I have been really struggling over this one all last week. Here it is:
In case of suspected BLADDER injury (described to me as a "nick") during a C-secxn, the established procedure is as follows: carmine indigo* or methylene blue is injected into the bladder via the Foley (urinary catheter) that all C-secxn patients have. If there is a nick in the bladder or anywhere else in the urinary tract, the blue will show in the pelvic cavity, whereupon the surgeon can repair the injury prior to closing (after the baby has been removed, of course). That is the common procedure. The Clin Ed RN for OB here is looking for EBP aka a rationale for using methylene blue (which has been identified in other uses as not so great).

I cannot find any. I broadened the search to hysterectomy/other pelvic surgery because C-secxn wasn't providing any real results. I have found out about other VERY dubious practices, such as flushing the bladder with "sterile" baby formula (formula is not sterile to OR standards and should never be used as a flush).

I have found many articles relating injuries to the ureters and how to repair them, but really nothing on the method used to assess the injuries in the first place. I have looked into actual surgical procedure textbooks, PubMed/Medline, EDS. I am by no means confident about my PubMed searching being comprehensive, so if anyone has any tips, please share them here or in private email. This search involves OB, Urology and Surgery-always hard when things cross specialities.

Can anyone help? Thanks so much.

*carmine indigo has become insanely expensive.

Eleanor Truex BSN, MLIS
Medical Librarian, Lakeshore Region

Saint Francis Hospital
355 Ridge Avenue | Evanston, IL 60202
Office: 847.316.2460

Saint Joseph Hospital
2900 North Lake Shore Drive | Chicago, IL 06057
Office: 773.665.3038

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