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Skills
Irrigating a Urinary Catheter
Quick Sheet
ALERT
• Avoid open catheter irrigation unless it is needed to relieve or prevent obstruction. The procedure requires breaking
or opening the connection between the catheter and drainage bag of a closed urinary drainage system.
• Maintain strict asepsis during open catheter irrigation to minimize contamination and subsequent development of a
urinary tract infection (UTI).
• If the patient’s bladder is distended, check to see if the flow of urine to the drainage bag has been blocked.
• When performing open irrigation, do not force the fluid through the tubing. The catheter may have become
completely occluded; if so, it will need to be changed.
• If the drainage output is less than the amount of irrigation solution infused, or if the patient complains of pain
during bladder irrigation, do the following:
• Examine the drainage tubing for clots, sediment, and kinks.
• Inspect the urine for the presence of or increase in blood clots and sediment.
• Evaluate the patient for pain and bladder distention.
• Notify the health care provider.
• If bright-red bleeding appears during continuous bladder irrigation (CBI) with the drip wide open, follow these steps:
• Assess for hypovolemic shock by measuring vital signs, checking skin color and moisture, and noting the patient’s
anxiety level.
• Leave the irrigation drip wide open, and notify the health care provider.
• If the patient has a fever; cloudy, foul-smelling urine; abdominal pain; or change in mental status, indicating a
possible infection, do the following:
• Notify the health care provider.
• Monitor the patient’s vital signs and the character of his or her urine.
• Empty the drainage bag frequently (every 1 to 2 hours) during bladder irrigation. The bag will fill rapidly, and the
irrigant will be unable to flow freely if it is not emptied. As a result, the bladder may become overdistended, causing
discomfort and possible injury.
• Remember to route tubes and catheters having different purposes in different, standardized directions (e.g., IV lines
routed toward the head; enteric lines toward the feet). This is especially important in the care of neonates.
1. Review the health care provider’s orders and the patient’s medical record. Verify the irrigation method and determine which solution is to
be used and in what amount.
2. Gather the necessary equipment and supplies.
3. Provide for the patient’s privacy.
4. Perform hand hygiene.
5. Introduce yourself to the patient and family, if present.
6. Identify the patient using two identifiers, such as name and date of birth or name and account number, according to agency policy.
Compare these identifiers with the information on the patient’s identification bracelet.
7. Explain the procedure to the patient and ensure that he or she agrees to treatment.
8. Lower the patient into a supine position, and palpate the patient’s bladder for distention and tenderness. Return the patient to a sitting
position as appropriate.
9. Check the collection bag for color, amount, and clarity of the urine. Look for mucous, clots, and sediments.
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10. Organize your supplies according to the type of irrigation the provider has ordered.
11. Raise the bed to an appropriate working height, and expose the junction of the catheter and drainage tubing. If the side rails are in use,
lower the rail on your side.
12. Expose the junction of the urinary catheter and drainage tubing. Apply gloves.
a. Trace tubing or catheter from the patient to the point of origin (1) before connecting or reconnecting any device or infusion, (2) at
any transition (e.g., new setting), and (3) as part of the hand-off process.
b. Label the tubing at a site close to the patient and at a site close to the source when there are different access sites or several bags.
13. Remove the catheter from the securement device.
14. For a closed continuous irrigation:
a. Clamp the irrigation tubing, and hang a bag of irrigating solution on the IV pole. Using aseptic technique, spike the designated
port of the irrigation solution bag with the tip of the sterile irrigation tubing.
b. Squeeze the drip chamber to fill it halfway. To open the tubing completely and displace the air inside it, release the clamp and
allow the solution to fill the tubing. Keep the end of the tubing sterile. Once the fluid has completely filled the tubing, close the
clamp.
c. Using a septic technique, securely connect the tubing to the port of the Y connector on the patient’s catheter.
i. Check vital signs immediately after making any connection per the organization’s practice.
ii. Do not force connections and avoid workarounds.
d. Adjust the clamp on the irrigation tubing to start the flow of solution into the bladder. If the provider has specified the volume,
calculate the drip rate and use the roller clamp to adjust it. If the patient’s urine is bright red or contains blood clots, increase the
irrigation rate until the drainage appears pink. Determine the rate according to the provider’s orders or your agency’s protocol.
e. Observe the outflow of fluid into the drainage bag, and empty the bag as needed. Goggles or other PPE may be needed when
emptying the drainage bag.
15. For a closed intermittent irrigation:
a. Pour the prescribed amount of sterile irrigating solution into a sterile container.
b. Use a septic technique to draw the prescribed volume of irrigant—usually 30 to 50 mL—into a needleless syringe. Place the sterile
cap on the tip of the needleless syringe.
c. Close off the catheter tubing below the soft injection port with a screw clamp, or fold the catheter tubing back onto itself and
secure it with a rubber band.
d. Use a circular motion to clean the catheter port or specimen port with an antiseptic swab.
e. Remove the sterile cap, and use a twisting motion to insert the tip of the needleless syringe into the port.
f. Inject the solution using slow, even pressure. Remove the syringe, and recap the port with a new catheter plug. Open the clamp or
free the rubber band, allowing the solution to drain into the urinary drainage bag. Some medicated irrigants must dwell in the
bladder for an extended length of time. During this period, the catheter must be clamped and cannot be left unattended.
16. For an open intermittent irrigation:
a. Follow strict aseptic technique during this procedure.
b. Open the sterile irrigation tray, and establish a sterile field.
c. Pour the required amount of sterile solution into the sterile container. Replace the cap on the large solution bottle. Add a sterile,
piston-type irrigation syringe to the sterile field. Open an antiseptic wipe so that it is ready for use.
d. Position a sterile drape under the catheter.
e. Aspirate the prescribed volume of irrigating solution (usually 30 mL) into the syringe. Rest the syringe in the sterile solution
container until you are ready to use it.
f. Move the sterile collection basin close to the patient’s thighs.
g. Apply sterile gloves, if required by agency policy.
h. Swab the connection point between the catheter and the drainage tubing with an antiseptic wipe before disconnecting it.
i. Disconnect the catheter from the drainage tubing, allowing any urine to flow into the sterile collection basin. Cover the open end
of the drainage tubing with a protective sterile cap, and position the drainage tubing so that it stays coiled on top of the bed with
the end resting on the sterile drape.
j. Insert the tip of the syringe into the catheter lumen, and gently push the plunger to instill the solution. Do not force the irrigation.
k. Remove the syringe, lower the catheter, and allow the solution to drain into the basin. The amount of drainage solution should be
equal to or greater than the amount of fluid instilled. If ordered, repeat the sequence of instillation and drainage until the
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drainage is clear of clots and sediment.
l. When the irrigation is complete, remove the protective cap from the urinary drainage tubing, clean the end of the tubing with an
antiseptic wipe, and reinsert it into the catheter lumen.
Anchor the catheter with the securement device to the patient’s leg. Remove gloves.
Help the patient into a safe and comfortable position. Lower the bed height, and adjust the side rails as necessary to ensure patient safety.
Place the call light within easy reach, and make sure the patient knows how to use it to summon assistance.
Put on clean gloves. Gather all contaminated supplies and dispose of in the appropriate receptacle.
Remove and dispose of gloves. Perform hand hygiene.
Document irrigation method, amount and type of irrigation solution, characteristics and amount of output, and the patient’s response.
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