Foley Irrigation in the OR

[L&DRNC]

Recently our doctors have asked the circulating RN to irrigate or flush a foley during a c-section to ensure that they have not nicked the bladder. They usually use betadine or methylene blue but recently we've had patients with iodine allergies so the surgeons have asked us to use sterile infant formula (similac, enfamil, whatever we have available in L&D). I'm trying to determine best practice to develop a competency for our nurses. Does anyone have experience with doing this in the OR and maintaining sterile field and how about the formula thing, I'm not even sure if irrigating a foley with formula is acceptable practice at all.

[PetiteOpRN]

Hmm...

Infant formula is the perfect growth medium for bacteria, sterile or not, which could lead to UTIs if not completely irrigated out. Furthermore, something tells me formula is not altogether bladder friendly (ie what is the pH, is there a chance you could cause spasm or some other harmful outcome?). I would question the practice until it is proven to be safe.

[canesdukegirl, BSN, RN]

Methylene blue is the accepted standard for irrigating the bladder to ensure there was no damage to the bladder. I would NOT irrigate with formula. Where in the heck did this doc get the idea that it was safe to do this?!?

[Argo]

Indigo carmine or methlyn blue. I asked for a clamp from the field. Clamp the foley, disconnect drain bag, connect irrigation syringe, retrograde fill bladder with saline/blue mix. Usually 250cc is the ticket. Formula is crazy.

[L&DRNC]

That's what I was hoping to hear. When the circulator told me formula I must have asked a dozen times what she meant until she brought me the bottle, put it in my hand, and said "Formula!" like I was the crazy one. I though perhaps I had missed something. Thanks for the input.

[daVinciNurse]

Ask your facility's library to get a copy of the AORN Journal from October 2006. This question is addressed in the clinical issues column of the Journal. Doesn't give a cut and dry answer, but certainly is a starting point for developing a policy/protocol for bladder irrigation to check bladder integrity. I'm used to a methylene blue solution instilled via a standard TUR type Y-tubing irrigation set used for routine cystoscopies. You can also use Toomey syringes to irrigate, but I find that creates more work and takes more time.

[LAM2010, BSN]

i just heard a story the other day where a surgeon used milk to check if the bladder was nicked. i thought it was weird, too.

[canesdukegirl, BSN, RN]

You can also use Toomey syringes to irrigate, but I find that creates more work and takes more time.

OMG! This reminds me of the time the GI surgeon wanted to check for bladder integrity during a case. I had to crawl up under the drapes and had to irrigate with a freaking Toomey syringe. Someone came in the room while I was on my hands and knees and started laughing. Then I hear the person ask, "Is Canes cussing yet?" (I was!) I had no idea who it was and found out later it was the GI department chair!

[4L&D]

Sorry for the late reply just came upon this.

Formula is not that crazy but isn't always the right choice as always it depends on the patient. All the solutions have their own side effects from increased risk of bladder infection, cardiac compromise to Serotonin Syndrome so the patient's history needs to be considered and the best option used. The first time I had to do this I thought it was crazy too but I've seen adverse reactions to other solutions and would opt for a bladder infection especially if the patient is on antidepressants.