PROCEDURE CHECKLIST Chapter 27: Intermittent Bladder or ...

PROCEDURE CHECKLIST
Chapter 27: Intermittent Bladder or Catheter Irrigation

Check (9) Yes or No

PROCEDURE STEPS Yes No COMMENTS

1. Uses sterile irrigation solution, warmed to room
temperature.

2. Never disconnects the drainage tubing from the
catheter.

3. If not already present, inserts a 3-way (triple
lumen) indwelling catheter.

Intermittent Irrigation, Three-way (Triple Lumen) Indwelling catheter

4. Prepares the irrigation fluid and tubing:
a. Closes the clamp on the connecting tubing.
b. Spikes the tubing into the appropriate portal on
the irrigation solution container, using aseptic
technique.
c. Inverts the container and hangs it on the IV pole.
d. Removes protective cap from the distal end of
the connecting tubing; holds end of tubing over a
sink and opens the roller clamp slowly, allowing
solution to completely fill the tubing. Recaps the
tubing.

5. Dons clean procedure gloves.

6. Drapes patient so that only the connection port on
the indwelling catheter is visible.

7. Prior to beginning the flow of irrigation solution,
empties any urine that may be in the bedside drainage
bag and documents amount.

8. Determines whether the irrigant is to remain in the
bladder for any length of time. If irrigant is to remain
in the bladder for a certain time period, clamps the
drainage tubing for that time.

9. Slowly opens roller clamp on the irrigation tubing.

10. Instills or irrigates with the prescribed amount of
irrigant.

11. When the correct amount of irrigant has been used
and/or the goals of the irrigation have been met, closes
the roller clamp on the irrigation tubing, leaving the
tubing connected to the catheter for use during the next
irrigation.

12. Removes gloves; washes hands.

Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing

13. Makes patient comfortable.
Intermittent Irrigation, Two-Way Indwelling Catheter

14. Dons clean procedure gloves; empties any urine
currently in the bedside drainage bag.

15. Drapes patient so that only the specimen removal
port on the drainage tubing is exposed.

16. Places a waterproof drape beneath the exposed
port.

17. Opens the sterile irrigation supplies. Pours
approximately 100 mL of the irrigating solution into
the sterile container, using aseptic technique.

18. Swabs specimen removal port with antiseptic
swab.

19. Draws irrigation solution into the syringe. (For
catheter irrigation, use a total of 30–40 mL; for bladder
irrigation the amount is usually 100– 200 mL.)

20. Inserts the needle into the specimen port. Points
the needle toward the bladder.

21. Holds the specimen port with the fingers; does not
lay the tubing/port in the palm of the hand when
accessing the port.

22. Clamps drainage tubing distal to the specimen
port.

23. Injects the solution, holding the specimen port
slightly above the level of the bladder.

24. If meets resistance, has patient turn slightly and
attempts a second time. If resistance continues, stops
the procedure and notifies the physician.

25. When the irrigant has been injected, withdraws the
needle. Refills the syringe if necessary.

26. Does NOT recap the needle. If necessary to repeat
the irrigation, rests the needle end of the syringe in the
irrigation solution container.

27. Unclamps the drainage tubing and allows the
irrigant and urine to flow into the bedside drainage bag
by gravity. (If the solution is to remain in the bladder
for a prescribed time, leaves the tubing clamped for
that time period.)

28. Repeats the procedure as necessary until the
prescribed amount has been instilled, or until the goal
of the irrigation is met. (e.g. removal of clots, mucus,
urine flowing freely, etc.)

Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing

29. Removes gloves, washes hands.
30. Returns patient to a position of comfort.

Recommendation: Pass ______ Needs more practice ______

Student: Date:

Instructor: Date:

Copyright © 2007, F. A. Davis Company, Wilkinson & Van Leuven/Procedure Checklists for Fundamentals of Nursing