Thanks for your comment.
he presented with acute rapidly enlarging clot that occupied all his bladder.
I had to open his bladder to clear it out.
now he is forming small clots that is blocking his catheters.
I m currently using ordinary saline but could not find reported recommendations regarding what rate to be used to prevent further clots and at the same time not cause bleeding on its own.
what rate will you recommend for infusing the bladder?
Dear Mohamed,
have you got one or two catheters in the bladder? What about irrigating with N Saline at 20 mls/h of N Saline through SPC and draining out through a large urethral Foley.
Let me know how you are getting on.
Best wishes
Salvo
Thanks Salvo
Its now day 8 post cystotomy and clot evacuation. He is much better and the urine is getting clearer (still rosy).
I have 14fr SPC and 12fr urethral and irrigating through one and draining through the other.
I m running it at a rate of 35 drops of normal saline/min, which gives around 200mls/hr, and it's coming straight from the other catheter and he doesn't have pain or clots anymore.
I was hoping to wait until colour clears more then decrease the rate .
he is 7 year old. I thought slower rate might not clear the clots initially, but I may be able to slow it in the next few days
It sounds good, well done! 200 mls/h is quite a lot, as long as it works. Keep an eye on u and e.
Keep in touch
Thanks a lot
His UEs are fine. Bloods closely monitored as he is post BM transplant.
it seems quite a lot to me as well but catheters were getting blocked a lot initially
best wiahes
Mohamed
Seems to me we are seeing a lot less these problematic hemorrhagic cystitis kids being referred from oncology. I guess it is the refinement in the toxic drugs that they use. I would have managed with cystoscopy and evacuation of clot, followed with SPC and UC with saline irrigation.
This was post Bone marrow transplant post BK polyoma virus cause of cystitis.
The clot was massive and occupied the whole bladder.
I tried cystoscopically first which was a complete failure and the clot could not be irrigated.
The only possible way to clear it was through cystotomy.
After that case, I will not try cystoscopically again unless the clot was small and in its early stage.
The other useful adjunct was the size of the SPC and The UC. Size 12 kept on getting blocked and it was only when we up sized it to size 14 that we managed to irrigate better.
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