The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [189]
Procedure
3 Perform the procedure using an aseptic technique. To minimize the risk of infection (Fraise and Bradley 2009, E).
4 Open the outer wrappings of the pack and put it on the top shelf of the trolley. To prepare equipment. E
5 Insert the end of the irrigation giving set into the fluid bag and hang the bag on the infusion stand. Allow fluid to run through the tubing so that air is expelled. To prime the irrigation set so that it is ready for use. Air is expelled in order to prevent discomfort from air in the patient’s bladder. E
6 Clamp the catheter and place absorbent sheet under the catheter junction. To prevent leakage of urine through the irrigation arm when the spigot is removed. E
To contain any spillages.
7 Clean hands with a bactericidal alcohol handrub. Put on gloves. To minimize the risk of cross-infection (Fraise and Bradley 2009, E).
8 Place a sterile paper towel under the irrigation inlet of the catheter and remove the spigot. To create a sterile field. To prepare catheter for connection to irrigation set (Scholtes 2002, E).
9 Discard the spigot and gloves. To prevent reuse and reduce risk of cross-infection (Fraise and Bradley 2009, E).
10 Put on sterile gloves. Clean around the end of the irrigation arm with sterile low-linting gauze and an antiseptic solution. To remove surface organisms from gloves and catheter and to reduce the risk of introducing infection into the catheter (Fraise and Bradley 2009, E).
11 Attach the irrigation giving set to the irrigation arm of the catheter. Keep the clamp of the irrigation giving set closed. To prevent overdistension of the bladder, which can occur if fluid is run into the bladder before the drainage tube has been unclamped (Scholtes 2002, E).
12 Release the clamp on the catheter tube and allow any accumulated urine to drain into the catheter bag. Empty the urine from the catheter bag into a sterile jug. Urine drainage should be measured before commencing irrigation so that the fluid balance may be monitored more accurately (Scholtes 2002, E).
13 Discard the gloves. These will be contaminated, having handled the cathether bag (Fraise and Bradley 2009, E).
14 Set irrigation at the required rate and ensure that fluid is draining into the catheter bag. To check that the drainage system is patent and to prevent fluid accumulating in the bladder. E
Postprocedure
15 Make the patient comfortable, remove unnecessary equipment and clean the trolley. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).
16 Wash hands. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).
Problem-solving table 6.3 Prevention and resolution (Procedure guideline 6.8)
Procedure guideline 6.9 Care of the patient during bladder irrigation
Essential equipment
Sterile dressing pack
Antiseptic solution
Bactericidal alcohol handrub
Clamp
Disposable irrigation set
Infusion stand
Sterile jug
Absorbent sheet
Medicinal products
Sterile irrigation fluid
Action Rationale
1 Adjust the rate of infusion according to the degree of haematuria. This will be greatest in the first 12 hours following surgery (average fluid input is 6–9 litres during the first 12 hours, falling to 3–6 litres during the next 12 hours). The aim is to obtain a drainage fluid which is rosé in colour. To remove blood from the bladder before it clots and to minimize the risk of catheter obstruction and clot retention (Scholtes 2002, E).
2 Check the volume in the drainage bag frequently when infusion is in progress, for example half-hourly or hourly, or more frequently as required. To ensure that fluid is draining from the bladder and to detect blockages as soon as possible, also to prevent overdistension of the bladder and patient discomfort. To empty catheter drainage bags before they reach capacity.
3 Using rubber-tipped ‘milking’ tongs, ‘milk’ the catheter and