Bladder washouts

A bladder washout is a technique used to flush out the catheter and bladder by introducing a catheter maintenance solution into the bladder through the catheter.
A bladder washout might be needed if:
  • there is a lot of sediment in the urine
  • the catheter is not draining correctly
  • the catheter has blocked and is not being replaced
Advantages of a bladder washout:
  • it offers an alternative to those who cannot drink large amounts of fluids to treat a urinary tract infection or heavy sediment
  • if the catheter repeatedly blocks and someone is unwilling or unable to do frequent catheter changes
  • stretching the bladder frequently can help avoid shrinkage
Disadvantages of a bladder washout:
  • every time the catheter is disconnected from the drainage bag, an entry point for infection is created
  • it introduces foreign fluid into the bladder
  • the procedure takes time
  • it can cause bleeding and blood clots if not done carefully
  • it risks damaging the epithelial lining of the bladder
  • studies have shown it has little or no effect on most infections
  • bladder washouts can induce autonomic dysreflexia in some people with spinal cord injury

A consultant explains why nowadays some doctors prefer not to do bladder washouts.

Age at interview 49

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Do you recommend that people do any regular bladder washouts, or only when they get blocked?

No, we prefer not to use bladder washouts in fact. They have been used in the past but they can also damage the surface of the bladder. They can wash off the surface cells of the bladder and so if it’s contentious, a very contentious point whether to use bladder washouts or not.

If a catheter became blocked, would you try to unblock it using a washout?

Yes, you can. Yes, of course

Before changing it?

No, I think the most straightforward thing is to change the catheter and get rid of it because, as soon as you put a catheter in the bladder, a film forms on the surface of the catheter. We call it a conditioning film. And bacteria then attaches itself onto the surface of the catheter to form what we call a biofilm. And it’s in that bio film, especially if the proteus mirabilis organism is there, that we get these calcific deposit’s forming.

And if the catheter blocks as a result of encrustation, the best thing to do is to take it out and put in a clean catheter. And then maintain a high fluid intake, and to drink those citrated fluids in order to reduce the risk of catheter encrustation.

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There is little research available to suggest whether there is a difference between the various solutions to treat encrustation and blockage*. For persistent encrustation, a catheter maintenance solution may be tried before the leg bag or catheter valve is changed after all other measures have been tried. e.g. more frequent catheter changes.
Some people we interviewed had never had a bladder washout. Several others had, though how often they had one varied. Ian, who’d had an indwelling catheter for over 20 years, said he had many blockages until he started using bladder washouts to try and prevent them. Michelle said bladder washouts never worked for her – they give her headaches because her bladder is so small. Whenever her catheter becomes blocked, she always has to have it changed.

Hayley had been trying to get a prescription for the bladder washout solutions because she felt…

Age at interview 46

Gender Female

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What do you use to wash it out with?

There are two sorts. There’s an acidic wash out which apparently is good for breaking up bits of stone, or just a straight saline.

But you say the nurses aren’t too keen on that.

No, and trying to get the prescription filled. I actually, it took me a long time to get a prescription because I had to find somebody who would agree to writing one. And we literally went to about eight pharmacies who didn’t have it in. Oh we can get it in tomorrow, two days, and no, the prescription, they’d only given me one. And I just, basically I was looking on –

Is this the GP?

This was, well it was actually the district nurses, they’re not as supportive I have to be honest.

But who gives you the prescription?

The district nurse, yeah.

Oh they can do it?

Some of them are prescribing, yeah..

So you say you’ve only done that a few times.

Yeah, I’d love somebody to be doing a trial on it so I can actually, can I, that’s my gut feeling, I could be completely wrong and you know hands up if I am.

But I think you become intuitive anyway with any condition that you have, any situation you’re in. And my intuition says because the bladder is, if you like, a plastic carrier bag with a hole in, that’s quite small. If you can, the only way you can wash it is to rinse it out. And if you’re only washing it by drinking, then eventually you’re going to need to wash it from the other end as well, if you see what I mean

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Badg does a bladder washout every week with a saline solution. All the equipment he needs is…

Age at interview 58

Gender Male

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How often do you need to change the bag?

The bag I change weekly. I have a bladder wash once a week and change everything from the catheter downwards in effect.

You do that?

I do that, yeah. It used to be called a Suby-G, which had some other chemicals in it, but I think the general feeling now is for just a saline chloride mix. So yeah I give that a good sloosh around two or three times, fill it up, empty it, fill it up, empty it. And then I throw all the leg bag, night bag and flip flow away and put a new set on.

And these you get on prescription do you?

Yeah.

Are they delivered here?

Yeah, the pharmacy, there’s a pharmacy in the village that deliver it, as pharmacy’s will these days.

