Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C).
2. 2.Show
   Screen the bed. Ensure that the patient is in a comfortable position, allowing the nurse access to the catheter.
   For the patient's privacy and to reduce the risk of cross‐infection (Fraise and Bradley [81], E).
3. 3.Show
   Wash hands with soap and water and/or alcohol‐based handrub and apply personal protective equipment.
   To decontaminate hands and reduce the risk of cross‐infection (NHS England and NHSI [161], C).

Procedure

1. 4.Show
   Perform the procedure using an aseptic technique.
   To minimize the risk of infection (Loveday et al. [135], R).
2. 5.Show
   Open the outer wrappings of the sterile dressing pack and place it on the top shelf of the trolley.
   To prepare the equipment. E
3. 6.Show
   Insert the end of the irrigation giving set into the fluid bag and hang the bag on the infusion stand. Allow the fluid to run through the tubing so that air is expelled.
   To prime the irrigation set so that it is ready for use. Air is expelled in order to prevent discomfort from air in the patient's bladder. E
4. 7.Show
   Clamp the catheter and place an absorbent sheet under the catheter junction.
   To prevent leakage of urine through the irrigation arm when the spigot is removed. E
5. 8.Show
   Clean hands with an alcohol‐based handrub. Put on clean gloves.
   Handling the packets may have contaminated hands; to minimize the risk of cross‐infection (NHS England and NHSI [161], C).
6. 9.Show
   Place a sterile paper towel under the irrigation inlet of the catheter and remove the spigot.
   To create a sterile field and to prepare the catheter for connection to the irrigation set (Clarebrough et al. [48], E).
7. 10.Show
   Discard the spigot and gloves. Clean hands with an alcohol‐based handrub.
   To prevent reuse and reduce the risk of cross‐infection (NHS England and NHSI [161], C).
8. 11.Show
   Put on sterile gloves. Clean around the end of the irrigation arm with sterile low‐linting gauze and an antiseptic solution or wipe.
   To remove surface organisms from the gloves and the catheter and to reduce the risk of introducing infection into the catheter (Loveday et al. [135], R).
9. 12.Show
   Attach the irrigation giving set to the irrigation arm of the catheter. Keep the clamp of the irrigation giving set closed.
   To prevent over‐distension of the bladder, which can occur if fluid is run into the bladder before the drainage tube has been unclamped (Clarebrough et al. [48], E).
10. 13.Show
    Release the clamp on the catheter tube and allow any accumulated urine to drain into the catheter bag. Empty the urine from the catheter bag into a sterile jug.
    Urine drainage should be measured before commencing irrigation so that the fluid balance may be accurately monitored (Clarebrough et al. [48], E).
11. 14.Show
    Discard the gloves.
    These will be contaminated, having handled the cathether bag (NHS England and NHSI [161], C).
12. 15.Show
    Set irrigation at the required rate (see Box 6.1), titrated to the colour of the urine output, and ensure that fluid is draining into the catheter bag.
    To check that the drainage system is patent and to prevent fluid accumulating in the bladder. E

Post‐procedure

1. 16.Show
   Make the patient comfortable, remove unnecessary equipment and clean the trolley.
   To reduce the risk of cross‐infection (Fraise and Bradley [81], E).
2. 17.Show
   Remove gloves and apron and dispose according to local policy. Wash hands or use an alcohol‐based handrub.
   To reduce the risk of cross‐infection (NHS England and NHSI [161], C).
3. 18.Show
   Check blood results 8–12 hours after irrigation has been commenced.
   To ensure absorption has not occurred. E
4. 19.Show
   Record information in relevant documents; this should include:

   • reason for irrigation
   • date and time irrigation commenced
   • volume, colour and characteristics of urine output.
   To provide a point of reference or comparison in the event of later queries (NMC [178], C).
5. 20.Show
   Ensure an accurate fluid balance is commenced and maintained throughout irrigation (Figure 6.15 provides an example of a bladder irrigation chart).
   To monitor irrigation and to ensure fluid irrigated is also being drained. This will also enable monitoring for any absorption. E