Amicar bladder irrigation is a specialized medical procedure used to manage significant bleeding within the bladder. This treatment involves introducing a specific medication directly into the bladder to help control and stop hemorrhage. It is employed when other methods have not been successful in controlling internal bleeding.
What is Amicar Bladder Irrigation?
Amicar is the brand name for aminocaproic acid, a medication classified as an antifibrinolytic agent. Its primary function is to help stabilize existing blood clots and prevent new ones from breaking down prematurely. The medication achieves this by interfering with plasmin, an enzyme in the body that dissolves fibrin, a protein that forms the meshwork of blood clots.
Bladder irrigation refers to flushing the urinary bladder with a liquid solution. When Amicar is used, it is prepared as a solution with normal saline. This approach directly delivers the clot-stabilizing medication to the bleeding site within the bladder, helping to control excessive blood loss.
When is Amicar Bladder Irrigation Used?
Amicar bladder irrigation is primarily used for severe hematuria, which is gross blood in the urine, often appearing as red or dark brown. This treatment is an option when initial, less invasive measures fail to control the bleeding. A common scenario is after prostate surgeries, such as a transurethral resection of the prostate (TURP), particularly if delayed or recurrent bleeding occurs due to excessive clot breakdown.
The procedure is also indicated for hemorrhagic cystitis, a condition characterized by inflammation and bleeding of the bladder lining. This can result from various causes, including certain types of chemotherapy, radiation therapy to the pelvic area, bladder trauma, or conditions like viral infections or bladder malignancy. However, it is not recommended for bleeding originating from the upper urinary tract due to the risk of forming dense clots that could obstruct the ureters.
How is the Procedure Performed?
The procedure begins with inserting a catheter into the bladder, often a three-way Foley catheter that allows for fluid inflow and outflow. Before introducing the Amicar solution, medical staff irrigate the bladder with normal saline to remove existing blood clots. This initial step is important because Amicar can react with existing clots, potentially forming hard, stone-like masses that are difficult to remove later.
Once the bladder is clear of clots, a continuous flow of the Amicar solution is initiated through the catheter. The solution, which often contains 200 mg of aminocaproic acid per liter of normal saline, is delivered from bags hung on an IV pole, with the flow rate adjusted based on the severity of the bleeding. The goal is to achieve a clear or lightly pink drainage from the bladder. This continuous irrigation is maintained for about 24 hours after the urine clears, and the procedure is performed within a hospital setting.
What to Expect and Potential Side Effects
During Amicar bladder irrigation, patients may experience a feeling of fullness in the bladder or a persistent urge to urinate due to the continuous fluid inflow. Some discomfort or bladder spasms are common sensations, which can be managed with medications. Healthcare providers closely monitor the color and clarity of the drainage to gauge the treatment’s effectiveness and adjust the irrigation rate as needed.
Amicar bladder irrigation has fewer systemic side effects compared to oral or intravenous administration due to minimal bloodstream absorption. However, potential complications exist. The most notable is the formation of dense clots within the bladder if existing clots are not removed before starting the irrigation. In rare instances, systemic absorption could increase the risk of blood clots elsewhere in the body. Patients or caregivers should immediately report any worsening bleeding, inability to drain urine, severe bladder pain, or signs of new clotting, such as leg swelling or chest discomfort, to their medical team.