Resuming Continuous Bladder Irrigation in Patients with Hematuria

Primary Indications for Resuming CBI

• Resume CBI immediately when gross hematuria returns after initial resolution, as this is the most common sign suggesting complications such as secondary hemorrhage 1

Risk Factors That Should Lower the Threshold for Resuming CBI

• Patients on anticoagulation or antiplatelet therapy have higher risk of recurrent bleeding and should have CBI resumed at earlier signs of hematuria 2
• Patients with moderate to severe renal injuries who develop hematuria should have CBI resumed promptly as secondary hemorrhage occurs in up to 25% of these cases within 2 weeks of injury 1

Monitoring Parameters to Guide CBI Resumption

• Monitor urine color closely - any change from clear to pink or red indicates the need to resume CBI 1

Duration of Resumed CBI

• For patients with renal trauma, CBI may need to be continued until both gross and microscopic hematuria have resolved 1
• For patients on anticoagulation therapy who develop recurrent bleeding, CBI may need to be continued for a longer period until stable clear urine is achieved 2

Follow-up After CBI Discontinuation

• After resolution of hematuria and discontinuation of CBI, patients should be monitored for at least 48 hours for recurrence before discharge 1
• Patients should be advised to restrict activity until microscopic hematuria has completely resolved 1
• Patients with moderate to severe renal injuries should have follow-up imaging within 48 hours of CBI discontinuation to ensure no ongoing urinary extravasation 1