CONTINUOUS BLADDER IRRIGATION (CBI)
PURPOSE
Continuous bladder irrigation may be necessary to help remove tissue chips, blood clots and other debris from
the bladder after surgery or to treat/manage gross hematuria from an irritated, inflamed or infected bladder
lining.
POLICY STATEMENTS
Initiation of continuous bladder irrigation (CBI) requires a prescriber’s order. The order must include the type
and amount of solution to use for irrigating the bladder and flow rate.
A 3-way triple lumen catheter is required for CBI.
Aseptic technique is essential to minimize risk of catheter associated urinary tract infections.
A replacement solution bag must always be available in room to ensure solution does not run out.
Saline solution for irrigation will be stored and infused at room temperature to avoid bladder spasms.
Strict Intake and Output monitoring is required for patients on CBI.
SITE APPLICABILITY
All clinical inpatient areas.
PRACTICE LEVEL/COMPETENCIES
Continuous bladder irrigation is considered an advanced pediatric nursing skill that is practiced after the RN
has the required education and has had learning validated by the appropriate clinical support person.
EQUIPMENT
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Normal saline irrigating solution (X2) at room temperature
Bladder irrigation set
Sterile urinary drainage set (large size)
Gloves
IV pole
Supplies required for inserting catheter as per Indwelling Urinary Catheterization procedure
3-way catheter of appropriate size (sizes 16, 18, 20 FR available at BCCH). Larger sizes may
be ordered
PROCEDURE
Rationale
1. PERFORM hand hygiene.
Routine infection control practices; reduces
transmission of microorganisms.
Removes air from tubing that could cause bladder
distention.
2. PREPARE irrigation set by spiking irrigating
solution with bladder irrigation set and PRIME
tubing.
3. IDENTIFY patient and EXPLAIN procedure.
Failure to correctly identify patients prior to procedures
may result in errors.
Reduces child and family’s anxiety. Evaluates and
reinforces understanding of previously taught
information and confirms consent for procedure.
LastReviewDate
CC.15.10
BC Children’s
Sep 04, 2013
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
Hospital Child & Youth Feb
Health
Policy and Procedure Manual
15, 2010
Page 1 of 3
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Oct 01, 2016 17:22
Generated By
Anonymous
CONTINUOUS BLADDER IRRIGATION (CBI)
4. INSERT 3-way catheter as per Indwelling Urinary
Catheterization procedure if not already insitu.
5. Aseptically ATTACH drainage bag tubing to large
centre port of catheter.
3-way catheter allows for constant irrigation of bladder
with one port for inflow of irrigation solution and one
port for outflow of returns. The 3rd port is for inflating
the balloon.
Centre port is the outflow lumen.
6. SCRUB the opening to the inflow lumen of the
Use of strict aseptic technique when handling any of
catheter (small side lumen) with a
the equipment helps prevent introduction of
chlorhexidine/alcohol swab for 30 seconds and
microorganisms into the urinary tract.
allow to dry. Aseptically ATTACH the primed
irrigation tubing to this port.
7. OPEN clamp to irrigation solution. VISUALIZE drip Initiates bladder irrigation.
chamber and ensure free flowing solution. ADJUST
Flow rate determined based on child’s size and goals
flow rate to the rate ordered.
of therapy.
8. OPEN clamp on drainage bag and ensure free
Adequate drainage must be maintained to prevent
flowing of urine and irrigation solution.
bladder distention and discomfort.
9. To prevent air from entering the system, DO NOT Air could lead to bladder distention and discomfort.
ALLOW the irrigation fluid container to empty
completely. Close roller clamp, remove near empty
container and replace with new container. Unclamp
and resume irrigation as ordered.
10. INSTRUCT child/family to notify staff of any
Encourages prompt reporting of symptoms and
discomfort. If child complains of severe abdominal facilitates prompt identification of problems.
pain, stop the irrigation and investigate to ensure
that the bladder is not distended.
11. MONITOR hourly inflow of solution and output of
urine/solution. SUBTRACT output from inflow to
determine urine output.
12. REMOVE equipment and dispose appropriately.
Routine infection control practices; reduces
PERFORM hand hygiene.
transmission of microorganisms.
DOCUMENTATION
DOCUMENT
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o
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o
o
o
o
o
o
on appropriate record:
date and time
type and amount of irrigation solution used
amount and quality of returns
estimated urine output (output – inflow = urine output)
patient concerns/adverse reactions and interventions required (eg. manual irrigation, use of
bladder scanner)
patient’s comfort/pain level
patient’s response to procedure(s)
patient/family teaching
other pertinent actions or observation
REFERENCES
Cutts, B. (2005). Developing and Implementing a New Bladder Irrigation Chart. Nursing Standard, 20(8):4852.
Grey Bruce Health Services. Continuous Bladder Irrigation Clinical Protocol. August 2007. Owen Sound,
Ontario.
LastReviewDate
CC.15.10
BC Children’s
Sep 04, 2013
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
Hospital Child & Youth Feb
Health
Policy and Procedure Manual
15, 2010
Page 2 of 3
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Oct 01, 2016 17:22
Generated By
Anonymous
CONTINUOUS BLADDER IRRIGATION (CBI)
Leonard, C. and Lebet, R.M. (2008) Continuous Bladder Irrigation. In Trivets Verger, J. and Lebet, R.M. (Ed),
AACN Procedure Manual for Pediatric Acute and Critical Care (pp.811-814). St. Louis,
Missouri:Saunders Elsevier.
Vancouver Coastal Health. Patient Care Guideline – Continuous Bladder Irrigation (CBI), Procedure for.
Reviewed/Revised September 2009. Vancouver, BC.
LastReviewDate
CC.15.10
BC Children’s
Sep 04, 2013
Disclaimer Message
Refer to online version – Print copy may not be current – Discard after use
Create Date
Hospital Child & Youth Feb
Health
Policy and Procedure Manual
15, 2010
Page 3 of 3
The following information, i.e. guideline/educational material/policy or procedure, has been developed for use only within BC Children's Hospital (BC Children's) and BC Women's Hospital and Health Centre (BC Women's).
Agencies other than BC Children's or BC Women's should use this information as a guideline for reference purposes only. All materials are the property of BC Children's and BC Women's and may only be reprinted in whole or
in part with our expressed permission. Contact PolicyCoordinator@cw.bc.ca with questions.
Date/Time Generated
Oct 01, 2016 17:22
Generated By
Anonymous