Fluid for Continuous Bladder Irrigation (CBI)
Use sterile normal saline (0.9% sodium chloride) or sterile water for continuous bladder irrigation.
Primary Irrigation Solution
Sterile normal saline (0.9% NaCl) is the standard irrigation fluid for CBI in urological procedures, particularly following transurethral resection of the prostate (TURP) or bladder procedures with significant bleeding risk. This isotonic solution minimizes the risk of fluid absorption complications while effectively clearing blood clots and maintaining catheter patency.
Alternative: Sterile Water
Sterile water may be used as an alternative irrigation solution, though it carries specific risks:
- Hypotonicity risk: If absorbed systemically through open venous sinuses (particularly during TURP), sterile water can cause hyponatremia, hemolysis, and TURP syndrome
- Use with caution: Reserve sterile water for situations where minimal systemic absorption is expected or when normal saline is contraindicated
Key Clinical Considerations
Volume and Flow Rate
- Adjust irrigation rate to maintain light pink or clear urine output
- Typical flow rates range from 50-300 mL/hour depending on bleeding severity
- Monitor for clot formation requiring increased flow or manual irrigation
Monitoring Parameters
- Fluid balance: Track input (irrigation) versus output to detect absorption
- Serum sodium: Check if patient develops confusion, nausea, or neurological changes suggesting hyponatremia
- Hemoglobin: Monitor for ongoing bleeding requiring intervention beyond irrigation
Common Pitfalls
- Never use tap water for CBI due to infection risk and unpredictable electrolyte composition
- Avoid hypotonic solutions in patients with large prostatic resection beds or prolonged irrigation needs
- Don't ignore sudden decrease in output: May indicate catheter obstruction requiring manual irrigation or catheter replacement
- Monitor for bladder distension: Ensure outflow matches or exceeds inflow to prevent bladder rupture