The call bell in the room with the Murphy Drip patient is going off, we know it is likely an urgent matter and we hustle to answer it. The patient is in visible distress and indicating that their bladder feels full.
They may or may not have noticed the drip chamber is empty and fluid is not running. Let’s take a moment to review our previous bad drawing.
As soon as we know we are picking up a patient with a Murphy Drip, the room must be stocked with the following:
- Wash basin indicated for Murphy Drip contents/output (Don’t mix this up with their other basin they use to wash up, ew)
- Towels (or Ultrasorbs)
- Piston syringes (I like to have at least three)
- Sterile normal saline bottle
- A bedside table readily available
Anytime the patient complains of bladder fullness, close the titrating clamp. We don’t need irrigation fluid exerting pressure and making the patient more uncomfortable as we are about to introduce normal saline (NS) to manually irrigate the bladder. Having the patient shift side to side in bed may relieve the pressure or dislodge a clot or two, but there is already indication to manually irrigate.
As nurses we only get one back, we need to protect it (future nursing rule!). Raise the bed to a comfortable height and make sure the bedside table is within easy reach. Set up the bedside table (D) by laying down a clean towel/ultrasorb and place our piston syringe/bottle, sterile NS, and wash basin on top. Open the piston syringe and bottle, fill the bottle with the NS. If this is not a new NS bottle, lip some of the contents into a trash bin (for our fallen RN homies), then pour. Slide another towel underneath the Foley/Leg bag connector, for expected drips.
Calmly talk the patient through manual irrigation process. Pinch off (B) the Foley line and remove the leg bag line (A). If you have an alert and oriented patient, give them the leg bag line to hold. Remind them not to touch the end and we will hopefully take their mind off what is coming next. If your patient is unable to participate, have a technician assist.
The bladder is (usually) a sterile environment. Since we are not going to be touching the Foley opening or the end of the piston syringe, we’ll be using regular gloves for standard contact precautions. This can be a messy procedure. My friend Jake, a RN in the Boston area, recommends a face shield. We are definitely in the splash zone.
While pinching the Foley line (B) off with our non-dominant hand, draw up NS into the piston syringe and insert it into the opening of the Foley. Note how my poorly drawn hands (C) are positioned. My non-dominant hand firmly grasps the piston syringe and the index finger of my dominant hand fits in the circular end of the piston’s plunger. This is because we often need to pull back with significant force (careful not to pop the plunger out) to dislodge clots.
Monitoring the patients response, gently push the piston syringe contents into the bladder. This will make the patient uncomfortable, there is no way around it. As soon as we’ve emptied the syringe pull back firmly. With any luck, we’ll have dislodged some clots. DO NOT REINTRODUCE CLOTS INTO THE BLADDER. Discard the contents of the piston syringe into the wash basin. We can assess them afterwards to include in our documentation.
It is common to instill 50cc of NS, pull back, and get no return. It is also common to instill 50cc, pull back, and get 50cc of fluid and no clots. As long as there are no clots in the syringe, re-instill with more force than previous and use a pumping motion. You will be surprised if not shocked at the amount of force the urologists use to manually irrigate. There are other techniques they use (that a nurse would/could never) that I won’t even discuss. Ultimately, patency must be restored. Irrigate until no clots are present. When we hook up the drainage bag to the Foley, we should see immediate return. If not, repeat the process above. In the event we cannot regain patency, contact the provider immediately.
To remain sterile, the piston syringes are one time use only. Once we’ve completed an irrigation session, throw it out. Clean off the bedside table and scrub it with your facilities preferred product. Be prepared to do this process at a moments notice. Unless your patient is in a coma, they will be letting you know they need help, one way or another.
In my final post on Murphy Drips I will discuss I/O’s, tips on patient assessment and share some anecdotes on the fun I’ve had with this wonderful treatment. Until next time!