What should I see for follow up in a patient ongoing bladder wash ?
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continuous bladder irrigation follow up monitoring nursing assessment
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bladder washout catheter irrigation complications monitoring
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Here is a comprehensive guide on what to monitor during follow-up in a patient on ongoing bladder washout/irrigation:
Follow-Up Assessment in a Patient on Bladder Washout (Continuous Bladder Irrigation)
1. Catheter Patency & Drainage
- Verify outflow is free and unobstructed — this is the most critical check (Bailey & Love's, p. 348)
- Check all three lumens of the catheter (in triple-lumen Foley setups): irrigation in, drainage out, and balloon
- Ensure tubing is not kinked, clamped, or dependent loops pooling fluid
- Monitor for clot retention — dark red/clotted output suggests inadequate irrigation rate or active bleeding
2. Urine Output & Fluid Balance
| Parameter | What to Check |
|---|---|
| Output colour | Should gradually clear from red/pink → straw-coloured |
| Output volume | Must exceed irrigation input; negative difference = retained fluid |
| Fluid balance | Hourly/4-hourly input-output charts; watch for net positive balance |
| Urine output | Ensure adequate (≥0.5 mL/kg/hr) once bleeding is controlled |
3. Irrigation Rate Titration
- Adjust irrigation rate based on outflow colour — dark red = increase rate; pale yellow = can reduce rate
- Never run dry (air embolism risk); ensure bag is changed promptly
- Document rate adjustments and correlate with output clarity
4. Vital Signs & Haemodynamic Status
- Blood pressure & heart rate — assess for haemorrhagic compromise or shock
- Temperature — fever may indicate urinary tract infection or sepsis
- Respiratory rate & SpO₂ — especially if TUR syndrome is suspected (see below)
- Serum sodium — hyponatraemia is the hallmark of TUR syndrome (absorption of hypotonic irrigant)
5. TUR Syndrome Surveillance (post-TURP especially)
A specific, potentially life-threatening complication to actively exclude:
- Symptoms: confusion, nausea, visual disturbance, bradycardia, hypotension
- Biochemistry: hyponatraemia (Na⁺ < 130 mEq/L), hypo-osmolality
- Management: slow the irrigation, restrict fluids, consider hypertonic saline if severe
6. Pain & Bladder Spasm
- Monitor for bladder spasms (painful involuntary contractions) — common with CBI
- Assess pain score regularly
- Anticholinergics (e.g., oxybutynin) or antispasmodics may be needed
- Distinguish spasm from catheter blockage (both cause suprapubic pain)
7. Signs of Infection
- Assess urine for cloudiness, foul odour, purulence
- Check WBC count, CRP, blood cultures if fever develops
- Catheter-associated UTI (CAUTI) risk increases with duration of irrigation
- Review need for antibiotics / catheter change
8. Wound and Perineal/Urethral Site
- Check urethral meatus for discharge, excoriation, or trauma
- Ensure catheter is secured to avoid traction
- Inspect suprapubic site if suprapubic catheter is in use
9. When to Escalate
| Finding | Action |
|---|---|
| No/minimal output despite irrigation running | Check for blockage; manual bladder irrigation if needed |
| Persistent bright red haemorrhage | Increase irrigation rate; surgical review |
| Confusion + hyponatraemia | Suspect TUR syndrome; senior review urgently |
| Fever + offensive urine | Cultures; antibiotics; consider catheter change |
| Acute urinary retention despite catheter | Re-examine catheter position and patency; imaging if needed |
10. Discontinuation Criteria
Bladder washout is generally discontinued when:
- Urine clears to pale yellow/straw colour for a sustained period (usually >4–6 hours)
- No further bleeding
- Fluid balance is stable
- Patient is tolerating oral hydration adequately
Summary: The core pillars of follow-up are catheter patency, output colour and volume, fluid balance, haemodynamic stability, and vigilance for TUR syndrome in post-TURP patients. Regular reassessment (typically hourly) is standard practice until irrigation is safely weaned.
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