Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient.
   To ensure that the patient understands the procedure and gives their valid consent (NMC [178], C).
2. 2.Show
   Check the patient's full blood count, as instructed by the medical staff, and inform them of any deficit before administration.
   Absorption of the drug through the bladder wall may cause some myelosuppression. However, there are differing opinions as to whether regular checks are necessary. E
3. 3.Show
   Check all the details on the container of cytotoxic drug against the patient's prescription chart.
   To minimize the risk of error and comply with legal requirements (NMC [177], C).
4. 4.Show
   Assemble all necessary equipment, including the cytotoxic drug container, and proceed to the patient.
   To ensure that the instillation proceeds smoothly and without interruption. E
5. 5.Show
   Screen the patient's bed/couch.
   To ensure privacy during the procedure. E
6. 6.Show
   Check that the patient's identity matches the patient's details on the prescription chart.
   To ensure that the correct patient has been identified.

   To reduce the risk of error (NMC [177], C).

Procedure

1. 7.Show
   If the patient does not have a catheter in situ, then pass a catheter (see Chapter c06: Elimination).
   To enable the medication to be administered. E
2. 8.Show
   Ensure the bladder is empty of urine.
   To prevent dilution of the drug. (Washburn [264], E).
3. 9.Show
   Put on gloves, apron and eye protection.
   To protect the nurse from contact with the cytotoxic drugs. With correct technique, the risk of contamination is minimal but splashes can occur (Wilkes [268], E).
4. 10.Show
   Using aseptic technique and sterile gloves, place a receiver under the end of the catheter to catch any urine and disconnect the drainage bag.
   To protect the patient from infection. To protect the nurse from drug spillage. To gain access to the catheter. To prevent urine from soiling the bed. E
5. 11.Show
   Remove the cover from the urotainer, connect to the catheter and release the clamp on the urotainer.
   To facilitate drug instillation. E
6. 12.Show
   Using gravity to create pressure, instil the cytotoxic drug into the bladder. Gentle squeezing may be needed to assist this process.
   Rapid instillation would be uncomfortable for the patient, especially if the bladder is small or scarred from previous treatment or disease. E
7. 13.Show
   When the correct prescribed volume has been instilled, slide urotainer clamp over filling port.
   To prevent drainage of drug from the bladder (Weinstein and Hagle [265], E).
8. 14.Show
   When the drug has been in the bladder for 1 hour, ask the patient to micturate or slide clamp across filling port and place receiver under connectors. Disconnect urotainer and connect new drainage bag.
   One hour is the usual time specified for intravesical drugs to ensure the maximum therapeutic effect with minimum toxicity. To prevent contamination of bedlinen (Nixon and Schulmeister [176]). E

Post‐procedure

1. 15.Show
   If the catheter is to be removed, withdraw the water from the catheter balloon (if appropriate – some catheters do not have a balloon) using the sterile syringe and remove the catheter using gentle traction. Dispose of equipment into clinical waste bag and seal.
   The catheter may not be required for continued urinary drainage, and may have been inserted to facilitate drug administration, particularly in the outpatient department. The risk of infection is greater if the catheter remains in situ (Weinstein and Hagle [265], E).
2. 16.Show
   The patient should be made aware that their urine may be cloudy. Instruct the patient to report any discomfort or inability to pass urine immediately to ward staff or general practitioner/district nurse, or to telephone the hospital if anxious.
   To detect and resolve any problems at the earliest moment. To reduce anxiety experienced by the patient. E
3. 17.Show
   Record the administration of the medication in the patient's records.
   To ensure that medication and interventions are recorded (NMC [177], E).