Emergency Cases Northwest Group

031 Irrigation Irritation

Situation

Bladder irrigation was not flowing: the 3 way catheter was blocked with clot.

Background

A man had clot urinary retention: manually washed out via 3 way catheter and then irrigation commenced. Later went to speak to him and found the irrigation clamp open but not flowing, and the bladder had become palpable again [no apparent catheter output either]. Manually washed the bladder out again, more clot++ removed. Irrigation re started and flowed nicely, catheter outputting again.

Assessment

After the initial washout the bladder irrigation fluid hadn’t been flowing fast enough. This led to another clot formation which blocked the lumen of the 3 way catheter. The increased bladder pressure from this new bladder outlet obstruction caused the irrigation fluid to stop flowing.

In this case all that happened was the irrigation fluid stopped flowing but it could have continued to flow, increased pressure in the bladder and then caused it to rupture.

Recommendation

After the initial washout, make sure irrigation fluid is flowing constantly to prevent another clot formation.

BUT if a clot has formed again then stop the irrigation and do another washout, restarting the irrigation after that.

Otherwise irrigating the bladder with a clot still inside it may cause a bladder rupture.

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group