Continuous Bladder Irrigation (CBI)

CBI is a controlled way to keep a three-way indwelling urinary catheter draining while bleeding is producing blood or clots. Sterile solution enters through the irrigation lumen and exits with urine through the drainage lumen, so a functioning outflow path matters as much as the inflow. The bag should hang 60–90 cm (24–36 in) above the bladder: that height uses gravity without the excess pressure associated with higher placement. Routine CBI uses sterile normal saline. This is distinct from the hypotonic irrigants used during some monopolar TURP procedures; do not transfer intraoperative fluid assumptions to postoperative CBI. If the patient develops suprapubic pain, increasing abdominal girth, or reduced return, stop irrigation rather than increasing the rate. Persistent absent return or heavy clot burden needs urgent urological assessment. CBI is contraindicated with bladder perforation, severe obstructive uropathy, uncontrolled septic UTI, or a known allergy to the solution. The procedure therefore has two safety questions: is the bladder draining, and could the operative irrigant have been absorbed?