Continuous Bladder Irrigation (CBI)

Continuous Bladder Irrigation (CBI) 

Purpose: 

Continuous bladder irrigation (CBI) is ordered to clean the bladder and remove blood clots, mucous, and products of urine decomposition. It is also used to instill medication and prevent plugging of the catheter. 

Policy: 

• A physician's order is required to initiate a CBI. 

• The physician's order must specify the type of solution, frequency, and amount to be given over a specific period. 

• Continuous bladder irrigation is administered by licensed nursing personnel. 

Procedure: 

1. Preparation: 

• Gather the necessary solutions and tubing. 

• Verify the physician's order and identify the resident. 

2. Catheterization: 

• If not previously done, catheterize the resident with a three-way indwelling catheter and attach it to a closed drainage system (refer to catheter insertion/removal procedure). 

• Secure the catheter to the thigh to prevent injury. 

3. Solution Preparation: 

• Ensure the solution is at room temperature. 

• Attach the tubing to the solution bottle and hang the bottle from an intravenous (IV) pole. 

• Run fluid through the tubing to expel air, then close the tubing clamp. 

4. Connecting and Starting Irrigation: 

• Connect the tubing to the irrigation connection of the three-way catheter. 

• Empty and measure the drainage bag contents prior to opening the solution clamp. 

• Open the irrigation solution clamp to adjust the flow rate. 

• Ensure that the tubing is not kinked and that drainage is lower than bladder level. 

5. Monitoring and Maintenance: 

• Empty and measure the drainage bag contents as ordered or every shift and as necessary. 

• At the end of each shift, compute the true urinary output by subtracting the irrigation instilled from the total output. Record the true output on the I&O record. 

• If medication is added to the solution, document it on the Medication Administration Record (MAR). 

6. Discontinuing CBI: 

• Clamp the tubing and catheter at the distal ends. 

• Disconnect the tubing from the catheter. 

• Cover the top of the catheter with a sterile plug or change to a two-way catheter. 

• Document on the I&O Record, recording the time and amount of solution instilled up to that point. 

• Discard disposable equipment. 

7. Documentation: 

• Document in Nurses Notes the effectiveness of irrigation/medication and note any adverse signs or symptoms. Inform the physician as necessary. Record on the Treatment Administration Record (TAR). 

• Update the Resident Care Plan. 

Compliance and Documentation: 

• Adhere to CMS guidelines and Requirements of Participation for Long-Term Care Facilities. 

• Document the CBI procedure, including the resident’s response and any observations, in their medical record. 

• Note any complications or difficulties encountered during the procedure. 

• Regularly review and update techniques for CBI according to the latest clinical best practices and regulatory standards. 

• Provide training to staff on proper CBI procedures to ensure resident safety and comfort. 

• Conduct regular audits to ensure compliance with this policy and address any gaps in practice or documentation. 

References: 

• Centers for Medicare & Medicaid Services (CMS). State Operations Manual (SOM), Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. 

• CMS Requirements of Participation for Nursing Homes.