Irrigation 101.

Convincing a piece of intestine that it's no longer intestinal.


Flushing out the mucous:

Monday following surgery (day +3) at 7:00 AM the resident doctor came to check me over as usual. But this time, after checking my stitches and listening to my lungs and stomach, he spread out a pad on my bed on which he unpacked a irrigation kit. It consists of one tray (size of a bread pan), a huge syringe (size of a push-up pop), a bottle of saline solution (0.09%) and a clamp (hemostat). At this point I still had one of those big collection bags connected to each of my catheters. So the idea here is two fold:

1. Flush the Neo bladder of any mucous the intestinal tissue is still producing (2 feet of the small intestine was used to make it - remember).
2. Start introducing liquid into this new pouch to introduce it to it's new function. All urine is currently passing directly out of my body via those kidney stints. The new bladder is just sitting there empty so all of the 'origami' can heal.
3. Check  the connection between the chamber where the Foley catheter goes and the chamber where the Supra Pelvic Catheter (SPC) goes. 

Irrigation procedure:

1. Pull back covers to expose all the tubing and the body areas where they enter (remember this for later). 
2. Place pads under tubing to catch any leakage. 
3. Clamp off catheter tube coming out of penis (either catheter can be chosen to clamp first). 
4. Disconnect tubing going to collection bag. 
5. Open ostomy collection collection bag at the collar (like a zip lock). 
6. Carefully slide bag away from body enough to retrieve catheter tube (take care not to pull the stints.)
7. Fill syringe with about 20 ccs of saline (about half full). 
8. Attach syringe to tube that was removed from ostomy bag. 
9. Inject saline into tube. 
10. Now try to withdraw whatever liquid will come out by pulling (carefully) on the syringe plunger. ( you should get saline along with lots of mucus - sometimes you do and sometimes you get nothing)
11. Repeat step #7 - #10 at least two more times. 
12. When you've gotten all you can get it's time to switch ends and repeat the process on the foley catheter. Move clamp from Foley tube to ostomy tube and infuse and withdraw saline 2 or three times. 
13. Finally unclamp the ostomy tube and replace in collection pouch. 
14. Infuse 20 more cc's of saline into the foley tube and verify that it comes out the foley tube. Thus verifying the bladder is still open from one end to another. 

Class discussion: 

Tuesday night and Wednesday morning (day 5) had been an awful time for me. I had only slept about an hour all night and I was tired and depressed (at not being able to sleep mostly).  I was just dozing off after morning 'rounds' when Dr. Moore walked in with his irrigation equipment. He asked me if I minded if he demonstrated the technique to a few of the staff. I said 'no' and he beckoned in about a dozen nurses who gathered around my bed. Of course this perked me right up - always the ham - suddenly I had an audience. My modesty quickly passed (remember #1 above) as I watched their faces and helped out with the demonstration wherever I could ( I was begining to feel like an expert, myself, by now).

It only takes about ten minutes and everyone was gone again leaving my wife and I to laugh and say; "what was that?".  I must have been a good test subject (dummy) because when Dr. Moore came for the evening irrigation (two-a-day) he had another dozen or so nurses from the next shift.

I learned that since my particular surgery is only performed a few times a year at St. Mary's, much of the post surgical care that is unique to this surgery has been left to the resident doctor. There is a feeling by the doctors that this is more of a nursing thing and they are attempting to shift some of the tasks to the nursing staff. Hence the demonstration.

This was just one more incident that supported the feeling that I was a special patient in the ward. I have no doubt that all patients are made to feel special in the surgery recovery ward at St. Mary's but I felt like I was a little bit more...