does bladder irrigation have to be aseptic technique?

[matt59]

Hi, & thanks in advance for any & all help I get with this. I am a nsg student nearing the end of his summer semester, & as we all have a short presentation to make on our last clinical (thursday the 12th), mine became something to do with evidence based practice & bladder irrigation. I was assigned this as my project after I asked my instructor if bladder irrigation should be performed utilizing aseptic technique; the reason I made this inquiry was that the way it seems to be performed where I am assigned for clinicals, it is not performed using sterile technique, & I questioned this (not to rock any boats) because i was genuinely curious why the act of inserting a catheter is supposed to be performed meticulously sterile, but not the act of injecting 30 mL of (what was before it was left open for a specified period of 24 hours) sterile saline.

There is absolutely no flippancy to my question; I am genuinely curious as to whether this is dependant upon hospital protocol. Every article I could find on the internet from applicable journals seem to indicate the use of sterile technique for this procedure. Does anyone know if there is evidence based practice to the contrary, & if so, does anyone have any suggestions as to where I could access this information?

Thanks/matt

[Super Nurf]

We have bladder irrigation kits with everything (the syringe and basin), and from what I can recall from the last time I did it, we use aseptic technique (non sterile gloves) but the irrigation tray itself and the solution stays sterile so anything going into the bladder itself is sterile, as opposed to a catheterization where you must have a total sterile field (sterile gloves)so no germs are introduced into the bladder via the outside of the urethral opening, which you are touching to clean and insert the tubing into the bladder. This is a very valid question.

[meownsmile, BSN, RN]

I second supernerf, well said.

[CritterLover, BSN, RN]

yes, it is sterile, since the bladder is a sterile environment.

you might not need to wear sterile gloves, because you don't have to touch anything that goes into the bladder in order to irrigate the bladder.

when you put the foley in (or straight cath), you have to touch the "inside" part of the catheter, so you have to wear sterile gloves.

when you irrigate the bladder, you don't have to touch the sterile solution. nor do you have to touch the tip of the irrigation syringe. so, you do not need to wear sterile gloves.

(by the way, though the irrigation solution is good for 24hrs, a new bladder irrigation set up needs to be opened each time -- no way to keep it sterile)

it is kind of like flushing an iv. it, too, needs to be sterile. but, since you arn't touching either the saline that is being flushed into the patient, nor the end of the syringe, you don't have to wear sterile gloves.

[matt59]

(by the way, though the irrigation solution is good for 24hrs, a new bladder irrigation set up needs to be opened each time -- no way to keep it sterile)

okay, so this cuts to the chase of my question. if the irrigating solution is opened & dated, but not resealed & the syringe is left in the bottle of irrigating solution, there is nothing aseptic about this, right? essentially, wouldn't the only way ti keep a sterile field for this procedure be to everytime open up a new bottle of irrigating solution & break out a new syringe?

thanks/matt

[CritterLover, BSN, RN]

correct.

the irrigation solution that is saved should be left in the original bottle (with the screw-on top) with the lid on tight until needed next. and it is good for 24 hours from when it was opened.

the unused portion of the solution that has been poured needs to be discarded.

my suggestion would be to look it up in the facility p&p manual, and do the task that way.

[SuesquatchRN, BSN, RN]

I irrigate someone every morning and it's just clean, not sterile.

[Elektra6, ASN, BSN, RN]

I irrigate someone every morning and it's just clean, not sterile.

I do this in homecare using clean technique as well. I don't like it, but that's what they have been doing (with MD approval) for years. I think in a hospital it should be sterile. Always err on the side of being sterile, it won't hurt.

[TrudyRN]

In the home, clean is ok because there is just one patient and no chance of cross-contamination.

In the hospital, sterility is required, I guess because there are so many people and all their germs involved, potentially, that, therefore, there is greater chance of causing infection.

Did your instructor get mad? She was probably embarrassed to not know the answer herself, if she did get mad. I applaud your desire to learn and understand. So should she.

BTW, I think at least the gloves used during irrigation should be sterile.

[matt59]

I irrigate someone every morning and it's just clean, not sterile.

Suesquatch, thank you for your input. I have been a noncontributing observer of this site for a little while & have observed & enjoyed your input. Okay, then, not intending to be confrontational but only trying to get this on terms that I can understand, I am not following why the initial insertion of the french is taught as such a meticulously sterile procedure, & yet sterile nss can be poured into a (for lack of a better word coming to mind) unsealed vial in which the syringe simply sort of floats in. Grant it, it is all to be changed q 24 hrs, but it hardly seems to me as if this treats the bladder as a sterile area, as although the french is sterile uponinsertion, the irrigating solution seems like it cannot be.

Anyway, thankyou for your input. I am putting together a pretty good report (I think) for next thursday after clinical; I have a very vague policy & procedure manual from the hospital where I do my clinicals, & I have some very specific (sterile) procedures I got off of nsg journals on the net--I may very well use some of the input I took off this site (w/out using usernames) to expound upon my presentation.

Btw, I worked w/ one of (in my opinion) the greatest most even tempered most helpful nurses in the world today & one of the most uncommunicative CTs (almost to the point of being surly) for whom I was bending over backwards to help in anyway I could, even though this semester we are supposed to be concentrating on nsg paperwork & interventions.

Oh well, thanks again/matt

[matt59]

Trudy, thank you for your reply, & I hope you read my previous post. No, she was not mad, & if embarrassed, she certainly knows how not to show it. My RN today said, "Matt, you did a lot better than the last time we worked together, but you wear your emotional state on your face." Anyway, back to my instructor, she simply smiled & told me that now I knew what my end of semester presentation was about. I do have some groundwork now to go on (my hospital's vague policy & procedure on bladder irrigation which I will juxtapose w/ the nsg journals I pulled off of the net, along w/ feed back from real nurses on this site. & btw, it would appear that clean vs sterile gloves are the very LEAST of anyone's worries.

Again, thank you for all your help/matt

In the home, clean is ok because there is just one patient and no chance of cross-contamination.

In the hospital, sterility is required, I guess because there are so many people and all their germs involved, potentially, that, therefore, there is greater chance of causing infection.

Did your instructor get mad? She was probably embarrassed to not know the answer herself, if she did get mad. I applaud your desire to learn and understand. So should she.

BTW, I think at least the gloves used during irrigation should be sterile.

[Hygeia79]

bladder is a sterile, so it must be sterile