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Summary
Continuous bladder irrigation is a widely used
procedure following urological surgery. Nurses
monitor patients to minimise complications and to
provide an accurate record of fluid input and output.
Through observation in practice and discussion with a
ward team, it was identified that the documentation
in use for recording fluid balance was inadequate.
This resulted in inconsistencies and omissions in
documentation, which led to inaccuracies in fluid
balance. Development of a new chart has attempted
to address these issues. It has been developed as a
result of concerns identified in practice and adapted
to meet the needs of the clinical area.
Author
Beverley Cutts is a lecturer (adult nursing) at the
Institute of Health and Social Care Studies, Le
Vauquiedor, St Martins, Guernsey.
Email: bcutts@hssd.gov.gg
Keywords
Minimising risk
Maintenance of fluid balance is important, and when
monitoring bladder irrigation it is necessary to
identify the patients urine output and to monitor the
amount of irrigating fluid to ensure that total output
exceeds input (Fillingham and Douglas 1997,
Scholtes 2002). If output
decreases it may indicate that the catheter is
blocked. The patient will present with symptoms
similar to acute urinary retention, such as
experiencing abdominal pain and a sensation of
bladder fullness. There may also be leakage around
the catheter (Weaver 2001). In this instance, bladder
irrigation should be turned off to prevent any further
discomfort and the tubing should be examined for
kinks. If the clot cannot be dislodged by milking the
tubing, a bladder washout will be required to remove
the clot mechanically. This should be considered only
48 november 2 :: vol 20 no 8 :: 2005
undergoing bladder irrigation is an
important nursing intervention to
identify and prevent complications
associated with this therapy. It is
imperative that nurses document fluid
balance correctly and have an
underpinning knowledge to minimise
risk to patients. This can be problematic
in general wards and where nurses may
not have the necessary skills and
experience to care for urology patients
(Ng 2001).
Clinical assessment Working on an acute
surgical ward at Princess Elizabeth
Hospital, Guernsey, for patients following
urological surgery, observation and
discussion with colleagues revealed that
fluid balance for patients with bladder
irrigation was being managed and
documented ineffectively. The chart
being used was designed for universal
use and, although the columns for intake
were labelled, the columns for output
were blank. Thus, when the chart was
used for bladder irrigation, nurses had to
label the columns themselves. It was
often unclear how much bladder
irrigation a patient had received, making
accurate monitoring of output
problematic. Two key issues were
identified:
Inconsistencies in documentation and
the use of abbreviations that had not
been defined.
Inaccurate documentation leading to
inaccuracies in fluid balance
monitoring. For example, not all staff
recorded the time when a new bladder
irrigation unit was set up or
completed, making it difficult to
account for changes in a patients
condition.
NURSING STANDARD
Identification of monitoring problems needs to be
considered with respect to professional and clinical
issues:
Professional issues focus on the role and
responsibility of the nurse with respect to standards
of care and identifying risk to provide safe and
competent care (Nursing and Midwifery Council
(NMC) 2004).
Clinical issues relate to the skills and knowledge
required to manage patients undergoing bladder
irrigation.
To address some of these problems and achieve best
practice, the surgical ward team decided to develop a
document that would provide a complete record of a
patients input and output while receiving bladder
irrigation (Figure 2).
Record keeping
Having identified problems with existing documentation,
it was clear that the documentation contributed to
ineffective monitoring of a patients condition. The
NMCs (2005) Guidelines for Records and Record
NURSING STANDARD
november 2 :: vol 20 no 8 ::
2005 49
FIGURE 1
Bladder irrigation system
Irrigation solution
Clamps
Bladder
Three-way
irrigation catheter
Giving set
Clamp
Urine
drainage bag
50
FIGURE 2
no
Bladder irrigation chart
er
vol
no
FLUID/BLADDER IRRIGATION CHART
2005
DATE:
Oral
intake
ar
Affix label
Intravenous (IV)
Oral
Runnin
g total
IV
Runnin
g total
Bladder irrigation
Time
Fluid type
1630
1700
200
200
1730
Tea
150
350
1820
1830
Water
150
500
1825
2030
2030
&
WARD:
Commen d
ce
1000 1000
Commen d
ce
(A)
Time
1700
(B)
Volum
e put
up
(C)
Volum
e run
in
Urine
2000
1800
Other
&
science
500
2000
200
0
1905
1925
(D)
Total
volum
e out
Outpu
t
Urine
runnin
g
total
1600
100
1000
200
0
1600
600
700
NURSING
ST
24 hour total:
24 hour total:
Method of development
Searches were undertaken on the Cumulative Index of Nursing and Allied Health
Literature (CINAHL) and Cochrane databases as well as other electronic sources.
NURSING STANDARD
&
ar
Conclusion
References
Dougherty L, Lister S (Eds) (2004) Royal Marsden Hospital Manual of Clinical Nursing Procedures.
Sixth edition. Blackwell Publishing, Oxford.
BOX 1
Bladder irrigation chart: guidelines for use
Indications for use
Bladder irrigation is required to:
Prevent the formation and retention of clots, for example, following bladder or prostatic surgery.
Remove heavily contaminated material from a diseased urinary bladder.
Aim of the bladder irrigation chart
To provide an accurate record of a patients input and output during a period of bladder irrigation.
Recording bladder irrigation section (see Figure 2)
1.
Record the time (column A) and the fluid volume in each bag (column B) of irrigating fluid as it is put
up.
2.
When the irrigating fluid has run into the bladder, record the time in column A and the original volume in the bag in column C.
3.
The catheter bag should be emptied whenever a bag of irrigating fluid is empty or as necessary. The amount should be recorded in
column D.
4.
When each bag of fluid has run through, add up the total volume drained by the catheter in column D. Subtract this from total volume
run in (column C) to find urine output. Total volume out (column D) minus volume run in (column C) equals urine output.
5.
If a bag of irrigating fluid is discontinued, the volume run in can be calculated by measuring the volume left in the bag and
deducting this value from the original volume. This should be recorded in column C.
Oral intake and intravenous infusions can be recorded on the same chart to provide one record and enable accurate fluid balance to be
measured.
Adapted from The Royal Marsden Hospital Manual of Clinical Nursing Procedures (Dougherty and Lister 2004).
NURSING STANDARD