Toomey Syringe
The Toomey syringe (catheter-tip syringe) is the manual bladder-irrigation workhorse — a wide-barrel, 60 mL syringe with a tapered open catheter tip (no Luer hub) that seats directly into the funnel end of a Foley, Coudé, or three-way catheter. It is the standard bedside, OR back-table, and inpatient-ward instrument for manual bladder washout (MBW), tissue / clot evacuation through a catheter, and intravesical medication instillation.
Design
- 60 mL barrel (50 / 70 mL variants exist; 60 mL is the predominant clinical size).
- Tapered smooth catheter tip — slips directly into the catheter funnel with a friction seal; no Luer adapter required.
- Wide internal bore — accepts small clot fragments, mucus, and tissue chips on aspiration without clogging.
- Flanged plunger — supports one-handed thumb-and-finger irrigation-aspiration cycles.
- Disposable polypropylene; reusable autoclavable glass variants are historical.
Reconstructive / Functional Urology Uses
Manual Bladder Washout for Clot Retention
The dominant use. The Toomey is the irrigation arm of the CATCH-22 protocol (Clarebrough 2018) — a structured manual-bladder-washout pathway for inpatient clot retention. The protocol pairs a Toomey-type catheter-tip syringe with a ≥ 22 Fr catheter and emphasizes aggressive irrigation volume: the urology service performed washouts averaging ~ 5,400 mL per attempt vs ~ 145 mL for referring teams — a ~ 37× volume gap that explained most of the clinical failures referred to urology.[1]
Technique: instill 50–60 mL normal saline → aspirate, repeat until the return is clear. Forceful but controlled — over-pressurization in a small-capacity / trabeculated / neurogenic bladder risks bladder perforation; under-volume irrigation just moves clot around.
The companion catheter physics (lumen geometry, eyelet pattern, three-way vs two-way) are addressed on the Three-Way Catheter page.
Post-Procedure Bladder Irrigation
After TURP / HoLEP chip evacuation by Ellik, after open bladder closure, after AUS or IPP reservoir / pump work that disturbs the bladder, and after any urethroplasty or fistula-repair case with intravesical work — a final Toomey washout through the catheter at the end of the case clears residual blood, chip remnants, and irrigation debris before the patient leaves the OR.
Intravesical Medication Instillation
The Toomey is the standard instillation device for non-oncologic bladder agents in the reconstructive / functional urology space:
- Povidone-iodine bladder irrigation for recurrent UTI prevention in NLUTD patients on CIC — Moussa 2021 RCT data support reduction in symptomatic rUTI with periodic dilute-povidone instillation.[2]
- Heparin / DMSO / lidocaine bladder cocktails for IC / BPS symptomatic relief.
- Intravesical antibiotic instillation in selected NLUTD / catheterized patients per institutional protocol.
- Bladder priming for urodynamics or VCUG when a gravity drip is not set up — barrel as funnel with the plunger removed.
(Intravesical chemotherapy and BCG instillation for bladder cancer is the oncology use case, outside WARWIKI scope.)
Catheter Patency / Troubleshooting
The Toomey is the first-line bedside tool for the "is this Foley actually obstructed?" question — a gentle 30–60 mL instill / aspirate cycle distinguishes mechanical obstruction (no return, no flow restoration) from clot occlusion (return clears with washout) from balloon malposition (asymmetric flow).
Bedside / OR-Adjacent Adjunct Uses
- Wound and graft irrigation — buccal-graft bed, donor-site irrigation, perineal-wound copious-irrigation pre-closure.
- Donor-site rinse during STSG harvest with the irrigant of choice.
- Bedside cystoscopy bladder fill when the dedicated tubing is unavailable — barrel-as-funnel.
