Living with a urinary catheter
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.
A consultant explains why nowadays some doctors prefer not to do bladder washouts.
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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.
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.
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...
Dave describes how he looks after his catheter and catheter site. He occasionally uses a bladder...
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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.
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...
Gavin’s wife used to do his bladder washouts when he was first injured. He now does his own and...
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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.
*Shepherd AJ, Mackay WG, Hagen S. Washout policies in long‐term indwelling urinary catheterisation in adults. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD004012. DOI: 10.1002/14651858.CD004012.pub5.
Last reviewed October 2018.
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