ST. TAMMANY PARISH HOSPITAL
COVINGTON, LOUISIANA
DEPARTMENT OF NURSING
ADOPTED DATE:
April, 1994
REVIEW/REVISE DATE: 6/96; 8/99; 10/01;
10/04; 9/05; 7/08
____________________________________
DIRECTOR OF NURSING
TITLE:
INTRAVESICULAR ADMINISTRATION OF TICE BCG VACCINE FOR CARCINOMA
IN SITU OF THE BLADDER
PROCEDURE
CRITERIA FOR PERFORMANCE:
A qualified physician or a RN with knowledge of immunologic agents may administer live BCG vaccine intravesically. A
written informed consent must be obtained prior to initial administration of BCG vaccine.
OBJECTIVE:
To administer intravesicular TICE BCG vaccine in a safe appropriate manner
INDICATIONS FOR TREATMENT:
Treatment and prophylaxis of carcinoma in situ of the bladder and for prophylaxis of primary of primary or recurrent stage Ta
and/or T1 papillary tumors after TURP. Not indicated for papillary tumors of stages higher than T1.
CONTRAINDICATIONS:
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Immunosuppressed patients or persons with congenital or acquired immune deficiencies, whether due to
concurrent disease (e.g., AIDS, leukemia, lymphoma) cancer therapy (e.g., cytotoxic drugs, radiation) or
immunosuppressive therapy (e.g., corticosteroids).
Treatment should be postponed until resolution of a concurrent febrile illness, urinary tract infection, or gross
hematuria.
Persons with active tuberculosis. Rule out in individuals who are PPD positive before starting treatment.
Concurrent treatment with antibiotics, since antimicrobial therapy may interfere with effectiveness; concurrent
infections.
EQUIPMENT/SUPPLIES:
Short term catheter tray with #16 French red rubber catheter
Chemotherapy Waste Disposal Can
Chemotherapy protective gown, gloves, and mat
2 – Eye shields, for the nurse administering and for the patient
2 – Masks for the nurse administering and for the patient
Absorbent blue pads
BCG Vaccine reconstituted from Pharmacy in Biohazard Disposal Bag
50cc sterile, preservative-free Saline
60cc catheter tip syringe
2 cups of Bleach
PROCEDURE:
NURSING ACTION
1. Wash hands
2. Place patient in private room with no other patients. Get
baseline set of vital signs. Assess for the
presence/absence of fever or urinary tract infections.
3. Verify results of urinalysis done pre-treatment. Call
results to physician treating patients.
4. Have the patient urinate before treatment begins if
possible
5. Place blue pad under patient on the bed to decrease
the chance of linen contamination
6. Have patient lie supine in bed. Using sterile catheterization procedures, drape and catheterize the patient with a
short term catheterization tray and a #16 French red
rubber catheter.
7. Empty the bladder of any residual urine.
8. Don chemotherapy administration protective
gown and gloves. In addition, don a face mask and eye
shield. Have Chemotherapy Waste Disposal Can in room.
9. The patient should don a mask and eye shield during
the instillation of solution and then they may be removed.
1. To decrease unwanted exposure of other patients,
including chemotherapy patients.
3. Patient should not receive BCG if symptoms of UTI,
elevated WBC, or blood in urine are evident since it can
promote a systemic BCG infection.
6. Every effort should be made to make the catheterization non-traumataic.
7. To enable the patient to hold the bladder instillation the
required 1 – 2 hours.
8. To decrease possibility of exposure to live BCG
Vaccine during instillation. Gown, gloves, and mask may
be removed after administration, but should be used in
cleaning up after procedure also.
9. To decrease possibility of exposure to live BCG
Vaccine.
10. Draw up 40cc of preservative-free Normal Saline into
a 60cc catheter tip syringe. Using chemotherapy
absorbent mat, dispense the cloudy BCG suspension into
the end of the catheter tip syringe containing 40cc of
preservative-free Normal Saline
11. Place empty BCG syringe in Chemotherapy Waste
Can and close lid.
