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IRRIGATING CYSTOCLYSIS 1.Discuss cystoclysis as to: 1.

1 DEFINITION OF TERMS Cystoclysis- Is a type of irrigation in which saline solution is introduced into the bladder. -It is also called as a continuous bladder irrigation.

1.2 PURPOSE OF CYSTOCLYSIS y To restore or maintain the patency of the bladder.- It prevents the obstruction of the catheter. y To relieve bladder spasm. Draining the urine from the bladder can relieve the spasm y y To irrigate bladder with medication treat infection or bladder irritation. To drain the bladder when acute urinary retention is present.

TYPES OF IRRIGATING CYSTOCLYSIS 1. Closed Bladder Irrigation System does not require that the system be opened

for frequent intermittent irrigations or continuous irrigation without disrupting the sterile alignment of the catheter and drainage system through use of a three-way catheter

can be used to instill medication, encourage hemostasis, flush clots and debris out of the bladder and catheter.

3 ways catheter

2. Open Irrigation System The bladder is drained using a 60-mL syringe. opening of the closed drainage system to instill bladder irrigations is used when bladder irrigations are required less frequently and there are no blood clots or large mucous fragments.

1.3 INDICATIONS OF IRRIGATING CYSTOCLYSIS y Acute Urinary Retention- Patients with acute urinary retention is unable to urinate because nerve dysfunction, constipation, infection, or medication such as anticholinergics and anti-depressants causing a bladder spasm. We can use this procedure in order to drain urine out of the bladder therefore relieving bladder spasm. y Urinary Tract Infection- We can instill medication into the catheter such as antibiotics in order to drain it into the urinary tract therefore curing Urinary Tract Infection. y Prostatic Hematuria- Presence of blood in the urine. Cystoclysis can help preventing formation of clots. y Post-surgically after prostatectomy / who have had surgery of the urinary tract Patients who undergo surgery in the urinary tract are at risk for formation of clots. The procedure can help by preventing formation of clots that may cause blockage to the bladder.

1.4 CONTRAINDICATIONS OF IRRIGATING CYSTOCLYSIS

y y

Hypersensitivity to the solution to be used Patients with defects in the bladder mucosa or bladder wall It can cause further injury to the bladder wall.

2. NURSING RESPONSIBILITIES Before: 1. check physician s order for type of irrigation and irrigation solution to use, date, time room and name of the client 2. explain the procedure to the client 3. gather the necessary materials 4. do medical handwashing 5. open the IV tubing then do priming 6. assess lower abdomen for bladder distention

7. position the patient dorsal recumbent or supine

During: 1. drape the patient exposing the leg where the catheter is being taped 2. do gloving 3. cleanse the catheter injection port with antiseptic swab 4. regulate the flow rate in its ordered rate 5. measure urine output every hour

After: 1. after care 2. do proper documentation - amount of solution used as irrigant, amount returned as drainage, characteristics of output, calculation
3. GUIDELINES INVOLVED IN IRRIGATING CYSTOCLYSIS y Determine whether the irrigation will be open or close. - There are two types of irrigating cystoclysis: the open and close irrigation system. Also a physician s order is required to perform this operation. The order should include the type of solution to be used, the rate of the irrigation and whether the irrigation should be continuous or intermittent. Set up sterile irrigating supplies, maintaining sterile technique per agency protocol. - It is important to maintain the sterility of equipments. Insertion and maintenance of (threeway) foley catheter patency involves a closed drainage system and sterile technique. Sterility and patency of CBI system is maintained to avoid infection and occlusions. Use only clearly labeled or prepared solutions for irrigation. - In irrigating cystoclysis, irrigant solutions are used like sterile normal saline solution so it is important to use only clearly labeled or prepared solutions to ensure that the right solutions are used and to prevent committing errors. Also most of Foley catheter insertion are done with antibiotic solutions so a doctor s order is needed. Flush tubing prior to irrigation. - To clear air from the tubing that might cause bladder distention and to know patency of tubing.

y y y

Check for bladder distention. - Detects whether catheter is malfunctioning or blocking urinary drainage. Cleanse site of entry or end of Y-connector with antiseptic/disinfectant. - To prevent infection Saline solution for infusion should be stored and infused at a room temperature. - Normal Saline Solutions could be irritating to the delicate tissues inside the urethra and bladder, especially if there s already some trauma due to the insertion and presence of the catheter so whatever solution is used should be warm to the body temperature because cold solution can cause spasms that are very uncomfortable for the patient. Strict input and output is recommended for all patients receiving CBI. - Special attention to frail elderly and /or history of pelvic floor or bladder radiation. These patients are at high risk for bladder perforation. If an obstruction occurs in the catheter, the irrigation should be shut off, and manual irrigation should be performed to remove obstruction. When manual irrigant flow freely, the irrigation can be resumed. To determine an accurate output during bladder irrigation, subtract the amount of irrigant used from the amount of drainage obtained. The difference is the patient s output of urine and blood.

Source: Kathleen Hoerth Belland.Clinical Nursing Procedures. Black et al(2001) Medical Surgical Nursing.6th edition.Toronto: W.B. Saunders Perry, A.Potter, P.(2002) Clinical Nursing Skills and Techniques 5th edition, St. Loius:Mosby

Date

Bottle #

Total Volume 1000 ml

Time hooked 2pm

2/20/09

Rate of Flow titrated

Time

Present Volume 1,000 900 750 550 450 350

2pm 3pm 4pm 5pm 6pm 7pm

Amount Instilled Solution 100 150 200 100 100

Total Urine Output 240 240 300 170 60

Actual Urine Output 140 90 100 70 -40