Bladder Irrigation - Pediatric

Bladder irrigation is a way to flush out mucus and other debris that can build up in the bladder. This material may look like small pieces, flakes, or "floaties" in the urine. People who use urinary catheters can develop a buildup of mucus, stone crystals, or bacteria in their bladder. Over time, this buildup can increase the risk of bladder infections and bladder stones.

Think of your bladder as a snow globe. When you shake a snow globe, the particles floating inside move around. Bladder irrigation works in a similar way. The irrigation fluid stirs up mucus and debris in the bladder. Once the debris is floating in the fluid, it can drain out through the catheter.

Bladder irrigation may help:

• Reduce mucus buildup
• Lower the risk of urinary tract infections (UTIs). A UTI is an infection anywhere in the urinary system, including the bladder.
• Prevent bladder stones

Your urology provider will tell you which irrigation solution to use. This may be:

• Normal saline
• Water
• Distilled water
• Dilute vinegar

Your provider will also tell you how often to irrigate your bladder. Do not change the irrigation solution or schedule unless your provider tells you to.

You will need your regular catheterization supplies, plus:

• 60mL catheter-tipped syringe
  • The syringe does not need to be sterile, but it should be clean.
  • The same syringe can usually be used for at least one month if it is cleaned with diluted vinegar after use. (See below for instructions on cleaning your supplies with diluted vinegar.)
• Irrigation solution
  • At least 300 mL
  • The solution recommended by your provider
• Container for irrigation solution
  • The container does not need to be sterile
• Urinal or basin
  • Used to collect urine and used irrigation fluid

Irrigation solution: _______________________________ Irrigation volume: ___________ mL

1. Wash your hands with soap and water.
2. Pour the irrigation solution into the plastic container.
3. Catheterize as you normally would to empty your bladder completely.
   1. If you are irrigating a Foley catheter:
      1. Clean the connection between the Foley catheter and drainage bag with a clean wet wipe.
      2. Disconnect the drainage bag from the catheter.
      3. Connect the irrigation syringe directly to the catheter.
      4. Do not allow the open end of the drainage bag to touch any surfaces. This helps keep it clean and reduces the risk of contamination.
4. Draw up 60 mL of irrigation solution into the catheter-tipped syringe and push it into your bladder through the catheter. Push the solution in with steady pressure. You may use a gentle pulsating "stop-go" motion to help loosen mucus and debris, similar to shaking a snow globe. Stop if you feel pain, pressure, or resistance when pushing in the solution. Do not force the solution into the bladder. If the problem continues, contact your provider.
5. If applicable, pinch off the catheter, draw up additional irrigation solution, and push it into the bladder using same technique. Repeat as needed to reach the total recommended irrigation volume as listed above.
6. Pull back on the syringe plunger to remove used irrigation solution. Remove 60mL if your prescribed irrigation volume is greater than 60mL. Remove 30 mL if your prescribed irrigation volume is 60mL.
   • Check the fluid for mucus or debris, then discard it in the urinal or basin.
7. If you see debris or mucus in the removed solution, draw up another 60mL (or 30mL if that was the volume removed) of clean solution into the syringe and push it into your bladder. Then repeat step 6.
8. Continue the cycle of adding clean solution (step 7) and removing the used solution (step 6). Repeat until the fluid coming out is free of mucus and debris. This may require up to 300 mL of solution.
9. When irrigation is complete, remove the remaining used irrigation solution from the bladder, leaving the last 30mL in the bladder.
10. Allow the last 30mL to drain naturally through the catheter. This helps prevent the catheter from pulling against the bladder wall.
11. Wash your hands thoroughly. If told to do so, clean all your supplies with diluted vinegar. (See cleaning instructions below).

Follow the schedule recommended by your urology provider. Some people need to irrigate daily, twice weekly, or just as needed.

Use bottled pharmacy saline if available. If pharmacy saline is not available, you may prepare saline at home using one of the methods below.

Option 1 (make at home)

Mix:

• 1 gallon distilled water
• 8 teaspoons table salt

Shake or stir until all the salt is dissolved.

You can store this solution in the refrigerator for up to two weeks; after that, throw it away.

Option 2 (make at home)

1. Boil 2 quarts of tap water for 10 minutes.
2. Add 4 teaspoons of table salt to the boiling water.
3. Let the solution cool.
4. Store in a clean plastic bottle, preferably the bottle provided by the hospital.

You can keep this solution for 24 hours refrigerated; after that, throw it away.

If the saline looks cloudy, has particles, or smells unusual, throw it away and make a fresh batch.

If your provider suggests using dilute vinegar for the irrigation solution, follow these instructions. Use regular household white vinegar (5% acidity), and mix the amount shown below into your irrigation solution.

Helpful measurements:

• One teaspoon = 5 mL
• One tablespoon = 15 mL

1. Mix:
   1. 1 ½ cups white vinegar
   2. 2 quarts (8 cups) water
2. Take apart the syringe and place the syringe, plunger, and container used for irrigation into a bathtub, sink, or large basin.
3. Soak the supplies in the vinegar mixture for 30 minutes.
4. Drain the mixture and rinse all supplies with clean water.  
5. Do not use a bleach solution during this process, as it can damage the equipment.
6. Allow supplies to air dry completely before storing them in a clean, dry place.  

If you cannot put fluid into your bladder, cannot pull fluid back out, or think the catheter is blocked:

1. Remove the current catheter.
2. Insert a new catheter, drain your bladder, and attempt irrigation again. 

It is normal for the amount of fluid removed to vary slightly from the amount put into the bladder. If a large amount remains in the bladder, or if you cannot drain the bladder comfortably, contact your provider. 

Contact your provider if:

• You cannot insert the catheter
• You cannot drain your bladder
• Irrigation becomes painful.
• You develop fever, chills, or symptoms of a urinary tract infection.
• Your urine becomes significantly bloody.
• Your bladder remains full or uncomfortable after irrigation.