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Peter did fortnightly bladder washouts and, since he started these, has gone back to 12-weekly catheter changes. Sara has bladder washouts twice a week and described what this involved. She uses Suby G and Solution R, acidic catheter maintenance solutions which dissolve the minerals that have been deposited’

Dave describes how he looks after his catheter and catheter site. He occasionally uses a bladder…

Age at interview 31

Gender Male

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I was certainly made aware [by medical staff] that you’re prone to bladder infections, which should normally be treated with antibiotics.

You’re certainly encouraged to drink plenty of fluids. Because of the increase in susceptibility to infection, fluid intake is important and keeping the catheter site clean, washing regularly with saline water is important.

Is that round the site?

Yes. And what else?

Do you ever have to wash the bladder out with anything? 1

Yes, occasionally I wash the bladder out. Certainly if there was any sign of minor blockage, a bladder washout would be used. Recently I haven’t had too many problems with that. But I certainly did have one or two occasions in hospital when the catheter did actually block, would have to be removed and a new catheter inserted because of debris in the bladder.

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Sara describes how she does a bladder washout. It can be painful because her bladder has shrunk…

Age at interview 60

Gender Female

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The Suby-G I use on a Wednesday and what you do is you take the catheter off the flip flow and you take that lid off there and you attach it actually to the catheter, not the flip flow. And then you push one side in and you leave it for five minutes, drain it out, push your second side in, leave it for five minutes, drain it out, put it all back together again.

To drain it out, does it just come out naturally or do you have to use a syringe?

No.

Just naturally?

Just turn it off, yes.

Oh right. And then on the other day of the week you use?

Solution R

Again, the same thing, squeeze it in?

Yes, with that one it is different because you squeeze it in (it’s a sort of concertina shape) and immediately release it and you do it five times. Now a lot of people don’t bother doing it five times.

This is the Optiflow?

Yes, a lot of people just do it once or twice, I mean I like five, or maybe if they’re good they might do it three times, but I do it five times. It hurts because it’s 500 ml, no not 500 ml, what is it?

100 ml.

100 ml there, and my bladder has shrunk so much I can hardly get it in me but it hurts, but its okay.

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Faye has weekly bladder washouts at the hospital, which have prevented blockages. She said they…

Age at interview 29

Gender Female

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Does the catheter ever get blocked?

It used to, yes, but I’m going down to the local hospital for bladder washouts every week, and that has stopped it.

You were going down every week?

I am doing.

For somebody who wants to know what a bladder washout is, can you explain that?

Yeah, it’s just a bag or a bottle with sterile water in and they’ll just put it through the catheter and wait for it to come out. It’s painless, quick to do.

So you have to go to the hospital for that?

Yeah. Most people do it their selves. But my urologist don’t want me

to.

Have you asked if you could do it yourself?

Yeah I’ve asked on a couple of occasions, but he’s just said no, he’d rather someone else does it.

Okay. So you have to go to the outpatients do you for that?

Just the local hospital.

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Alex said that sometimes the district nurse gave her a bladder washout when the catheter became blocked but, at other times, the catheter would be changed. Some people did their own bladder washouts at home. Several people had a professional carer do the washout and a few people had their partner do it.

Gavin’s wife used to do his bladder washouts when he was first injured. He now does his own and…

Age at interview 28

Gender Male

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The bladder washes, you did those yourself did you?

I do them myself now. But initially my wife helped.

Yes. If someone wanted to know, what does it all involve?

The instructions on the bladder washout, I used to do it a particular way. And, after speaking to the urology nurse, she advised me to do it a different way. So, until told otherwise, I would follow the instructions. But it’s as simple as basically emptying the bladder washout down the catheter, the opposite way urine would come out, clipping it off and leaving it in there for a period of time. Like I said, follow the instructions until told otherwise.

And then releasing it, letting the debris that’s been dissolved come out. But I always found on the inside of the catheter you would get a covering or a layer of, I presume, debris and things that would usually come out of your urine because it’s sat still in there. And, whilst the bladder washout is in the catheter, in the bladder, I would roll the catheter in my fingers to release that into the fluid. So, as you let it out, it brought everything out. And that seems to help with the smell and the look of the catheter. It makes it clearer.

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*Shepherd AJ, Mackay WG, Hagen S. Washout policies in long‚Äêterm indwelling urinary catheterisation in adults. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD004012. DOI: 10.1002/14651858.CD004012.pub5.

Blockages

One of the common complications of long-term catheter use is encrustation by mineral salts, leading to catheter blockage. Crystalline deposits can form on the retention...

Leaking

Leakage around the catheter, or by-passing, is usually caused by a catheter blockage or bladder spasms. Other causes include infection, catheter encrustation, and loss of...