Continuous Bladder Irrigation (CBI) is a medical procedure used primarily in hospital settings to maintain a clear pathway for urine flow. This involves the constant infusion of a sterile solution directly into the bladder. This continuous flow prevents the accumulation of material that could otherwise obstruct the urinary tract. The goal of this intervention is to ensure the bladder remains patent, allowing for the free passage of fluid and debris. This technique is often initiated immediately following certain surgical procedures to prevent complications related to internal bleeding.
Purpose and Necessity
The need for Continuous Bladder Irrigation arises most frequently after urological surgeries, especially a Transurethral Resection of the Prostate (TURP). During this procedure, tissue is removed from the prostate gland, which results in exposed blood vessels within the bladder wall. These vessels are prone to bleeding, causing blood to enter the bladder.
If this blood is allowed to pool, it can quickly clot and form a mass large enough to plug the urinary catheter, leading to a complete blockage. This obstruction can cause significant patient discomfort and lead to urinary retention. The constant, high-volume flow of irrigant is necessary to wash away blood before it has the opportunity to solidify into an obstructive clot within the catheter or the bladder itself.
CBI is also employed to manage severe, uncontrolled hematuria, which is significant blood in the urine. In these instances, the rapid infusion of sterile fluid acts as a mechanical flushing mechanism. This action dilutes the concentration of blood and physically pushes out any existing small clots, ensuring the drainage system remains functional until the bleeding can be controlled medically.
The Mechanics of Fluid Delivery
The procedure relies on a specific piece of equipment known as a triple-lumen catheter. One channel, the irrigation inflow lumen, is connected to the sterile irrigating solution, typically 0.9% sodium chloride (normal saline), which hangs from an intravenous pole. This fluid flows continuously into the bladder, usually driven by gravity or, less commonly, by a mechanical pump to maintain a steady pressure.
A second channel, the drainage outflow lumen, is significantly wider to accommodate the infused fluid, urine, blood, and any debris or blood clots from the bladder. This mixture exits the bladder and collects in a large-volume drainage bag. The third channel is a small inflation lumen, used to inflate a balloon at the catheter’s tip, securing the device in place and preventing dislodgement.
The rate of fluid delivery is carefully titrated to achieve a specific goal: clear output. If the drainage fluid remains dark red or contains numerous clots, the flow rate of the sterile solution is increased to provide a more aggressive flush. Conversely, as the drainage clears and becomes a light pink or straw color, the infusion rate is gradually slowed down.
Monitoring and Patient Experience
A crucial aspect of managing Continuous Bladder Irrigation is the meticulous tracking of fluid balance, referred to as Intake and Output (I/O). The healthcare team calculates the true amount of urine the patient is producing by subtracting the total volume of irrigation fluid infused from the total volume collected in the drainage bag. Accurate I/O tracking is performed regularly to monitor kidney function and detect potential fluid absorption by the patient.
The nurse closely monitors the color and clarity of the drainage fluid. The goal is to see the fluid transition from a deep red, indicating active bleeding, to a pale pink, and eventually to a clear, straw-colored liquid. This visual assessment guides the adjustments to the irrigation flow rate, ensuring the patient receives the minimum effective dose of fluid necessary to clear the bladder.
Bladder spasms are a common complication. These occur because the catheter and the cold irrigating fluid can irritate the bladder lining. Spasms are described as a cramping pain in the lower abdomen or suprapubic area, and they can sometimes lead to leakage around the catheter. Pain management, often involving antispasmodic medications, is used to alleviate this discomfort.
Recognizing and Managing Complications
Despite careful management, complications can arise, the most common being an acute catheter blockage. This is usually signaled by a sudden absence of fluid output in the drainage bag, even though the irrigation fluid is still flowing into the bladder. If a blockage occurs, the bladder can rapidly become distended and painful, requiring immediate intervention to prevent trauma or potential rupture.
Manual irrigation is often used for a complete blockage, involving a nurse or physician using a large syringe to forcefully inject and then aspirate small volumes of sterile saline directly into the catheter. This action is designed to break up and remove the clot that is obstructing the drainage lumen. If patency cannot be immediately re-established, the continuous irrigation must be temporarily stopped to prevent excessive fluid buildup in the bladder.
Fluid absorption is a systemic complication, where the sterile irrigant enters the patient’s bloodstream through open surgical sites within the bladder. This is a possibility when the irrigation pressure is too high or the flow is obstructed. Absorption of a large volume of saline can lead to hyperchloremic metabolic acidosis or fluid overload, requiring careful monitoring of the patient’s vital signs and electrolyte levels. Signs of infection, such as fever, cloudy urine, or persistent discomfort after the irrigation has cleared, also necessitate prompt medical evaluation and treatment.