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Pre‐procedural considerations

Specific patient preparations

Instillation first involves the insertion of a urinary catheter, drainage of the bladder, then the instillation of the drug. This usually takes about 50–60 minutes. The drug is retained for 1–2 hours with frequent movement by the patient to disperse it through the bladder (Sewell et al. [230], Wilkes [268]). Therapy may be repeated on alternating days for three doses or weekly for varying lengths of time (4–12 weeks).
Table 23.7  Prevention and resolution (Procedure guideline 23.10)
ProblemCausePreventionAction
No drainage of urine when the catheter is inserted.Bladder is empty or the catheter is in the wrong place, for example in the urethra or in a false track. False tracks may develop after repeated cystoscopy or bladder surgery.Ensure experienced nurses catheterize the patient and check notes for any previous difficulties with insertion or false tracks.Do not inflate the balloon but tape the catheter to the skin to keep it in position. Check when the patient last micturated. Encourage the patient to drink a few glasses of fluid. Do not give the drug until urine flow is seen or correct positioning of the catheter is established. Inform a doctor if no urine has drained during the next 30 minutes.
No drainage of urine when catheter unclamped.Blocked with clots or debris.May not be possible to prevent.Check the position of the catheter and perform bladder lavage if necessary.
Patient has pain during instillation of the drug or while the drug is in the bladder.Following resection of mucosa, the bladder can become acutely sensitive to irritants, thus causing painful spasm, resulting in possible expulsion of the cytotoxic agent.Administer analgesics pre procedure. Help to keep the patient as calm and comfortable as possible.Allow the drug to drain out and/or stop instillation if the pain is severe. Inform a doctor. Administer Entonox if appropriate (see Chapter c22) and have analgesics prescribed for subsequent administration.
Patient is unable to retain the requisite drug volume in the bladder for the time required.Low bladder capacity; weak sphincter muscles or unstable detrusor muscle causing uncontrolled bladder contractions.May not be able to prevent.The nurse should record the actual duration of the drug in the bladder and inform a doctor if the patient is unable to retain the drug in the bladder.
Patient is unable to pass urine following removal of catheter.Anxiety; poor bladder tone or prostatism.Reassure patient and encourage fluids prior to removal.The nurse should provide comfort and reassurance to the patient and encourage the patient to drink fluids.
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