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Intravesicular Chemotherapy Administration in Urology Clinic

  • 1.  Intravesicular Chemotherapy Administration in Urology Clinic

    Posted 01-13-2020 18:48
    Our management is trying to force the Chemotherapy Nurses in the Cancer Center Infusion Clinic to cross-train in the Urology Clinic to give intravesicular (bladder instillation) chemotherapy.  Management requires nurses to work alone in the Urology clinic giving chemotherapy to Male patients on a distant ward without the support of another chemotherapy nurse except to deliver and verify the chemotherapy dose, patient, and consent.  In the Infusion Clinic, we are required to have 2 chemotherapy nurses present at all times when a patient is being treated.  What are the policies and standard of care practices in other clinics?


  • 2.  RE: Intravesicular Chemotherapy Administration in Urology Clinic

    Posted 01-14-2020 06:41
    Hi Donna,
    Interesting timing.  With the BCG shortage, our clinic is being asked to instill gemcitabine for a sub group of patients.  We have drafted policy around this using the ONS safe
    hadling guidlines & the guidlines from the American Urological Association.  The policy is not complete yet.  I can send it to you when it is finished.  In the meantime check out this document for some guidance:
    American Urological Association. (2019). Intravesical Administration of Therapeutic Medication. Retrieved from: https://www.auanet.org/guidelines/intravesical-administration-of-therapeutic-medications

    tina

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    Christina Klein MSN, RN, OCN, CRNI
    Oncology Educator
    Cancer Treatment Centers of America
    Philadelphia PA
    215-537-5586
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  • 3.  RE: Intravesicular Chemotherapy Administration in Urology Clinic

    Posted 01-14-2020 10:12
    We have  similar situation that we would like to add to this thread for discussion:

    In the past BCG was administered in MD office by non-chemo/biotherapy certified RNs. Does your practice require administering RNs to have ONS chemo/bio card?  What is ONS position/standard on this practice?

    What is best practice: Intravesical chemo/bio administration via Foley catheter to ensure closed system and decrease chance of exposure or straight catheterization and having patient hold medication and void?


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    Cathy Ollom RN, MSN, AOCNS
    Miami Cancer Institute
    Miami, FL
    Work 786-527-7649
    Personal 931-358-9516
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  • 4.  RE: Intravesicular Chemotherapy Administration in Urology Clinic

    Posted 01-14-2020 18:26
    Yes, intravesical chemotherapy requires chemo certified RN to administer; however, several of my colleagues, including myself,, have serious safety concerns in being required to perform the procedures alone in a remote clinic.

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    Donna McCallie RN MSN
    Regisrered Nurse (Infusion/ONC)
    West Palm Beach VA Medical Ctr
    Lake Park FL
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  • 5.  RE: Intravesicular Chemotherapy Administration in Urology Clinic

    Posted 01-15-2020 21:48
    At my hospital, the physician or a chemo competent nurse instills the chemo through a Foley. Then the regular staff removes the Foley after hours are complete and discharges patients.  We have to be checked off to do this and we have special instructions for the chemo and for discharge.

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    Cara Funderburk BSN RN
    Nurse Navigator
    Piedmont Medical Center
    York SC
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  • 6.  RE: Intravesicular Chemotherapy Administration in Urology Clinic

    Posted 01-16-2020 01:17
    Hello,
    Our infusion nurses who are chemotherapy certified started giving intravesical BCG, and mitomycin via a Foley catheter approximately 7 years ago. Two of our nurses did the research on the procedure and wrote a P&P on intravesical instillation using ONS guidelines and the American Urological standards of practice.  We worked in collaboration with our local urologists for training and to review the P&P.  We have recently revised our policy and procedure to reflect current evidence.  For example, we no longer turn the patient side to side and supine and prone as there was not insufficient evidence to support that practice.  Each of our nurses are competent in inserting coude catheters as well and have a competency in their employee file.  We tend to use coude catheter primarily as we do most of these procedures on men who have prostatic
    enlargement issues.  We have 8 chairs and one private room with a gurney bed.  We give the BCG or mitomycin in that room.

    I am wondering if those patients in the urology clinic could not come to your infusion clinic and be admitted for that procedure there?  I am not sure of your logistics, but just as a suggestion.  That way you'd have the team to support you. I don't feel the nurse should be doing that alone without a second chemo nurse verifier and without support of a competent staff.

    Shari

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    Shari Kellen
    RN OCN ONN-MSN-CNL student
    Infusion Charge Nurse
    Fremont, CA 94536

    Shari.kellen@yahoo.com
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  • 7.  RE: Intravesicular Chemotherapy Administration in Urology Clinic

    Posted 01-17-2020 09:16
    ​Hello,

    I'm not really sure what the question is. I work in an out-patient oncology clinic and we do not need to admit patients for this process. We have 2 private rooms with beds. We always have at least 2 chemotherapy competent nurses (provider card and or ONC) to verify and assist in the instillation with appropriate PPE. You can double verify with the Doctor, pharmacist or nurse practitioner. Thank you for the current information on turning the patient I will research that for our current practice.  I'm curious if you use a closed system transfer device and who makes or mixes your chemotherapy? We do accept outside physicians orders for  bladder instillation but that is totally up to the ordering Urologist or the patient preference. Maybe your patients are not aware that they can have this drug and instillation at an infusion center. I hope this is helpful.

    Trish Barrowcliff RN, BSN, OCN, CMSRN
    Staff RN, Charach Cancer treatment Center
    Commerce, Mi 48382
    pbarrowc@dmc.org

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    Patricia Barrowcliff RN, BSN, OCN
    Charach Cancer Treatment Center
    PNC Committee
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