Do Women Benefit from Continuous Bladder Irrigation?
Women do not benefit from routine continuous bladder irrigation for catheter management, but CBI is indicated specifically for managing active hematuria to prevent catheter obstruction from blood clots, particularly following urological procedures. 1, 2
Evidence Against Routine Bladder Irrigation in Women
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 (Grade A-I recommendation). 1
Key Study in Women with Long-Term Catheters
A randomized crossover trial specifically examined 32 long-term catheterized women comparing 10 weeks of once-daily normal saline irrigation versus no irrigation. 3 The results demonstrated:
- No difference in catheter obstruction rates between irrigation and no irrigation groups 3
- No difference in febrile episodes between groups 3
- No difference in prevalence or species of bacteriuria between groups 3
- The study concluded that once-daily irrigation is "a time-consuming and costly procedure that is unlikely to have an impact on the morbidity associated with such catheters" 3
This finding is reinforced by guideline evidence showing that in 32 women with long-term catheterization and bacteriuria, the prevalence and species of CA-bacteriuria, incidence of catheter obstructions, and febrile episodes (including CA-UTIs) were similar whether patients received once-daily normal saline irrigation or no irrigation. 1
When Women DO Benefit from Bladder Irrigation
Active Hematuria Management
CBI should be used for women with hematuria to prevent catheter obstruction from blood clots, particularly following urological procedures or in cases of severe bladder hemorrhage. 2 Specific indications include:
- Severe hematuria requiring clot prevention, especially when there is risk of urinary retention from clot formation 2
- Macroscopic hematuria with indwelling catheter requires CBI and possible endoscopic hemostasis treatment if necessary 2
- Persistent visible hematuria in the drainage bag 2, 4
Short-Term Perioperative Context
Bladder irrigation with antiseptics has shown benefit in preventing catheter-associated bacteriuria in surgical patients with short-term catheterization. 1 However, this evidence comes primarily from studies in men undergoing transurethral operations, not from studies specifically in women. 1
Clinical Algorithm for Women
For women with long-term catheters:
- Do NOT perform routine bladder irrigation 1, 3
- Do NOT add antimicrobials or antiseptics to drainage bags 1
- Monitor for catheter obstruction from urease-producing organisms (particularly Proteus mirabilis) 2, 4
For women with active hematuria:
- Initiate CBI with room temperature or body temperature sterile normal saline 4
- Continue CBI while visible hematuria persists in drainage bag 2, 4
- Discontinue CBI when hematuria resolves with clear urine output 2
Critical Pitfalls to Avoid
Do not irrigate catheters routinely to prevent infection, as this practice does not reduce catheter-associated bacteriuria or UTI and represents wasted resources. 1, 5, 3
Do not use antiseptic irrigation solutions (chlorhexidine, povidone-iodine) outside of short-term perioperative surgical contexts, as they are not indicated for routine long-term catheter management. 4, 5
Remove catheters as soon as clinically possible, as duration is the most important risk factor for complications. 4, 5