Bladder Washout & Irrigation 🚿
Manual bladder washout and continuous bladder irrigation (CBI), based on BAUS trainee guidance: indications, equipment, technique, troubleshooting, when to stop CBI and when to escalate.
🧠 Overview
- Manual bladder washout clears clots or debris by instilling and aspirating sterile saline, keeping the catheter patent.
- Continuous bladder irrigation (CBI) keeps the catheter patent, dilutes haematuria and helps prevent further clots while bleeding settles or definitive haemostasis is arranged.
- Clots can cause retention. The body breaks clots down with natural anticoagulants (plasmin), so persistent clot can lead to persistent bleeding.
- A general guide: it does not replace local guidance or senior advice.
🩸 Washout: indications
- Clot retention
- Persistent haematuria and/or haematuria with clots
- Catheter blockage
🧰 Washout: equipment
- Trolley
- 1 L 0.9% NaCl or sterile water (warm is more comfortable)
- Sterile bowl, plus a bowl to discard aspirate and clots
- 50 mL bladder tip (catheter tip) syringe
- Non-sterile gloves and apron
- New catheter bag
- Disposable bed pads
📝 Washout: procedure (ANTT)
- Wash hands, put on apron and gloves.
- Place pads under the patient. Position them comfortably supine, at 0° or 45°.
- Pour 1 L NaCl into the sterile bowl. Keep the discard bowl nearby.
- 3-way catheter: stop the irrigation or put a spigot in the third channel.
- Disconnect the catheter bag.
- Draw up 50 mL NaCl and connect the syringe to the outflow (middle) channel.
- Gently instil 50 mL, then withdraw. Warn the patient it may be uncomfortable.
- Aspirate as much back as you can and discard it.
- Repeat up to 1000 mL, or until the aspirate is clear of clots and drains rosé or clear.
- Reconnect the bag. Consider starting or resuming CBI.
- Document the procedure, any difficulties and the outcome.
- Patients may need serial washouts, sometimes more than one a day.
⚠️ After urological surgery
- Wash out very gently.
- Do not overdistend the bladder: risk of perforation.
🔧 Fluid goes in but won’t come back
- Usually clots or debris blocking the catheter tip, or a large organised clot.
- Check the catheter is placed correctly.
- Instil more fluid, up to 150 mL in total. Stop if there is pain.
- Gently advance and rotate the catheter with the balloon inflated.
- Change the catheter.
- Still not working: discuss with the urology registrar. They may want imaging to look for organised clot, and the patient may need theatre.
💧 CBI: indications
- Persistent or worsening haematuria after a bladder washout
- After an operation
🧰 CBI: equipment
- 3-way catheter in place, preferably large bore (20–22 Fr). It has an inflow port and an outflow (middle) port.
- Drip stand
- Two 3 L bags of sterile saline
- Irrigation giving set: single or dual spike for one or two bags. Dual spike sets have a Y-connector to choose one or two channels.
📝 CBI: set-up
- Similar to setting up an IV drip.
- Check the catheter is inserted correctly and draining.
- Hang the saline bags on the drip stand and connect them to the giving set.
- Prime the tubing with irrigation fluid to remove air.
- Connect the tubing to the inflow channel of the 3-way catheter.
- Run the irrigation, opening one bag at a time.
- Monitor for pain, catheter bypassing and urine output.
🛑 When to stop CBI
- Urine stays light pink or clear with irrigation stopped, after a period of observation
- No clots visible in the drainage bag
- Haemoglobin stable
- As per the operation note instructions
🚩 Call the urology registrar
- Very frequent washouts needed
- Significant haematuria
- Signs of anaemia, or the patient looks unwell
- Any change in observations: low BP, rising HR
- Blockage you can’t clear
- Post-op patient with worsening pain or poor drainage
- On CBI: haematuria not clearing or irrigation not running
Note Template
Ready-to-use clinical note structure
🕒 08 / 11 / 2026 — 16:03 Bladder washout / CBI Patient: [age] [sex] Indication: [clot retention / persistent haematuria ± clots / catheter blockage] Recent urological surgery: [N / Y: washed out very gently] Catheter: [2-way / 3-way] __ Fr 🚿 Washout (ANTT): • Fluid: [0.9% NaCl / sterile water] • Total instilled: __ mL (max 1000 mL) • Aspirate: [clots cleared / still clots] drains: [rosé / clear / heavily bloodstained] • Difficulties: [none / unable to aspirate: catheter checked, further fluid (≤150 mL), catheter advanced and rotated, catheter changed] 💧 CBI: • [started / resumed / not started] via inflow channel • Bypassing: [N / Y] Pain: [N / Y] 🩺 Obs: BP __ HR __ Hb: __ 📋 Plan: • Monitor pain, bypassing, urine output • Further washouts if needed • Urology registrar: [not required / discussed: reason] 👤 [Your Name], [Role] IMC: _______
Educational reference only. Medical disclaimer