What Is a Bladder Washout and When Is It Needed?

A bladder washout flushes sterile fluid into the bladder through an existing catheter, then lets it drain or draws it back out. It is a short procedure meant to clear whatever is stopping urine from draining.1BAUS. Bladder washout & Irrigation That makes it mostly a fix for a catheter that is blocked or keeps blocking, not a treatment for the bladder itself. Whether regular preventive washouts are worth doing is still uncertain, so many people only need one when a problem appears.2PubMed Central. Washout policies in long‐term indwelling urinary catheterisation in adults

What Happens During a Bladder Washout

The mechanics are simple. A syringe or a bag of sterile fluid is attached to the end of the catheter already in place, the fluid is pushed in, and then it is drawn back out.3QSCIS. Bladder washouts On the way out, the fluid carries clots, mucus, sediment or debris with it.4GCMEDICA. Bladder Irrigation vs Bladder Washout: Key Differences Because any germs introduced go straight into the bladder, the equipment and technique must be sterile.5UroToday. Bladder irrigation toolkit

A visit usually goes like this. The nurse washes their hands, puts on gloves and cleans the catheter connection before disconnecting the drainage bag. The fluid is run in slowly, then allowed to drain or gently drawn back. The returned fluid is checked for clots, grit or cloudiness, and the cycle is repeated if needed. Finally the drainage bag is reconnected and urine flow is checked.

It must also be done gently. Pushing fluid in with force raises the pressure inside the bladder, which can break open surgical stitches or even tear the bladder.6UroToday. Bladder irrigation toolkit Sudden severe pain is a reason to stop and get medical help.

Washouts are usually done by community or ward nurses. Some people or carers are trained to do their own routine washouts, but nobody should attempt one without training, because of the infection and pressure risks.

Signs Your Catheter Is Blocked

Many people assume bypassing means the catheter is too small or too loose, but often urine cannot get through the catheter, so it escapes around it. Some signs are easy to miss. In someone with dementia or confusion, the pain of a blocked catheter may show up as sudden agitation or confusion instead.12Queensland Government. Urinary catheter (IDC or SPC): trouble-shooting a blocked catheter In someone with a spinal cord injury at or above chest level, a dangerous blood pressure spike can be the first sign of a blockage.13Queensland Government. Urinary catheter (IDC or SPC): trouble-shooting a blocked catheter When either of these people suddenly becomes unwell, carers should check the catheter first.

Simple causes come first, too. Kinks or twists in the tubing can stop drainage just like a true blockage.14Piedmont Medical Solutions. Catheter Complication Warning Signs: When to Get Help Straighten the tubing and make sure nothing is pressing on it, and check that the bag sits below bladder level and isn’t overfull. Moving position or walking briefly may get flow going again. If nothing drains within a short time and pain grows, call the nurse or seek urgent care.

Why Catheters Block

In long-term catheters, the main culprit is crystal build-up. Certain bacteria, especially one called Proteus mirabilis, form a slimy layer on the catheter that hardens into crystals.15PubMed. Proteus mirabilis biofilms and the encrustation of urethral catheters These bacteria make urine more alkaline, which makes minerals settle out as crusty deposits.16PubMed. Proteus mirabilis biofilms and the encrustation of urethral catheters The crystals can partly or completely block the catheter’s channel.17PubMed. Proteus mirabilis biofilms and the encrustation of urethral catheters Catheters colonised only by bacteria that don’t do this rarely crust up.18PubMed. Proteus mirabilis biofilms and the encrustation of urethral catheters19PubMed Central. Bacteriophage Can Prevent Encrustation and Blockage of Urinary Catheters by Proteus mirabilis

Crystal build-up depends heavily on which bacteria are living on the catheter, so two people with the same type of catheter can have very different experiences. The longer a catheter stays in, the more layers of film and crystals can accumulate on it.

