Manual bladder washouts for urinary clot retention: training, technique and triumphs

1. No. 050 Manual bladder washouts for urinary clot retention: training, technique and triumphs Nathan Lawrentschuk1,2, Murtaza Dungerwalla1, Keshav Nahar1, Daniel Nour1 & Damien M Bolton1 1. University of Melbourne, Department of Surgery and 2.Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, Vic 3084 AUSTRALIA Posters Proudly Supported by: Introduction Urinary retention secondary to haemorrhage and clots (“clot retention”) is a common urological emergency. It may present de novo or be the result of recent surgery, trauma or clotting disorders. Despite how common clot retention is, the technique of how to perform an efficient and therapeutic washout is often not discussed or assumed as knowledge within the urological community. More recently the technique of washout was highlighted in the Victorian Audit of Surgical Mortality. • ManualBladder Washout Technique • The “Last clot + a litre rule” was followed • Fig 1. Transurethral approach Fig 2. The catheter is moved where the catheter and water pressure around the bladder to agitate clots help evacuate clots • Fig 3. Preparation for a manual • bladder washout • Fig 4. Result of a typical vigorous • manual washout Aim Manual bladder washouts for urinary clot retention are an integral skill for urologists and urology nurses as well as those in emergency setting to understand and perform. We outline the theory behind a manual bladder washout and aim to demonstrate in a series that a meticulous and efficient washout may have a positive impact on patient care. • Methods • Manual bladder washouts should be done with the aim of extracting all blood and associated clot material from the bladder in a timely and efficient fashion with minimal patient morbidity. • A washout involves a large bore Foley catheter which is moved around the bladder to dislodge clots and allow extraction. The result is a bladder (and prostate) that will contract around the balloon to aid in haemostasis due to vasoconstriction and the bulk muscle effect of detrusor contraction to help tamponade and allow the bleeding and hence clot formation to cease or be controlled by a gentle washout for a brief period until the haemorrhage settles. Ideally a washout should be done following the rule of “last clot plus a litre” using different catheter positioning in the bladder throughout to ensure all clots are dislodged and removed. • A prospective collection of patients having washouts and significant haemorrhage for a variety of procedures were selected for inclusion. Results Ten patients having continuous bladder washouts for a variety of pathologies had complete manual bladder washouts performed by one surgeon (NL). The washouts were done following the “last clot plus a litre” rule. The median time to haemorrhage cessation was 24 hours using a complete technique with clots being removed from all patients. Conclusions Manual bladder washouts appear poorly understood by both nurses and doctors. Clearly this valuable skill requires better teaching and supervising in all health settings to improve outcomes. A definitive manual bladder washout requires technique, time and persistence. Acknowledgements We acknowledge the dedication and assistance of the staff in Austin Hospital Melbourne Australia.