Generic Name: acetic acid irrigation

Uses

Bacteriuria and Bacteremia Associated with Indwelling Catheters

Constant or intermittent irrigation of the urinary bladder to help prevent growth and proliferation of susceptible urinary pathogens (especially ammonia-forming bacteria) associated with prolonged use of an indwelling urethral catheter.

Maintaining Patency of Indwelling Catheters

Periodic irrigation of an indwelling urethral catheter to help maintain patency.

Dosage and Administration

General

• Acetic acid irrigation contains 0.25% acetic acid; this preparation should not be confused with Acetic Acid NF, which contains 36–37% of the acid, or with Diluted Acetic Acid NF, which contains 5.7–6.3% of the acid.

Administration

Bladder Irrigation

For constant or intermittent irrigation, administer by gravity drip via a disposable administration set connected to an indwelling urethral catheter designed for continuous or intermittent 2-way flow. For periodic irrigation, may use a bulb or piston syringe to administer solution.

Use new (unused) container for each initial or repeat procedure; do not use unless seal is intact. Use separate containers for each patient.

Use aseptic technique to prepare and administer solution.

Acetic acid solution for irrigation is not for injection.

Rate of Administration

Continuous or intermittent irrigation: Rate will approximate urine flow rate and should be adjusted to maintain a urinary effluent pH of 4.5–5. Use nitrazine or other pH paper to monitor pH, preferably at least 4 times daily.

Dosage

Adults

Bacteriuria and Bacteremia Associated with Indwelling Catheters

Bladder Irrigation

Continuous or intermittent irrigation: Approximately 500–1500 mL of 0.25% acetic acid solution every 24 hours.

Maintaining Patency of Indwelling Catheters

Bladder Irrigation

Periodic irrigation: Approximately 50 mL of 0.25% acetic acid solution per irrigation.

Cautions

Contraindications

• Irrigation during transurethral surgical procedures.

Warnings/Precautions

Warnings

Appropriate Use of Acetic Acid 0.25% Solution for Irrigation

For urologic irrigation only.

Use in patients with urinary bladder mucosal lesions may cause lesion irritation. Systemic absorption of acetic acid via open lesions may result in systemic acidosis. If systemic absorption occurs, discontinue irrigation and evaluate patient for possible systemic acidosis, intravascular hemolysis, and circulatory overload; institute appropriate therapy as needed.

Major Toxicities

Systemic Acidosis

Systemic acidosis reported; may occur following absorption of acetic acid via open lesions of the bladder mucosa. (See Appropriate Use of Acetic Acid 0.25% Solution for Irrigation under Cautions.)

If systemic acidosis occurs, discontinue irrigation, reevaluate patient, and institute appropriate therapy.

Pain

Pain reported; if this occurs, discontinue irrigation, reevaluate patient, and institute appropriate therapy.

Hematuria

Hematuria reported; if this occurs, discontinue irrigation, reevaluate patient, and institute appropriate therapy.

Specific Populations

Pregnancy

Category C.

Lactation

Caution advised if acetic acid 0.25% solution for irrigation is used.

Pediatric Use

Safety and efficacy not established in pediatric patients.

Geriatric Use

Insufficient experience in patients >65 years of age to determine whether geriatric patients respond differently than younger adults. Systemic absorption unlikely (unless open lesions of the bladder mucosa are present); however, increased sensitivity cannot be ruled out.

Common Adverse Effects

Systemic acidosis, pain/urologic pain, hematuria.

Pharmacokinetics

Absorption

Bioavailability

Systemic absorption unlikely unless open lesions of the bladder mucosa are present. (See Appropriate Use of Acetic Acid 0.25% Solution for Irrigation under Cautions.)

Stability

Storage

Bladder Irrigation

Solution for Irrigation

20–25°C (may be exposed briefly to temperatures up to 40°C). Avoid excessive heat; do not warm >66°C. Do not freeze.

Use immediately after opening; discard unused portion.

Actions

• Exerts antimicrobial action against a variety of microorganisms (especially ammonia-forming bacteria) that often gain access to the urinary bladder in patients requiring prolonged indwelling urethral catheterization. Antimicrobial activity depends on administration at sufficient rate (continuous or intermittent) to maintain effluent pH ≤5.
• Reduces formation of calcium encrustations in indwelling catheter by maintaining low urine pH.

Advice to Patients

• Importance of reporting any adverse effects (e.g., pain, hematuria) to a clinician.
• Importance of understanding that acetic acid solution is intended for urologic irrigation only.
• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.
• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
• Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

AHFS Drug Information. © Copyright, 1959-2009, Selected Revisions April 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.