title: Continuous bladder irrigation in the monoplace hyperbaric chamber: Two case reports.
abstract: BACKGROUND
  Radiation-induced hemorrhagic cystitis is a serious side effect of radiation therapy. Anemia requiring transfusion can ensue. Treatment methods include bladder irrigation, fulguration, and hyperbaric oxygen (HBO2) therapy. Failure of treatment leads to cystectomy associated with a high risk of severe complications (42%) and mortality (16%). Continuous bladder irrigation (CBI) is often required to prevent further clot formation. HBO2 supports the healing process of radiation cystitis. In patients requiring CBI, the time in HBO2 can help cause clot accumulation and obstruction. We describe a method of providing CBI in a monoplace hyperbaric chamber.
  
  
  METHODS
  An IV to catheter adapter is used, allowing an IV pump to control CBI flow into the chamber. Drainage is collected in an extra-large (2- to 5-liter) bag. The rate is set so the volume does not exceed the bag's capacity. The bag is placed in a manner that precludes spilling and allows monitoring of outflow.
  
  
  RESULTS
  CBI was successfully maintained. Brief cases are presented and issues discussed.
  
  
  CONCLUSIONS
  CBI is easily maintained in a monoplace hyperbaric chamber, with readily available equipment allowing for uninterrupted CBI of hemorrhagic cystitis. HBO2 helps mitigate the potential side effects of other interventions in a previously irradiated area.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Cooper
authors.forename: Peter
authors.initials: P
authors.lastname: Allinson
authors.forename: Dana
authors.initials: D
authors.lastname: Winn
authors.forename: Lon
authors.initials: L
authors.lastname: Keim
authors.forename: Joe
authors.initials: J
authors.lastname: Sippel
authors.forename: Patty
authors.initials: P
authors.lastname: Shalberg
authors.forename: Kari
authors.initials: K
authors.lastname: Fowler
mesh_terms: D000369:Aged, 80 and over; D003556:Cystitis / Q000209:etiology / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D007507:Therapeutic Irrigation / Q000379:methods; D013927:Thrombosis / Q000517:prevention & control; D001743:Urinary Bladder