What type of irrigation solution should be used for bladder irrigation of a 3-way Foley catheter at a Skilled Nursing Facility (SNF)?

Bladder Irrigation Solution for 3-Way Foley Catheter in SNF

Use sterile normal saline (0.9% sodium chloride) for bladder irrigation through a 3-way Foley catheter in a skilled nursing facility. 1, 2

Standard Irrigation Solution

• Sterile normal saline is the recommended irrigation solution for continuous bladder irrigation (CBI) through 3-way Foley catheters 1, 2
• Room temperature or body temperature saline should be used rather than cold water, as body temperature saline provides better patient comfort 2
• The solution should be suspended approximately 80 cm above the catheter level to maintain adequate gravity flow 3, 4

When Bladder Irrigation is Indicated

Primary indication: Active hematuria requiring clot prevention, particularly following urological procedures or in cases of bladder hemorrhage 5, 2

• Continue CBI when there is persistent visible hematuria in the drainage bag 5, 2
• Discontinue when urine output becomes clear and bleeding parameters stabilize 5

Critical Pitfalls to Avoid

• Do NOT routinely irrigate catheters to prevent infection - catheter irrigation with normal saline should not be used routinely to reduce catheter-associated bacteriuria or UTI in patients with long-term catheterization 1
• Do NOT add antimicrobials or antiseptics to the drainage bag as routine practice, as this does not reduce infection risk 1, 5
• Do NOT use antiseptic irrigation solutions (chlorhexidine, povidone-iodine) in the SNF setting - these are only indicated for short-term perioperative use in surgical patients, not for routine long-term catheter management 1

Special Circumstances Requiring Alternative Solutions

Fungal cystitis (fluconazole-resistant species): Amphotericin B deoxycholate bladder irrigation at 50 mg/L sterile water daily for 5 days may be used for treatment of cystitis due to resistant Candida species 1, 2

Nephrostomy tube irrigation: If present, use Amphotericin B deoxycholate 25-50 mg in 200-500 mL sterile water for fungal infections 1

Practical Implementation

• Use a closed irrigation system with 1-2 liter bags of sterile normal saline 4
• Ensure adequate flow rate by maintaining proper height differential (80 cm above catheter) 3, 4
• Larger bore catheters (22F-24F) provide superior continuous irrigation flow compared to smaller sizes 3
• Monitor for catheter obstruction, particularly with urease-producing organisms like Proteus mirabilis that can cause encrustation 1, 5