Closed Bladder Irrigation (CBI): Procedure, Indications & Recovery

Closed bladder irrigation (CBI) is a sterile technique used to continuously flush the bladder via a three-way Foley catheter. It is primarily employed in hospital settings to manage postoperative bleeding or to instill therapeutic agents.

Primary Indications

• Removal of blood clots and debris after transurethral resection of the prostate (TURP), bladder tumor resection (TURBT), or traumatic hematuria.
• Prevention of catheter obstruction by clot retention.
• Intravesical chemotherapy (e.g., mitomycin C, gemcitabine) or immunotherapy (BCG) for non-muscle-invasive bladder cancer.
• Treatment of refractory urinary tract infections with antibiotic instillations (less common).

Procedure Overview

1. Three-way Foley catheter placed aseptically (typically 22–24 Fr).
2. Two inflow ports connected to gravity-fed irrigation bags (usually 0.9% normal saline or glycine 1.5% for TURP to avoid TURP syndrome).
3. Outflow port connected to closed drainage bag.
4. Flow rate titrated to keep effluent light pink to clear (typically 30–60 mL/min, up to 150 mL/min if heavy bleeding).
5. Continuous monitoring of input/output, fluid balance, and electrolyte levels (especially with glycine).

Patient Experience & Complications

• Mild bladder spasms or urgency common; antispasmodics (oxybutynin) may help.
• Discomfort at catheter site; secure catheter to prevent traction.
• Risks: infection (CAUTI), electrolyte imbalance (hyponatremia with glycine), bladder perforation (rare), catheter blockage.

Duration & Discontinuation

Typically continued 24–72 hours post-TURP until urine clears. Catheter removed after irrigation stops and patient demonstrates adequate spontaneous voiding.

CBI is a standard, effective tool for postoperative bladder management. Nursing vigilance ensures early detection of complications.