We’ve set up our Murphy Drip and now we’re ready to get bladder irrigation going. First thing’s first, we need a stash of irrigation fluid.
Due to the amount of fluid we potentially need, we used 2 liter bags of normal saline. Depending on how fast the drip is running will determine how many bags we’ll need. If the drip is running wide open (zero titration) we will need a lot of bags. Have the unit clerk order an appropriate amount and don’t forget about what the next shift will need.
Once we have our bags we’ll spike two of them (1a & 1b) making sure both lines are fully clamped (2a & 2b). Because there are two bags (a total of 4L) we have some flexibility in terms of how we are going to run our irrigation. We can either open one clamp or two, depending on how fast we need to irrigate to keep the line patent. One bag running wide open will drain over the course of approximately 15 minutes. Running back and forth to a patient’s room every 15 minutes is just not going to do. If the Murphy Drip must run wide open to prevent occlusion I’d recommended opening both clamps and titrating accordingly (we’ll discuss I/O’s later).
Speaking of titrating, much like I am typing to you now, while I am doing all these things (spiking the bags, working the clamps, monitoring the drip chamber, and titrating) I am educating the patient so they can participate in their care. The physician order for the Murphy Drip will read something to the effect of, “Titrate output to light pink” meaning we want the urine output/irrigation to be a nice watermelon pink color. We also tell the patient to let us know if they feel like their bladder is getting full or if the output darkens. It is common to have some level of awareness that they have fluid rushing in and out of their bladder, it is a completely different sensation when the Murphy Drip becomes occluded.
The next thing I do is teach the patient about the drip chamber (3). The drip chamber should always be running. There are three things that can stop that from happening. One, the titrating clamp (4) is closed. Two, the irrigation bags are empty. Three, and most critical, the line is occluded. Should the patient notice nothing happening in the drip chamber, I tell them to call me immediately to get things running again.
- Our three-way catheter
- Standard inflation port
- Standard output line to Foley bag
- (New) Input line for irrigation
- Tape anchor*
- Preferred, by me, as a securement device over the leg strap
- *Some urologists will tape the catheter ‘to tension’ meaning it’s taut. This keeps the tip of the Foley from moving about in the bladder, potentially rubbing against the site of the bleed. This is easily noted by the Foley not having any slack. The catheter should remain to tension, even if soiled. If it becomes released from tension for whatever reason, notify the surgical physicians assistant (SPA) to reapply tension.
- Where the catheter enters the patient’s urethra
- Catheter tip and balloon
- (a & b) are ureters entering the bladder. Here we can see multiple clots floating around in the bladder and I have indicated the site of the bleed as, “XXXXX” although it could present elsewhere.
- A towel or an ultrasorb to prevent the patient being soiled during manual irrigation, only needed when we are accessing the line. The Foley port is the one we used to irrigate. The irrigation remains in place once hooked up (rarely should there be any back flow).
Since I live in Rochester, NY and it snows eight months out of the year, I often refer to the Murphy Drip patient’s bladder as a snow globe. We like the irrigation to act as a shaking mechanism to either prevent large clots from forming, or keep them floating around the bladder until they naturally come out the line or are manually irrigated. However, sometimes the clots will be too large to fit through the catheter opening or a group of them will collect occluding the opening.
Up next I’ll discuss manually irrigating to regain patency of the catheter.