04/02/2026
Decompression hematuria
Rule out pumping vessel (cystoscopy) or reflux (mcug )
Before one of last resort instillations
Tranexamic Acid (TXA) — First-Line Bedside
Typically 1g (1000mg) of TXA diluted in 100mL of Normal Saline. 200 mg/100 mL of saline, instilled via catheter. Clamp for 60 minutes, then release/resume CBI. Repeat every 4-8 hours as needed.
Procedure: Instill via the catheter, clamp for 15–30 minutes, then resume Continuous Bladder Irrigation (CBI).
1% Alum solution 1% Alum solution (50g in 5L of sterile water). is irrigated through a 3-way catheter at a rate of roughly 250–300 mL/hr.
Silver Nitrate Concentrations vary widely, from 0.1% to 1%. It is usually instilled and allowed to "dwell" for 10–20 minutes before being flushed out with sterile water or saline.
Risks: It can be quite painful (often requiring sedation/anesthesia) and carries a risk of ureteral strictures if the solution refluxes back toward the kidneys.
Amicar (Aminocaproic Acid) Inhibits fibrinolysis (stops the body from breaking down clots). Often added to the saline irrigation bag (e.g., 200mg/L). Warning: Do not use if there is upper tract (kidney) bleeding, as it can cause permanent clots in the ureters.
Prostaglandins (PGE2/PGF2α) Causes smooth muscle contraction and vasoconstriction. Primarily used for bleeding caused by chemotherapy (Cyclophosphamide).
Formalin (Formaldehyde) Fixes tissue (like a preservative) and coagulates the entire lining. Last resort. Highly effective but very toxic. Requires a "Cystogram" first to ensure no reflux to kidneys and must be done under general anesthesia.
