice bright red bleeding with the irrigation infusion wide open?

Answer 37

Assess for hypovolemic shock. Leave irrigation infusion wide open and notify HCP.

Question 38

What should you do if the pt experiences pain with irrigation?

Answer 38

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.

Question 39

What should you teach a patient to expect that just had a urologic procedure?

Answer 39

bright red-tinged urine during the first 48hr after surgery is normal, followed by a change in urine ranging from pink-tinged to clear

Question 40

What should you teach a pt to maintain after surgery?

Answer 40

adequate oral intake of 2L/day

Question 41

Typically how long are CBIs in for?

Answer 41

24 Hours

Question 42

TURP syndrome?

Answer 42

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