Revised by: L. Person
Original Effective Date: 8/96
USC/Kenneth Norris Jr. Cancer Hospital
Division of Patient Care Services
Policies and Procedures
CHEMOTHERAPY RELATED PRACTICES
Last Revised/Reviewed
Date: 8/96, 1/97, 7/99, 5/00;
2/02; 5/02; 10/03, 1/05
DIVISIONAL MANUAL
3.19.11
Page 1 or 3
Reviewed by: J. Hibbs,
P. Newbon; A. Sy, R.
Poquette
Associate Administrator,
Patient Care Services:
Date:
SUBJECT:
Bladder Instillation: BCG, DMSO, or Chemotherapy Administration
PURPOSE:
To instill medications into the bladder for treatment of bladder cancer or interstitial cystitis.
POLICY:
1.0
Bladder instillation of any agents may be performed by a registered nurse or physician.
2.0
If chemotherapy is used during the instillation, the policies for chemotherapy administration and
handling will be followed.
2.1
The only exception to these policies is that the Urology Nurse Practitioner or Physician Assistant
may administer chemotherapeutic agents after demonstrating competence.
SUPPORTIVE DATA:
1.0
Bacillus Calmette-Guerin (BCG), is a inactive form of the tuberculosis bacteria that is used to treat
cancer of the bladder.
2.0
Dimethyl Sulfoxide (DMSO) is used for the symptomatic relief of interstitial cystitis.
3.0
Xylocaine jelly may be used to decrease discomfort and/or pain from the insertion of the catheter.
EQUIPMENT:
-16 fr. or 14 fr. Red Robinson catheter, Straight Cath Kit
-Sterile Gloves
-Xylocaine jelly
-Povidone-iodine swab stick-Medication as ordered from pharmacy
-Chemotherapy gown (if chemotherapy is to be instilled)
PROCEDURE:
1.0
Verify order for bladder instillation.
2.0
Gather equipment.
3.0
Complete double check of medication with chemotherapy qualified RN, pharmacist, physician, or
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Urology NP if chemotherapeutic agents are used.
4.0
Identify patient.
5.0
For Outpatient, escort patient to exam room and have them change into a gown.
6.0
Ensure patient understands procedure.
7.0
Set up equipment on sterile field. Don chemotherapy gown if administering chemotherapy.
8.0
Place patient in the appropriate position.
9.0
Don sterile gloves.
10.0
Cleanse urethra and insert catheter into bladder using sterile technique and drain the bladder.
11.0
Instill medication into the bladder via catheter.
12.0
11.1
If a foley catheter is in place, clamp for at least 1 hour, then unclamp and allow it to drain.
11.2.
If instilling DMSO, clamp the catheter for 20 minutes and then drain.
Instruct the patient to retain the medication for at least 1 hour if possible for chemotherapy.
12.1 For DMSO, instruct the patient to retain for 20 minutes.
13.0
Remove catheter after medication is instilled.
14.0
Utilize chemotherapy precautions, as appropriate, when handling urine.
15.0
Discard supplies in appropriate biohazard and/or chemotherapy waste hamper and chemotherapy
waste container.
OUTPATIENT
16.0
Discharge the patient home following the procedure. Assess patient prior to discharge regarding
and pain and/or discomfort following the procedure.
17.0
Instruct patient on signs and symptoms of adverse reaction and when to contact the clinic or
physician.
18.0
Enter the charges for the procedure and supplies used into the computerized system.
DOCUMENTATION:
1.0
In the Outpatient area on the Encounter Form document:
1.1
Pre- procedure assessment
1.2
Patient’s response to procedure preformed
1.3
Double checking of any chemotherapy agent
1.4
Medication administered
2.0
In the Inpatient area, on the Interdisciplinary Progress Note document:
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2.1
2.2
Pre-procedure assessment
Patient’s response to the treatment
3.0
On the Chemotherapy MAR document:
3.1
Agent, dose, route, time, double checking, name
4.0
On the Patient/Family Education Form, document:
4.1
Explanation of the procedure to the patient and or family
4.2
Level of understanding of the treatment and follow-up care including skin protection and
handling urine when discharged.
RELATED POLICIES AND PROCEDURES:
Division of Patient Care Services: Ambulatory Care Services Manual
Charge Input: Ambulatory Care
Documentation Instructions: Encounter Form
Division of Patient Care Services: Divisional Manual
Chemotherapy Administration
Chemotherapy Handling and Disposal
Patient Care Process Documentation
Patient Education
POLICY AND PROCEDURE DISTRIBUTION:
Division of Patient Care Services: Divisional Manual
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Vallidation of Intravesicular Chemotherapy Administration
Date
Verify order for bladder instillation, chemo agent.
Complete double check of medication with chemotherapy qualified RN,
Urology NP, or pharmacist
Set up equipment on sterile field. Don chemotherapy gown if splash is
anticipated.
Don sterile gloves. Cleanse urethra and insert catheter into bladder using
sterile technique and drain the bladder.
Instill medication into the bladder via catheter.
If a foley catheter is in place, clamp for at least 1 hour, Then
unclamp, and allow catheter to drain.
Remove catheter after medication is instilled and retained for the ordered
time. Instruct the patient to retain the medication for at least 1 hour if
possible for chemotherapy.
Utilize chemotherapy precautions, as appropriate, when handling urine.
Discard supplies in appropriate biohazard and/or chemotherapy waste
hamper and chemotherapy waste container.
Instruct nurses caring for patient who has received chemotherapy.
Documentation:
On the Patient/Family Education Form, document:
Explanation of the procedure to the patient and/or family
On the Interdisciplinary Progress Note document:
Pre-procedure assessment
Patient=s response to the treatment
On the Chemotherapy MAR document:
Agent, dose, route, double checked or family
Level of understanding of the treatment and follow-up care.
RN/NP __________________________________
Validator: ________________________________
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