From the Research
A good rate for continuous bladder irrigation (CBI) for blood clots in urine is not explicitly stated in the most recent and highest quality study, but based on the available evidence, a rate of 100 to 200 mL per hour is commonly recommended. This rate can be adjusted based on the severity of bleeding and the clarity of returning fluid, with the goal of preventing clot formation and bladder tamponade by continuously flushing out blood and clots 1. The irrigation fluid should be sterile normal saline or sterile water, maintained at room temperature.
Key Considerations
- The primary goal of CBI is to prevent clot formation and bladder tamponade by continuously flushing out blood and clots.
- The three-way Foley catheter used should be of adequate size (typically 22-24 French) to facilitate clot passage.
- Monitor the patient's fluid balance carefully, as excessive irrigation rates can lead to fluid overload, particularly in patients with cardiac or renal issues.
- Adjust the rate downward as bleeding subsides, and discontinue CBI when the returning fluid remains consistently clear for several hours.
- Regular assessment of catheter patency is essential to prevent blockage, which could lead to bladder distention and increased bleeding.
Adjusting the Rate
- Start with a moderate flow rate and titrate based on the color of the effluent, aiming for light pink to clear urine.
- The rate may need to be adjusted based on the individual patient's response to treatment and the severity of their bleeding.
- It is essential to balance the need to prevent clot formation with the risk of fluid overload and other potential complications.
Evidence Summary
The most recent and highest quality study on this topic is from 2016, which evaluated the safety and efficacy of intravesical alum for intractable hemorrhagic cystitis 1. While this study did not specifically address the optimal rate for CBI, it provides valuable insights into the management of hemorrhagic cystitis and the use of intravesical alum as a treatment option.