Manual irrigation

Manual bladder irrigation involves flushing a 3-way or 2-way urinary catheter manually with sterile sodium chloride 0.9% using a catheter-tipped syringe to evacuate all clots.

Manual irrigation may be followed by continuous bladder irrigation to minimise the risk of further clot formation and overdistention of the bladder.

The optimal outcome is removal of clots from the bladder, with the urine draining freely. Some sub‑optimal outcomes include the following:

• Overdistention of the bladder.
• Bladder rupture.
• Inability to clear clot in bladder, which may require catheter replacement or surgical removal of the clot. Consider replacement with a larger gauge (with larger drainage holes) or 3-way catheter, if the blocked catheter was a smaller gauge or a 2-way catheter.
• Development of a catheter-associated urinary tract infection (CAUTI) secondary to contamination during the procedure.
• Development of a CAUTI secondary to a break in the closed urinary drainage system and possible contamination during the procedure.

Manual irrigation must be gentle, as the increased pressure in the bladder can result in suture disruption or bladder perforation with resultant extravasation of urine.

Use sterile equipment and aseptic techniques for this procedure.

Use the Manual (intermittent) bladder irrigation checklist (PDF 226.4 KB) to demonstrate competency to safely perform this procedure.

Ordering and documenting manual bladder irrigation

While not contraindicated in patients who have had deep resection of bladder tumours, open bladder or renal transplant surgery, manual bladder irrigation must be ordered and documented by a urology medical officer or practitioner and be performed by an experienced clinician.

Documentation should include the reason for irrigation, volume instilled and returned, presence of clots or debris, patient tolerance, catheter patency post-procedure and any escalation.

If the catheter is blocked and the patient is within 72 hours of urological surgery, notify the urology registrar or consultant urologist. This is important following a transurethral resection of prostate (TURP) due to the risk of prostatic capsular perforation or sub‑trigonal catheter placement on reinsertion. It is also important following radical prostatectomy and bladder resection due to the risk of possible damage to surgical anastomosis and bladder perforation.

Nursing staff (unless an experienced urology nurse) and resident medical officers must not attempt re‑catheterisation unless authorised by a urology registrar or consultant urologist.

Equipment

• Personal protective equipment (PPE)
• Alcohol‑based hand rub
• 1 sterile catheter pack, a sterile dressing pack, or similar, to provide a sterile field
• 1 sterile kidney dish or sterile receptacle of at least 1 L volume (pending pack inclusion)
• 1 sterile catheter-tip 50 mL syringe
• Cleaning wipes, as per LHD supply and environmental cleaning protocols
• 6 x alcohol swabs, as per LHD supply (70% alcohol swabs, or 2% chlorhexidine and 70% alcohol swabs)
• 1 bottle 500 mL sterile sodium chloride 0.9%
• 1 sterile urinary drainage bag
• Disposable underpad
• Sterile gloves
• For clean, no-touch technique: a clean, non-sterile receptacle placed on lower shelf of the trolley, or on a separate trolley for drainage collection
• For sterile technique: an additional sterile kidney dish or sterile 1 L jug positioned within the sterile field.

Manual bladder irrigation procedure

Manual bladder irrigation aims to remove clots, restore urinary drainage and maintain catheter patency. Throughout the procedure:

• maintain aseptic technique
• minimise contamination
• support patient comfort and safety
• accurately document outcomes and fluid balance.