Clots and debris are the other cause. Blood in the urine after prostate or bladder surgery can form clots that plug the catheter.20Nursing CE Central. Continuous Bladder Irrigation Review Mucus and sediment can build up more slowly in long-term catheters.21NHS Ayrshire & Arran. Catheter Maintenance Solutions

The Solutions Used and When

Normal saline simply flushes out debris and mucus.22NHS Ayrshire & Arran. Catheter Maintenance Solutions For crystals there are two citric acid options. Solution G, a 3.2% citric acid, dissolves the crystals left by encrusting bacteria, and it contains magnesium oxide to soften the acid’s irritation of the bladder.23NHS Ayrshire & Arran. Catheter Maintenance Solutions Solution R, a stronger 6% citric acid, is used for severe crystal build-up.24NHS Ayrshire & Arran. Catheter Maintenance Solutions The citric acid solutions may also be used regularly to prevent repeat blockages, not just to clear one.25NHS Ayrshire & Arran. Catheter Maintenance Solutions

Saline works mechanically, so it can’t break down hard crystals stuck to the catheter surface. The acid solutions dissolve the deposits gradually, which takes some contact time.

Your care plan may name the solution, how often to use it and how long to leave it in. Acid solutions are often left in the bladder briefly before draining. Don’t swap solutions without the nurse’s or doctor’s agreement.

In special situations, doctors sometimes run an antifungal through the bladder to clear yeast found in urine. That works only for yeast in the bladder and does not treat infection elsewhere in the body. It is a hospital decision, not a routine washout.

Do Routine Washouts Actually Help

Comparisons of washouts with no washouts could not show whether washouts reduce urinary infections or help catheters last longer.26PubMed Central. Washout policies in long‐term indwelling urinary catheterisation in adults The trials were small and often poorly done, so it isn’t known whether washouts help or harm.27PubMed Central. Washout policies in long‐term indwelling urinary catheterisation in adults Acid washouts may lower blockage compared with saline, though the evidence is very uncertain.28PubMed Central. Do prophylactic catheter washouts reduce catheter-associated UTIs and blockage compared to standard care in adults with long-term catheters? Saline washouts showed no clear reduction in infection.29PubMed Central. Do prophylactic catheter washouts reduce catheter-associated UTIs and blockage compared to standard care in adults with long-term catheters?

People who had weekly washouts reported fewer blockages, less pain and fewer infections.30Continence. 320 – Patient and health care professionals’ perception of weekly prophylactic catheter washout in adults living with long-term catheters: Qualitative Study of the CATHETER II Trial They also needed fewer nurse call-outs and felt reassured.31Continence. 320 – Patient and health care professionals’ perception of weekly prophylactic catheter washout in adults living with long-term catheters: Qualitative Study of the CATHETER II Trial For someone who blocks often, a regular routine may be reasonable to discuss, even though proof is lacking. Many people with catheters never block, and each opening of the closed drainage system carries some infection risk, so routine use is left to individual need.

Risks to Know About

Autonomic dysreflexia is a sudden dangerous rise in blood pressure, mainly in people with spinal cord injuries at or above chest height.32Dr Jack Crozier. Bladder Washouts After Spinal Cord Injury A full bladder or blocked catheter is one of its most common triggers.33Dr Jack Crozier. Bladder Washouts After Spinal Cord Injury In people with high injuries, filling the bladder raised typical top blood pressure readings from about 125 to 200.34PubMed Central. Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury For these people, a blocked catheter should be cleared quickly, and washout fluid run in slowly.

Typical signs of a dangerous blood pressure spike are a pounding headache, flushing or sweating above the injury level, and a blocked nose. Sit the person upright and check the catheter and tubing at once. If symptoms don’t settle quickly, treat it as an emergency.

After a washout, fever, shivering or foul-smelling urine can mean infection. Acid solutions can irritate the bladder lining.35NHS Ayrshire & Arran. Catheter Maintenance Solutions36UroToday. Bladder irrigation toolkit Fresh bright red blood or severe pain needs prompt review.

