Bladder irrigation???

[dennall]

I thought that bladder irrigation after prostate surgery was to remove clots in the bladder and prevent oozing of blood. I have a multiple choice question that I am not sure of. It asks the purpose of continuos bladder irrigation after prostate surgery. My options are:

a. hydrate the pt

b. dilute the urine to stop clots from forming in the catheter

c. stop bleeding in the bladder

d. promote clot formation

I think the answer must be c, but I can't find anywhere that says the irrigation actually stops bleeding. Any help would be much appreciated.

[DutchgirlRN, ASN, RN]

I think it would be "b" because we would irrigate manually to remove clots when the flow slowed down. Once the bleeding slowed down and the foley was pulled we would have to do serial urines before the patient could be discharged

[swee2000]

The correct answer is "B".

[cardiacRN2006, ADN, RN]

I also say B. A, C, D are not right.

[swee2000]

"D" is definetly wrong because the last thing you want is for clots to form....hence the purpose of the CBI. "A" is wrong because the CBI will not hydrate the patient because the saline is going into the bladder through one port and coming right back out and into the catheter via another port. Also, it's not going into the veins like IV fluids used to hydrate patients would be.

[dennall]

Thank you all so much. I knew A & D were wrong, but had debated back and forth between B & C. I was just thinking about this and wondered if the Dr. actually orders the flow rate on continuous irrigation or can the nurse adjust it based upon the color of the output. I read in my book that it should be pink to light red and that the color would fluctuate based upon the flow of the irrigation.

[DutchgirlRN, ASN, RN]

Thank you all so much. I knew A & D were wrong, but had debated back and forth between B & C. I was just thinking about this and wondered if the Dr. actually orders the flow rate on continuous irrigation or can the nurse adjust it based upon the color of the output. I read in my book that it should be pink to light red and that the color would fluctuate based upon the flow of the irrigation.

Where I work we do adjust it based on the color of the output

[swee2000]

On my unit, most of the urologists will write an order that indicates for the nurse to either run the CBI wide open &/or to titrate it until the urine is a certain color & free of clots.

[Daytonite, BSN, RN]

i thought that bladder irrigation after prostate surgery was to remove clots in the bladder and prevent oozing of blood. i have a multiple choice question that i am not sure of. it asks the purpose of continuos bladder irrigation after prostate surgery. my options are:

a. hydrate the pt

b. dilute the urine to stop clots from forming in the catheter

c. stop bleeding in the bladder

d. promote clot formation

in my first hospital nursing job we had lots of patients who came back from turps and had continuous bladder irrigations. it would help for you to actually see a patient who is getting this treatment as well as to see what happens when it is not carried out correctly and blood clots obstruct the catheter and cause the bladder to become distended with urine. it only happens to you once as a nurse before you watch these patients like a hawk. our orders were to keep the irrigant flowing so that the urinary drainage was "pale salmon colored". depending on how much bleeding the patient had, we sometimes ran as much as 10,000 mls of saline per shift through a person's bladder.

the answer to the question is that the irrigant dilutes the urine. by doing that it prevents the blood from having a chance to form clots. if the irrigant is run too slow or not at all, a condition exists where the blood is allowed to congeal and form blood clots. these blood clots will not be able to make their way through the holes of the foley catheter and end up obstructing it resulting in no flow of urine + irrigant through the foley catheter = bladder distension. i saw this happen so many times to new nurses who had never had this kind of patient before. as i said, you make this mistake once as a new nurse. to correct it, you have to remove the foley catheter which is clogged with blood clots (hand irrigation won't help) and reinsert a new one (the first male catheterization for a lot of female nurses) and then keep the saline irrigation running as fast as it will go to keep that urine as faint a pink color as you can keep it!

[swee2000]

To correct it, you have to remove the foley catheter which is clogged with blood clots (hand irrigation won't help) and reinsert a new one (the first male catheterization for a lot of female nurses) and then keep the saline irrigation running as fast as it will go to keep that urine as faint a pink color as you can keep it!

I'm not disputing that what you said above isn't correct. But on the Med/Surg unit that I work on, if a 3-way catheter gets clogged from blood clots, the RNs always hand-irrigate it per MD order. They never just go and remove the cath in order to insert a new one. In fact, I can't say I've ever seen it done on my floor.

[Daytonite, BSN, RN]

I'm not disputing that what you said above isn't correct. But on the Med/Surg unit that I work on, if a 3-way catheter gets clogged from blood clots, the RNs always hand-irrigate it per MD order. They never just go and remove the cath in order to insert a new one. In fact, I can't say I've ever seen it done on my floor.

I don't dispute you either, but please keep in mind that this is a student forum. They are looking at the ideal situation, not at what is commonly practiced. Of course, before we removed any of these catheters we irrigated the hell out of them before removing and replacing them. I can't tell you how many clogged catheters I saw that got that way because the RNs let the irrigant run too slowly. Remember, what you saw, what I saw, is all personal experience. Maybe I just happened to work with a bunch of dumbbells.

[swee2000]

Oops, my bad. Sorry about that.