When Toomey Fails — Adjuncts for Tenacious Clot Retention
The Toomey is rate-limited by the operator's hand and the catheter calibre. When standard MBW does not clear the clot:
| Adjunct | Mechanism | Evidence |
|---|---|---|
| Direct sheath-to-wall-suction (~ 250 mmHg) via cystoscopy | Higher negative pressure than any manual technique | Goel 2011 case series — successful in patients who failed Ellik / Toomey MBW |
| Chymotrypsin + sodium bicarbonate intravesical irrigation | Enzymatic clot dissolution | Bo 2014 non-surgical-treatment series[3] |
| Hydrogen peroxide bladder irrigation | Oxidative clot dissolution | Xu 2020 case series — simple, effective in case-series data[4] |
| OR cystoscopy with Ellik evacuation | Larger-bore sheath, mechanical chip retrieval | Standard escalation when bedside MBW fails |
| Open / robotic cystotomy with clot evacuation | Direct visualization | Last-line salvage; reserved for surgical bladder or persistent uncontrollable retention |
Toomey vs Standard Syringes vs Bulb Syringe
| Device | Capacity | Catheter interface | Best fit |
|---|---|---|---|
| Toomey syringe | 60 mL (50 / 70 variants) | Tapered open tip → catheter funnel | Bladder irrigation, MBW, intravesical instillation |
| Luer-tip 60 mL syringe | 60 mL | Luer-lock → adapter required | General irrigation; not catheter-funnel compatible |
| Asepto bulb syringe | ~ 60–120 mL | Open tapered tip | Wound irrigation, cavity rinsing; less controlled vacuum on aspiration |
| Ellik evacuator | Continuous-cycle bulb | Sheath-mounted | Chip / clot evacuation through resectoscope sheath during transurethral cases |
Catheter Pairing for Maximum Flow
Effective MBW depends as much on the catheter as the syringe. Mesfin 2011 and Kobatake 2022 both quantified the design dependence: larger-lumen, multi-eyelet, three-way irrigation catheters clear clot substantially faster than smaller / single-eyelet variants.[5][6] Braasch 2006 mapped the lumen-geometry trade-offs across three-way designs.[7] See the Three-Way Catheter page for the catheter side of the pairing.
CATCH-22 reinforces this: ≥ 22 Fr is the practical minimum for adult clot retention; a Toomey paired with a 16 Fr Foley will lose the case on flow physics alone.[1]
Limitations
- Operator-power-limited — the hand-driven pressure ceiling is far below wall-suction or true cystoscopic evacuation.
- Trabeculated / small-capacity / NLUTD bladder — over-vigorous instillation risks bladder perforation; instill smaller volumes (20–30 mL) and aspirate more frequently in this group.
- Recent bladder anastomosis or fresh cystotomy closure — relatively contraindicated for forceful MBW until surgeon-set day-X; gentle low-volume irrigation only.
- Friction-seal slip — the tapered tip occasionally backs out under pressure; brace the catheter funnel with the non-dominant hand.
Historical Context — David Toomey
The Toomey syringe is named after Dr. David Toomey, who designed it as a purpose-built catheter-interface syringe for efficient bladder irrigation. The simple, purpose-built design has remained the global standard for manual bladder irrigation and intravesical instillation across nearly a century of urologic practice.
See also: Ellik Evacuator, Three-Way Catheter, Bladder Scanner.
References
1. Clarebrough E, McGrath S, Christidis D, Lawrentschuk N. "CATCH-22: a manual bladder washout protocol to improve care for clot retention." World J Urol. 2018;36(12):2043–2050. doi:10.1007/s00345-018-2346-z
2. Moussa M, Chakra MA, Papatsoris AG, et al. "Bladder irrigation with povidone-iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization." Neurourol Urodyn. 2021;40(2):672–679. doi:10.1002/nau.24607
3. Bo J, Yangyang Y, Jiayuan L, et al. "Evaluation of bladder clots using a nonsurgical treatment." Urology. 2014;83(2):498–9. doi:10.1016/j.urology.2013.09.022
4. Xu M, Jin L, Shan Y, Zhu J, Xue B. "A simple and effective method for bladder blood clot evacuation using hydrogen peroxide." J Int Med Res. 2020;48(5):300060520924546. doi:10.1177/0300060520924546
5. Mesfin S, Sarkissian C, Malaeb B, Monga M. "Catheter design for effective manual bladder irrigation." J Urol. 2011;186(6):2307–9. doi:10.1016/j.juro.2011.07.080
6. Kobatake K, Inoue S, Takemoto K, et al. "Evaluation of urinary catheters for effective manual bladder washout." Sci Rep. 2022;12(1):14359. doi:10.1038/s41598-022-18778-5
7. Braasch M, Antolak C, Hendlin K, et al. "Irrigation and drainage properties of three-way urethral catheters." Urology. 2006;67(1):40–4. doi:10.1016/j.urology.2005.07.007