An elderly man presents with new bloody urine x2days and abdominal distention/fullness. He noticed some clots prior to presentation and now hasn’t urinated x5hours despite a real urge to micturate. He has a h/o BPH and is on coumadin for afib. At clinic yesterday his INR was 2. On sono you appreciate a full bladder with 800cc of fluid. You d/w urology and plan for bladder irrigation. You are being shadowed by an eager med student. Talk her through the procedure.

1. Call central supply for a large (24gauge, for example) three way uretheral catheter.

2. Proceed as usual; it’s a sterile procedure. Inflate the catheter balloon.

3. Use a 60cc syringe to manually, intermittently irrigate via the irrigation port.

4. Before you begin, check out these sources for a step by step how to: