Continuous Bladder Irrigation (CBI) is a specialized medical procedure designed to continuously flush the bladder with a sterile solution, typically 0.9% normal saline. The primary goal of this constant flushing is to prevent the formation of blood clots within the bladder cavity. By continuously introducing and draining fluid, CBI ensures that any blood is washed out before it can coagulate and create an obstruction. This mechanism maintains the patency of the urinary catheter, allowing urine and debris to exit the body freely.
Primary Medical Applications
The necessity for Continuous Bladder Irrigation arises most often following urological surgeries performed inside the bladder or prostate gland. Procedures like a Transurethral Resection of the Prostate (TURP) frequently cause bleeding, which mixes with urine and creates an environment highly prone to clot formation. CBI acts as a prophylactic measure, preventing clots from aggregating into a large mass that could block the catheter or the bladder’s natural outflow.
The procedure is also employed to manage severe, non-surgical hematuria (significant blood in the urine) caused by trauma, radiation, or certain cancers. In these cases, the rapid rate of bleeding overwhelms the body’s ability to keep the bladder clear. Continuous irrigation is necessary to maintain urinary flow.
How the Irrigation System Works
The CBI system requires a specialized triple-lumen, or three-way, catheter. This unique catheter is inserted into the bladder through the urethra and features three separate channels. One channel is dedicated to inflating a small balloon inside the bladder, which anchors the catheter securely in place.
The second channel connects to the sterile irrigation fluid, allowing the solution to continuously flow into the bladder under gravity. The third and largest channel is the outflow tract, which drains the fluid, along with any urine, blood, or clots, into a collection bag. The flow rate is manually controlled by a clamp, similar to an intravenous drip.
The flow rate is adjusted based on the color of the fluid exiting the body. Staff increase the rate of infusion if the outflow is dark red or thick with clots to provide more vigorous washing. Conversely, the flow rate is gradually reduced as the drainage lightens to a clear pink or amber color, indicating that the bleeding has subsided. This continuous influx and outflow ensures the catheter remains clear and prevents clot retention.
Patient Monitoring and Immediate Troubleshooting
Detailed patient monitoring is paramount during Continuous Bladder Irrigation to ensure the system is working effectively. The most important metric is the accurate tracking of fluid input and output, referred to as Intake and Output (I&O). The volume of irrigation fluid infused is subtracted from the total drainage volume to determine the patient’s true urine output.
The goal for the drainage color is a light pink or straw-colored effluent, signifying minimal active bleeding. A sudden decrease in output, accompanied by patient complaints of lower abdominal pressure or pain, suggests a potential blockage. The most common cause of obstruction is a large blood clot lodged in the catheter’s drainage eyelets.
Bladder spasms are a frequent and uncomfortable side effect that may signal catheter obstruction or irritation. If a blockage is confirmed, a nurse may perform manual irrigation. This involves flushing the catheter directly with a large syringe of sterile saline to break up and aspirate the clot, restoring patency before continuous flow is resumed.
Recognizing Systemic Risks
While CBI is a routine procedure, it carries a risk of systemic complications requiring prompt recognition. The most significant risk involves the absorption of irrigation fluid into the bloodstream through the raw, surgically treated surfaces of the bladder or prostate. If the fluid is not isotonic, this absorption can cause a dangerous dilution of the body’s electrolytes, most notably sodium.
This condition, sometimes called Transurethral Resection of the Prostate (TURP) syndrome, can lead to hyponatremia. Symptoms include headache, nausea, confusion, and visual disturbances. In rare instances, it can progress to seizures and fluid overload.
Staff also monitor for signs of infection, which can occur when a catheter is placed in the urinary tract. Any fever, chills, or persistent pain must be reported immediately, as these signify a developing urinary tract infection. A sudden increase in bright red blood in the drainage, even with the flow rate maximized, suggests a significant hemorrhage requiring immediate medical intervention.