Can Continuous Bladder Irrigation Be Done Through a 2-Way Catheter?
No, continuous bladder irrigation (CBI) cannot be effectively performed through a 2-way catheter and requires a 3-way catheter for proper function. A 3-way catheter has a dedicated irrigation port that allows simultaneous inflow of irrigant and outflow of drainage, which is essential for preventing catheter obstruction from blood clots 1, 2.
Why a 3-Way Catheter Is Required
Functional Design Requirements
A 3-way catheter contains three separate lumens: one for balloon inflation, one for irrigation inflow, and one for drainage outflow, allowing continuous simultaneous irrigation and drainage 2, 3.
A 2-way catheter only has two lumens: one for balloon inflation and one for drainage, making it impossible to perform continuous irrigation while maintaining drainage 2.
Manual irrigation through a 2-way catheter's drainage port is technically possible but requires interrupting drainage, which defeats the purpose of continuous bladder irrigation and increases the risk of clot retention 2.
Clinical Context for CBI
Primary Indication
CBI should be used for patients with hematuria to prevent catheter obstruction from blood clots, particularly following urological procedures or in cases of severe bladder hemorrhage 1.
Macroscopic hematuria with an indwelling catheter requires CBI and possible endoscopic hemostasis treatment if necessary 1.
Optimal Catheter Selection for CBI
For effective continuous bladder irrigation, use a 22F to 24F 3-way catheter, as these sizes provide optimal irrigation and drainage flow rates 2, 3.
The Bardex 22F and 24F 3-way catheters demonstrated superior continuous irrigation flow (average flow rate 1.6-1.7 mL/s) compared to other brands tested 2.
The Rusch Simplastic 24F 3-way catheter provided the highest irrigation rates (average flow rate 4.6 mL/s) in comparative studies 3.
Common Pitfall to Avoid
Do not attempt continuous bladder irrigation with a 2-way catheter, as this will require repeated manual irrigation through the drainage port, interrupting drainage and potentially allowing clot formation and catheter obstruction 2, 4.
If a 2-way catheter is already in place and CBI becomes necessary, the catheter must be replaced with a 3-way catheter 4.