Washouts After Prostate or Bladder Surgery

Continuous bladder irrigation starts right after surgery, with fluid running steadily in and out through a special catheter.37Nursing CE Central. Continuous Bladder Irrigation Review It washes blood away before it can clot.38Nursing CE Central. Continuous Bladder Irrigation Review After prostate surgery, catheter blockage was about 4% in hospitals irrigating nearly everyone, versus about 13% where only heavy bleeders were irrigated.39PubMed. Continuous bladder irrigation following transurethral resection of the prostate (TURP) In one group after urinary tract surgery, the fluid was clear or only faintly pink over 90% of the time.40PubMed Central. Evaluation of functional parameters, patient-reported outcomes and workload related to continuous urinary bladder irrigation after transurethral surgery

In practice, the catheter has three channels: one inflates the balloon that holds it in place, one carries fluid in, and one carries urine and fluid out. A bag of sterile fluid hangs above the patient and runs in at a rate staff adjust, so the fluid coming out stays pale pink. The fluid going in is subtracted from the total coming out to work out how much urine the person actually made.

When the drainage turns darker red, the nurse speeds up the flow to flush the blood out before it clots. As bleeding settles and the fluid clears, the flow is slowed and then stopped. The catheter generally stays in for a while afterwards, so stopping continuous irrigation is a separate step from removing the catheter.

On the ward, staff watch the drainage colour. Pink urine is expected, but dark red urine or thick clots should be reported. Bladder spasms are common with the larger catheter.

When a clot blocks the catheter anyway, it is cleared with a manual washout through a wide catheter, and flushing continues for about a litre beyond the last clot.41PubMed. CATCH-22: a manual bladder washout protocol to improve care for clot retention A few people still need a return to theatre to stop bleeding or remove clots.42PubMed Central. Evaluation of functional parameters, patient-reported outcomes and workload related to continuous urinary bladder irrigation after transurethral surgery

Ways to Reduce Blockages Without Washouts

Citrate drinks are a simple, cheap way to make crystals less likely to form.43International Journal of Urological Nursing. Encrustations of the urinary catheter and prevention strategies: a literature review In one trial, diluted lemon juice raised the urine’s resistance to crystal formation more than drinking more fluid or potassium citrate did, though simply drinking more also helped.44PubMed. Strategy to control catheter encrustation with citrated drinks: a randomized crossover study Ask your nurse whether adding lemon juice drinks suits you. Anyone on fluid restrictions, for example because of heart or kidney problems, should check with their clinician before drinking more.

The catheter itself matters too. Crystal build-up is less on silicone and hydrogel-coated catheters.45Queensland Spinal Cord Injuries Service. Preventing Catheter Blockages: A Guide for Health Professionals If you block often, ask whether a different catheter type or change schedule could help.

A blockage diary makes that conversation easier. Note the date of each blockage and each catheter change. A regular pattern lets the nurse change the catheter just before it would block, so bring the diary to reviews.

Bladder Treatments That Aren’t Washouts

Some treatments also put fluid into the bladder, but to deliver medicine or prevent infection rather than to unblock a catheter. For interstitial cystitis, a long-term painful bladder condition, a medicine called DMSO is put into the bladder and is the usual first choice.46PubMed Central. Interstitial cystitis intravesical therapy It reduced symptoms and pain scores clearly,47PubMed. The Efficacy and Safety of Dimethyl Sulfoxide Into the Bladder for the Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Systematic Review and Meta-Analysis but around 37% had side effects, mostly mild.48PubMed. The Efficacy and Safety of Dimethyl Sulfoxide Into the Bladder for the Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Systematic Review and Meta-Analysis A mix of hyaluronic acid and chondroitin is an alternative being compared with it.49PubMed. A randomized, open-label, multicenter study of the efficacy and safety of intravesical hyaluronic acid and chondroitin sulfate versus dimethyl sulfoxide in women with bladder pain syndrome/interstitial cystitis Children with reconstructed bladders sometimes have regular irrigation, which kept bladder stones rare by preventing infections.50PubMed. Efficacy of bladder irrigation and surveillance program in prevention of urinary tract infections and bladder calculi in children with an ileocystoplasty and bladder neck repair

In an instillation, the medicine is placed in the bladder and usually held there for a set time, so it can act on the bladder lining. A washout flushes fluid through to clear a blockage, and the aim is to get the fluid out again quickly. Instillations are usually given on a planned course, whereas a washout is often a response to a problem.