Continuous Bladder Irrigation help

It has been 5 years since Ihave done a CBI, but yes we adjusted based on UOP. If we flowed in 300mL and there was 350mL in the foley, we had a +50. If we flowed in 300mL and there was 200mL in the foley we were -100. In the latter instance you would slow the irrigation (I think, been a while) and recheck the UOP soon. If no UOP, then irrigate. (again i think). We kept a running chart on a clipboard at the foot of the bed with the policy attached to it. you always want + UOP. I do remember that. Sorry i couldn't be more help.

You stated that you would manually irrigate it when you thought it was clogged. What made you think it was clogged? If the patient was comfortable and the urine was running clear, then there was no need to irrigate. If you were getting clots, the urine would have been very bloody, the Foley would have clogged off and the patient probably would have began to have spasms which is very uncomfortable for them. The day nurse was right about adjusting the flow to keep the urine free of clots;it sounds like you may have been manipulating it too much. Truly, if you were running the irrigation at a rate to keep it clear, you should have not been getting clots. The catheter tip might have also been in a bad position. Normally, there is no need to manually irrigate it periodically solely to check for clots. Oh and yes, you should irrigate and aspirate gently.

It is also a lot easier on the staff if you put the irrigation solution on a Y-set, so you can open up the second bag while you change the first. Also connect the drainage tubing(there is a special set of tubing for CBI's that has the inflow tubing -narrower- no need to be larger to allow for clots to pass and the outflow tubing-larger so clots won't obstruct the tubing to a 3 Liter drainage bottle(must be vented to alow fluid to displace the air.)

That way you don't need to spend so much time in the room. If you are getting output that equals the amount of irrigation solution plus a reasonable hourly urine output, you have no reason to worry. If less, you need to assess for obstruction.

I noticed when I had my last CBI patient that the previous shift had slowed the rate down to practically nothing. He was confused, restrained, and he was moaning. His abdomen was distended, and there was no flow to the drainage bag. I irrigated and got small clots and about 700 mls of output in about 3 minutes! I found out later that the drainage bag had last been emptied about 1/2 hour before. I suspect that it was clogged before that.

So no matter what the rate, my advice would be to check these patients pretty frequently, especially if they're confused.

I also do not irrigate when I have flow that approximates the flow of the dripping bag, if you get what I mean. In other words, if I have a patient who has a lot of clots, I want a pretty rapid rate of drip going in there to keep the line from clogging. If I see it running very clear for a couple of hours, I'll empty the drainage bag and turn it down to a moderate rate, so I can tell if the flow is still good.

I don't like to run these really slow because that's usually when there are more clots. I'd really rather empty bags than de-clot the catheter, so I let it run rapidly to moderate unless the patient's been running very nicely without difficulty all night.

Thanks for all your suggestions and ideas guys.

Angie, I agree that I feel more comfortable running it fast. There was acouple times on this shift where I thought it was clogged and then when I aspirated some clots, he then drained like 500 ccs each time. That was enough for me to worry a lot about it. I thought to myself, what if I had gotten busy with another patient (which I might have had I not been so worried) and then came back to find the patient with no further urine and a bladder that I can't manually irrigate....I just didn't want that to hapen.

Now you said that his lower abdomen got distended, well I checked my patient and he never seemed to get really distended so I guess I was OK anyway. Maybe even if it did clog and it wasn't fixed for a little while, I would be OK.

An alert and oriented patient would make this process easier definitely!