12. Attach the 60cc syringe to the catheter and gently
remove the plunger.
13. The reconstituted TICE BCG should be allowed to
enter the bladder by gravity flow over 3 – 4 minutes.
14. Once the instillation is completed, withdraw the
catheter into an absorbent blue bad to catch any droplets
that may exit the catheter tip.
15. The patient should lay prone for 15 minutes, supine
for 15 minutes, right lateral position for 15 minutes, then
left lateral position for 15 minutes for the first hour. The
patient should hold the solution in the bladder for at least 1
hour, preferably up to 2 hours.
16. The nurse should stay with the patient the first 15
minutes, then check on the patient every 15 minutes x 3 to
remind the patient to turn, then check every ½ hour x 2.
17. At the completion of the instillation, the patient should
be instructed to void in a sitting position in a commode
where 2 cups of bleach has been added before voiding.
The toilet should not be flushed for 15 minutes.
10. Gently swirl the syringe to mix after adding TICE BCG
Vaccine. The reconstituted TICE BCG must be used
immediately.
18. All chemotherapy equipment and blue pads should be
placed in the Chemotherapy Disposal Can. Housekeeping
should be called to remove the hazardous waste disposal.
19. Linen and gowns may be handled in routine fashion.
The room and bathroom are cleaned with disinfectant in
the routine fashion.
18. Containers should not be reused for other
chemotherapeutic waste. Goggles may be cleaned with
70% Isopropyl Alcohol solution using a disposal towel.
11. Decrease possibility of room contamination.
12. DO NOT DEPRESS THE PLUNGER AND FORCE
THE FLOW TO THE TICE BCG.
14. Discard immediately into the Chemotherapy Disposal
Can and snap lid.
15. Turning ensures that all bladder surfaces are coated
with the solution. The solution should be held for up to 2
hours to maximize bladder wall contact and drainage
effectiveness.
16. To monitor for possible local or systemic reactions.
17. Bleach kills the TICE BCG live vaccine. Allowing the
bleach to sit for 15 minutes allows time for the live virus to
die. Adding bleach BEFORE the patient voids minimizes
contaminated urine splashing on or outside the commode.
20. The patient should be instructed to:
a. Use 2 cups of bleach in the commode with each
voiding for 6 hours after completion of
treatment. Wait 15 minutes after voiding before
flushing. Wash hands well after each voiding.
a. Force fluids for 3-4 days after treatment (8-12
glasses of fluid/day) to flush out bladder.
b. Burning and frequent urination for the first day
or two after instillation is normal. Slight flu-like
symptoms are also possible.
d. If the patient experiences severe urinary side
effects – blood in the urine, a fever of 103
degrees or greater and/or flu-like symptoms
that last more than 48 hours – the patient
should contact the treating urologist
immediately.
21. Discharge vital signs, tolerance of treatment, and
patient understanding of discharge instructions should be
recorded.
20. Most reactions that are seen with BCG Vaccine are
local versus systemic and results from irritation to the
bladder wall. Forcing fluids will keep the patient voiding
frequently, decreasing the chance of bladder irritation,
bleeding, or urinary tract infections. The patient should
understand that if any symptoms of UTI persist or become
worse or if flu-like symptoms are present, the physician
needs to be notified at once.
Provide patient Micromedex patient information on
medication before discharge.
RELATED STANDARDS:
Foley Catherization Procedure
Chemotherapy Safety Management Protocol
REFERENCES:
Manufacturer’s Drug Insert – TICE BCG Vaccine, Organon Teknika Corporation, Dec. 2006.
Drug Information: Bacillus Calmette-Guerin (BCG) vaccine. Medline Plus website: www.nlm.nih.gov/medlineplus
DISTRIBUTION:
Infusion Suite; Medical Oncology Unit
K:\Oncology\CHEMO Protocols\procedures\tice bcg adm procedure.doc