Continuous Bladder irrigation

3 Ever done it? Its cool yes?

So I have one going. Boss comes by and says its going too fast.

I say...well how fast should it be going. She walks off and comes back with the printed very very official policy. it clearly sates that CBi should only run at a max of 50 ml per hour.

I roll my eyes and almost pass out. I ask her if she has thought about that math.

A bag of irrigant is 3000 ml.....

3000/50 = 60 yes? YES?

So I only have to change the bag every 60 hours? Silly me? I usually change them 2 or 4 times per shift....What have I been thinking.....
Thats crazy. I've never had a urologist come in and tell me my bag was going in too fast. I usually open it up enough where its fast but I can still see it dripping, rather than pouring out, in the chamber. I think an average bag for me will last about 70 - 90 minutes. Not good for the pt. if they start clotting. Anyway you can discuss with a urologist and maybe get the policy changed?

Are you certain she wasn't speaking of the concentration? I've never did a CBI at 50ml/hr it defeats the purpose.The nurse determines what the irrigation will be infused at. I would question the document.

It's been a loooong time, but it seems like our urologists would write the order "to keep clear," or "to keep pale pink." We'd change the bag q 2 hrs, give or take

Pale pink or clear. Have NEVER seen a set rate.

I have not seen a "set rate," either. I agree 50 cc per hr is a bit slow, and may not do much. Rarely do them anymore, but a bag would usually last thru 1-2 shifts. We would slow the rate down after the color starts clearing some. The rule of thumb I go by is if you see clots, go a little faster; if no clots and color is pink, slow down some. Maybe your policy is for medications, instead of saline?

If the patient doesn't clot off with the bag going in at only 50ml/hr, they don't need a CBI. Your boss is clueless and should be ashamed to spout off nonsense like that. If that is indeed your policy, whoever came up with that rate is also clueless.Nursing is supposed to titrate it to color on my unit.We had a patient on a CBI for a loooong time due to bladder damage from radiation. The urologist had us running 3L NS bags with some med in them (to help decrease bleeding, forgot what it was -- bags prepared by pharmacy) with a set rate -- the problem was, there was no drip rate on the CBI tubing packaging so we had no way to calculate the rate.

I have NEVER heard of such a thing...that defeats the purpose. I would check with the MD

I know what the MD would say......"the probably meant 500 ml/hr"

where is your managers brain? I wonder if it is a typo?

I do CBI all the time. 50mL an hour is way too slow and defeats the entire purpose. You were right to question her! She was WRONG.

Quote from rnmi2004If the patient doesn't clot off with the bag going in at only 50ml/hr, they don't need a CBI. Your boss is clueless and should be ashamed to spout off nonsense like that. If that is indeed your policy, whoever came up with that rate is also clueless.Nursing is supposed to titrate it to color on my unit.We had a patient on a CBI for a loooong time due to bladder damage from radiation. The urologist had us running 3L NS bags with some med in them (to help decrease bleeding, forgot what it was -- bags prepared by pharmacy) with a set rate -- the problem was, there was no drip rate on the CBI tubing packaging so we had no way to calculate the rate.

Get the uro docs to approve a protocol, which you will write. If all it says is, "Run to keep output light pink, increase if clots until cleared, notify prn for ... ," then you're covered for the right thing.