Bladder irrigation is a medical procedure that involves gently washing or flushing the inside of the urinary bladder with a sterile liquid solution. This process is performed using a urinary catheter, which is a thin, flexible tube inserted through the urethra to reach the bladder. The primary goal is to clear the bladder of any material that could cause a blockage, ensuring the urinary tract remains open and functional. Bladder irrigation is not a routine part of catheter care but a necessary treatment in specific circumstances to maintain health and prevent complications.
Primary Indications for Bladder Irrigation
The most common reason for needing bladder irrigation is following urological surgeries, particularly procedures on the bladder or prostate, such as a transurethral resection of the prostate (TURP). These operations can cause bleeding inside the bladder, leading to the formation of blood clots. If these clots are not removed, they can obstruct the urinary catheter, preventing urine from draining.
Preventing catheter blockage is a focus, as an obstruction can cause urine to back up, leading to discomfort and potential harm to the kidneys. The irrigation solution, often sterile saline, flushes out debris, including blood clots, mucous, and sediment. This ensures the catheter remains patent, allowing for continuous urine flow.
Bladder irrigation is also used to deliver specific medications directly to the bladder lining. This targeted approach treats conditions like bladder cancer (chemotherapy) or severe urinary tract infections (antibiotics) when oral medications are ineffective. Treatment duration varies by indication; post-surgical flushing often lasts a few days until the urine clears.
The Mechanics of the Procedure
Bladder irrigation requires specialized equipment, most notably a multi-lumen catheter. For continuous irrigation, a triple-lumen catheter is commonly used, which features three separate channels. One channel inflates the balloon that holds the catheter in place, the second allows sterile fluid to flow into the bladder, and the third is for the fluid and debris to drain out.
The procedure is categorized into two main types based on how the fluid is administered: Continuous Bladder Irrigation (CBI) and Intermittent Bladder Irrigation. CBI involves a constant, steady flow of sterile solution into the bladder, which then continuously drains out. The flow rate is carefully adjusted by a healthcare professional to ensure the outflow fluid is clearing the debris, often aiming for a pink or clear return.
Monitoring fluid balance is important for CBI; the amount of fluid draining must be accounted for by subtracting the infused irrigation solution volume to determine the patient’s actual urine output. Intermittent Bladder Irrigation, on the other hand, involves flushing the bladder at set intervals or only when a blockage is suspected. This is often done manually using a syringe to inject a measured amount of solution into the catheter’s irrigation port and then allowing it to drain out.
The irrigation solution is typically sterile 0.9% sodium chloride (normal saline), which is hung from an IV pole and connected to the catheter’s inflow port. The drainage system collects the fluid, which is regularly inspected for clarity and volume.
Recognizing and Managing Common Issues
A frequent issue experienced by patients during bladder irrigation is the occurrence of bladder spasms, which are painful, involuntary contractions of the bladder muscle. These spasms can feel like severe cramping or a sudden, urgent need to urinate, even though a catheter is in place. Spasms are often caused by the catheter’s presence, the irritation from the solution, or the collection of debris irritating the bladder wall.
Managing these spasms often involves adjusting the flow rate of the irrigation solution, as excessive pressure can worsen the contractions. Medications designed to relax the bladder muscle, such as anticholinergics, may be prescribed to reduce the frequency and severity of the spasms. It is also important to ensure the catheter tubing is not kinked and is draining properly, as a blocked catheter can trigger spasms.
Patient monitoring centers on the color, clarity, and total volume of the drainage. The goal is for the drainage fluid to gradually change from a darker color (indicating blood or debris) to a lighter pink or clear straw color. Signs requiring immediate medical attention include sudden, severe pain, a complete cessation of drainage, or the appearance of bright red blood, which may indicate a new blockage or complication.