Saturday, September 14, 2013

Continuous Bladder Irrigation

The last two nights I have had a relatively new experience.  I was taking care of a patient who was admitted for blood clots in the ureter, von Willebrand disease (a blood clotting disorder) and possibly a UTI.  The plan of care for this patient included continuous bladder irrigation (CBI).  I had only ever had a patient with a CBI once and it was a loooong time ago. 
The first night with the CBI started out fine.  The irrigation was flowing into the bladder and it was flowing out like it should.  There were no clots in the urine so that was a good sign.  In order to keep track of the CBI, the urine is emptied every hour just to keep an eye on the output. 
About halfway through the night, I noticed the catheter was not draining as much as it should have been.  In fact it didn’t look like it was draining at all.  So I decided it needed to be flushed.  When I flushed the catheter, I got a bunch of blood clots that had been clotting off the catheter.  As soon as it was flushed it started draining perfectly again.  It was fine for the rest of the shift.
The second night was horrendous.  During the day shift, the urology residents had turned the flow down to almost a slow trickle.  The thing about this is that when you do that you actually allow more blood clots to form because there is nothing irrigating them out.  Everything seemed to be going fine, until about 0300 when the catheter was clotted off again.  So I flushed it again, but this time even though I got out some of the clots, I couldn’t get it to flow again.  So I called the doctor to see if I should turn it up.  He told me to leave it alone.  So I left it alone and kept an eye on it.  At 0500 the urology residents showed up and they were pissed.  They went off about how it was a bad thing to let it get clotted off and I should have flushed it and should have turned up the rate and “manA I just did everything wrong”.  It was frustrating especially since I had spoken to the doctor but I just shrugged it off and went with the flow.  Apparently it was clotted off to the point of they had to flush it for almost thirty minutes before they got it flowing.  Hmm…probably would have been nice if the rate would have been turned up some.  Thankfully the patient was fine and no harm was caused.
  

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