Continuous bladder irrigation (CBI) is a specialized procedure often used in a hospital setting following certain surgical interventions on the urinary tract. The technique involves a controlled flow of fluid into the bladder, which is necessary to prevent potentially serious complications that can arise from internal bleeding.
Defining Continuous Bladder Irrigation
Continuous Bladder Irrigation is a medical technique designed to flush the bladder with a sterile solution on a non-stop basis. The primary function of this continuous flow is to prevent the accumulation of blood, tissue fragments, or sediment that can lead to blood clots within the bladder. By preventing these clots, the procedure ensures that the urinary catheter, a tube used for draining urine, remains open and functional.
The constant flushing action helps to maintain catheter patency. If a clot were to form and block the catheter, urine would be unable to drain, causing a buildup in the bladder and leading to a painful condition called urinary retention. CBI is a sustained, passive process that runs over a period of days until the risk of significant bleeding has passed.
How the Procedure Works
The mechanics of continuous bladder irrigation rely on a specialized device called a triple-lumen, or three-way, catheter. This catheter contains three distinct internal channels. One lumen is dedicated to the continuous inflow of the irrigating solution, typically sterile 0.9% normal saline, which enters the bladder. A second, larger lumen acts as the drainage channel, allowing the combined irrigant fluid and any urine or debris to exit the bladder and collect in a drainage bag. The third, smallest lumen is used solely to inflate a balloon at the catheter tip, anchoring the device securely inside the bladder to prevent accidental removal.
The rate at which the sterile fluid flows into the bladder must be constantly adjusted, a process known as titration. Healthcare staff monitor the color and clarity of the drainage fluid, or effluent, to determine the necessary flow rate. If the drainage is dark red or contains thick clots, the infusion rate is increased to provide more aggressive flushing action. The goal is to reduce the flow rate gradually as the fluid lightens, aiming for a pale pink or clear yellow effluent, which signifies that the bleeding is under control. Accurate monitoring of intake and output is performed to ensure the volume of fluid entering closely matches the volume draining out.
Primary Medical Uses
The most frequent application of continuous bladder irrigation is immediately following specific urological surgeries. In particular, it is a standard part of post-operative care after a Transurethral Resection of the Prostate (TURP). This common procedure to treat an enlarged prostate often results in bleeding from the surgical site within the prostatic urethra.
CBI is also indicated for the management of severe, gross hematuria, which is the presence of visible blood in the urine. This condition can stem from various causes, including trauma, kidney stones, or certain bladder conditions like hemorrhagic cystitis, which causes significant bleeding into the bladder wall. In these instances, the rapid and continuous flushing ensures that the bladder does not become distended with a large, obstructive clot. CBI ensures continuous drainage and helps reduce complications until the underlying source of bleeding is controlled.
Recognizing and Managing Complications
Continuous bladder irrigation requires careful monitoring because several complications can arise. The most immediate concern is a clot blockage, which occurs when a large clot or collection of debris obstructs the drainage lumen of the catheter. Signs of this problem include a sudden stop in the drainage, a decrease in the volume of effluent, or the patient reporting severe bladder pain and spasms. If a blockage occurs, a nurse or physician must perform manual irrigation with a large syringe to dislodge the clot, often by forcefully instilling and withdrawing small amounts of sterile solution.
Another significant risk is a fluid imbalance, specifically the absorption of the irrigation fluid into the bloodstream. This is a particular concern if the surgical site has extensive open blood vessels, potentially leading to TURP syndrome. Rapid absorption of fluid can lead to fluid overload, taxing the cardiovascular system, or cause hyponatremia, a dangerously low level of sodium in the blood. Hyponatremia can manifest as confusion, nausea, or seizures, and its prevention is why isotonic fluids like normal saline are the preferred irrigants today.
The presence of a catheter and the continuous flow of fluid also create a potential pathway for infection. Catheter-associated urinary tract infection (CAUTI) is a risk with any indwelling catheter. Signs of infection include fever, chills, cloudy or foul-smelling urine, or flank pain. Any sudden change in the patient’s condition, severe pain, or signs of a blockage should be immediately reported to the healthcare provider, as prompt intervention is necessary to manage these complications safely.