When should Continuous Bladder Irrigation (CBI) be used in urology patients?

Indications for Continuous Bladder Irrigation (CBI) in Urology Patients

Continuous bladder irrigation (CBI) should be used primarily for management of hematuria following urological procedures such as TURP, open prostatectomy, and cystectomy to prevent clot formation and urinary retention. 1

Primary Indications for CBI

1. Post-operative hematuria management:

   • After transurethral resection of the prostate (TURP) 1, 2
   • Following open prostatectomy 1, 3
   • Post-cystectomy 1
   • After transurethral resection of bladder tumors (TURB) 3

2. Severe hematuria requiring clot prevention:

   • Studies show CBI significantly reduces the incidence of clot retention (8/76 with CBI vs 21/70 without CBI) 4
   • Prevents need for repeat surgical intervention for clot evacuation 2

CBI Setup and Administration

Equipment requirements:

• Three-way Foley catheter (22-24Fr size preferred) 1
• Sterile normal saline solution (0.9% sodium chloride) 1
• Irrigation bag positioned 80-100 cm above bladder level 1, 3

Flow rate management:

• Initial flow rate: 30-50 ml per hour 1
• Titrate based on effluent color and bleeding severity 1
• For severe hematuria: irrigation every 4-6 hours 1

Monitoring and Management Protocol

1. Regular monitoring:

   • Check effluent color every 1-2 hours 1
   • Assess for clot formation and bladder spasms 1

2. Clot management:

   • Gentle aspiration for clot extraction if needed 1
   • Maintain aseptic technique during all manipulations 1

3. Flow rate adjustment:

   • Increase flow with darker effluent 4
   • Gradually decrease as bleeding subsides 1

Efficacy and Benefits

• Reduces catheter obstruction rates (4.4% with routine CBI vs 12.9% without) 2
• Improves visualization during endourologic procedures 3
• Automated systems can reduce irrigation volume (24.2L vs 54.6L with manual systems) 4
• Decreases incidence of bladder spasms (12/76 with CBI vs 39/70 without) 4

Potential Complications and Prevention

• Infection risk: Maintain closed drainage system 1
• Bladder trauma: Avoid excessive irrigation pressure 1
• Fluid absorption: Monitor for TUR syndrome, especially with continuous flow 5
• Catheter blockage: Ensure adequate flow rate to prevent clot formation 2

When to Discontinue CBI

• When effluent is consistently light pink or clear 1
• Monitor for return of hematuria after discontinuation 1
• Remove catheter as soon as clinically possible to reduce infection risk 1

Special Considerations

• For patients requiring long-term management, consider intermittent clean catheterization instead of permanent catheterization 1
• Automated CBI systems may improve efficiency and reduce complications in the future 6, 4

CBI remains a cornerstone management strategy for post-operative hematuria in urological patients, with evidence showing significant reduction in clot retention and need for repeat interventions when properly implemented.