How is Amicar (aminocaproic acid) used for bladder irrigation?

Amicar Bladder Irrigation: Clinical Use and Evidence

Primary Indication and Evidence Base

Amicar (aminocaproic acid) bladder irrigation has limited evidence supporting its use and should generally not be employed for routine bladder irrigation, as it showed no significant advantage over normal saline in the only randomized controlled trial conducted for post-prostatectomy bleeding. 1

Specific Clinical Context Where It Has Been Used

Post-Transurethral Resection Bleeding

• A 0.5% solution of epsilon aminocaproic acid has been studied for bladder irrigation following transurethral resection of the prostate 1
• The randomized, double-blind trial demonstrated no significant benefit over normal saline in measured postoperative blood loss, irrigant volume, hours of catheterization, or length of hospital stay 1
• Systemic absorption after irrigation with EACA was not detectable 1

Hemorrhagic Cystitis (Case Report Level Evidence Only)

• A 2.5 g solution has been reported as bladder instillation for intractable hematuria in adenovirus-induced hemorrhagic cystitis following bone marrow transplant 2
• This represents anecdotal evidence only, not guideline-supported practice 2

Standard Bladder Irrigation Recommendations Instead

The Infectious Diseases Society of America explicitly recommends against routine catheter irrigation with antimicrobials or other agents to reduce catheter-associated bacteriuria or UTI in patients with long-term indwelling catheterization. 3

Appropriate Irrigation Solutions

• Sterile normal saline is the standard irrigation solution for continuous bladder irrigation through 3-way Foley catheters 4
• Room temperature or body temperature saline is preferred over cold water for patient comfort 4

When Bladder Irrigation Is Indicated

• Active hematuria following urological procedures to prevent catheter obstruction from blood clots 4
• Persistent visible hematuria in the drainage bag 4
• Catheter blockage from urease-producing organisms, particularly Proteus mirabilis 4

Critical Pitfalls to Avoid

• Do not use Amicar irrigation routinely, as evidence does not support superiority over normal saline 1
• Do not irrigate catheters routinely to prevent infection, as this practice does not reduce catheter-associated bacteriuria or UTI 3, 4
• Do not add antimicrobials or antiseptics to irrigation solutions as routine practice in long-term catheterization 4
• Do not use antiseptic irrigation solutions (chlorhexidine, povidone-iodine) outside of short-term perioperative surgical contexts 4

Alternative Evidence-Based Approaches for Bleeding

• Continuous bladder irrigation with normal saline remains the standard approach for managing post-procedural hematuria 4
• Remove or replace catheters as soon as clinically possible, as duration is the most important risk factor for complications 4, 5