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Bladder Washing (Bladder Irrigation) – Procedure, Indications, and Nursing Care

Introduction

Bladder washing (also called bladder irrigation or bladder lavage) is a medical procedure used to clean the urinary bladder by flushing it with sterile fluid. It helps remove blood clots, mucus, debris, pus, or other unwanted materials from the bladder.
It is commonly performed through a Foley catheter or a three-way urinary catheter in patients with urinary retention, post-surgical bleeding, or certain bladder infections.

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Purpose of Bladder Washing

• To remove blood clots, debris, or pus from the bladder.

• To prevent or relieve catheter blockage.

• To treat or prevent infection by flushing the bladder with antiseptic or antibiotic solutions.

• To maintain catheter patency in patients with continuous bladder drainage.

• To control bleeding in post-TURP (Transurethral Resection of Prostate) or bladder surgery patients.

• To collect samples for diagnostic testing (e.g., cytology or culture).

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Indications

Bladder washing is indicated in:

1. Post-surgical bladder bleeding (e.g., TURP, bladder tumor resection).

2. Hematuria with clot retention.

3. Chronic urinary catheter blockage due to mucus or debris.

4. Bladder infection requiring antiseptic irrigation.

5. Urinary retention caused by obstruction within the catheter lumen.

6. Diagnostic purposes (collection of bladder washings for cytology).

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Contraindications

Bladder irrigation should be avoided in:

• Recent bladder or urethral injury.

• Severe urethral strictures.

• Suspected bladder perforation.

• Allergy to the irrigating solution.

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Types of Bladder Irrigation

1. Continuous Bladder Irrigation (CBI)

   • Performed through a three-way Foley catheter.

   • Sterile saline is continuously infused and drained to prevent clot formation.

2. Intermittent Bladder Irrigation

   • Irrigation is done at set intervals using a syringe.

   • Used for clearing blockage or delivering medication.

3. Open Bladder Irrigation

   • Catheter is disconnected from drainage, bladder is irrigated manually with a syringe.

4. Closed Bladder Irrigation

   • Irrigation is performed without breaking the closed urinary drainage system, reducing infection risk.

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Articles Required

• Sterile bladder irrigating solution (normal saline or prescribed medicated solution).

• Irrigation set or syringe (50–60 mL catheter-tip syringe).

• Sterile gloves.

• Antiseptic solution (povidone-iodine).

• Kidney tray.

• Gauze pieces.

• Waste disposal bag.

• Clamp (if required).

• Three-way Foley catheter (for continuous irrigation).

• Catheter fixation tape.

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Procedure of Bladder Washing (Intermittent Irrigation)

Preparation

1. Explain the procedure to the patient to gain cooperation.

2. Obtain informed consent if required.

3. Wash hands and wear sterile gloves.

4. Position the patient supine with legs slightly apart.

5. Place a waterproof sheet under the patient’s hips.

6. Ensure privacy.

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Steps

A. For Intermittent Irrigation

1. Clamp the drainage tubing from the catheter bag.

2. Clean the catheter connection with antiseptic swab.

3. Attach the catheter-tip syringe filled with sterile irrigating solution to the catheter.

4. Gently instill 30–60 mL of solution into the bladder.

5. Withdraw the fluid along with debris or clots into the syringe.

6. Repeat the process until the returned fluid is clear (do not exceed prescribed volume).

7. Disconnect the syringe and reconnect the drainage bag.

8. Dispose of waste as per biohazard guidelines.

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B. For Continuous Bladder Irrigation (CBI)

1. Ensure the patient has a three-way Foley catheter inserted.

2. Connect the irrigation solution bag to the irrigation port using sterile tubing.

3. Hang the bag above bladder level.

4. Adjust the flow rate to keep urine light pink or clear (as per physician’s order).

5. Monitor the input and output accurately.

6. Check for blockages or kinks in tubing.

7. Observe for patient discomfort or signs of bladder distension.

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Aftercare

• Ensure the catheter is draining freely.

• Record amount of solution used and output measured.

• Observe for any abnormal findings (e.g., fresh bleeding, cloudy urine, foul odor).

• Provide perineal care if needed.

• Educate the patient on catheter and fluid management.

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Complications

• Urinary tract infection (UTI) due to poor aseptic technique.

• Bladder spasms from rapid or excessive irrigation.

• Catheter blockage if clots are not fully cleared.

• Trauma to bladder or urethra from forceful irrigation.

• Electrolyte imbalance if hypotonic solutions are used.

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Nursing Responsibilities

• Maintain strict asepsis during the procedure.

• Monitor fluid balance (input vs output).

• Prevent catheter dislodgement.

• Watch for signs of infection or bladder injury.

• Communicate any abnormal findings to the physician immediately.

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Key Points

• Always use prescribed irrigation solution.

• Never use excessive force during flushing to avoid bladder injury.

• Maintain closed drainage system whenever possible.

• Document time, type of irrigation, solution used, amount returned, and observations.