Mitomycin Intravesical Therapy Standard operating procedure Michael e. debakey va medical center Houston, tx Alrabaa haman,RN,MSN,Nurse Manager Brittany swaney RN David Davila, LVN Dr. Jeffrey Jones, Chief of Urology

What is Mitomycin? Pharmacologic Category: Antineoplastic Agent Dosing 40mg is retained in the bladder for two hours;you must have the patient rotate every 15-30 minutes Done weekly for 6 weeks Warnings/Precautions Bladder fibrosis and contraction has been reported Side Effects Burning on urination, urinary frequency, cramping, pain, bleeding, contact dermatitis

Personal Protective Equipment Must wear double latex non-powdered gloves Worn no longer than 30 minutes Changed immediately if contaminated Disposable long sleeve gown must be worn Double gloves must be worn when handling emesis, urine, stool and contaminated linens of patients receiving antineoplastic drugs during treatment and the 48 hours post drug administration. All staff MUST wash their hands after completion of any procedures that involve antineoplastic drugs Patients receiving chemotherapy drugs should be given a gown/pajamas to change into prior to administration

Handling Mitomycin Chemotherapy medications will be labeled “chemotherapy” If the administrator of the chemotherapy drug is pregnant or planning to become pregnant, notify your supervisor Used syringes, needles, vials, bottles, gloves, gowns, etc. MUST be disposed of in a YELLOW sharps container and MUST be labeled “Chemotherapy Biohazard”. Used containers will be placed in the soiled utility room

Administering Mitomycin Prior to administration the chemotherapy must be verified by two RNs and documented (must ensure consent is signed and there is an order for the drug and administration as well) Patient must have UA done and reviewed prior to admin. Patients should have no signs of UTI prior to administration Have disposable Chux, gloves, gown, Foley, Kelly clamp, and proper disposal container Place Chux pad under the patient During Foley insertion it is important to gently insert the catheter to avoid urethral trauma to avoid complications Instill Mitomycin into the bladder via Foley catheter Have the patient move from side to side every 15-30 minutes for 2 hours (to distribute medication in bladder) Dispose of soiled equipment in Yellow Chemotherapy waste container

Patient Education Instruct the patient to wash genitalia area and hands with soap and water after each voiding Instruct the patient to double flush the toilet after each voiding If any urine spills clean thoroughly with a disinfectant Encourage patient to use one designated bathroom Patient should sit to urinate Patient should report immediately if they have any gross hematuria, dysuria, or contact dermatitis symptoms

Contamination In the Event of Contamination Remove gloves and gown, wash contaminated skin with soap and water. Notify supervisor, proceed to Employee Health. Eye Exposure: flood the effected eye at the eye wash station for a minimum of 15-30 minutes. During and following emergency treatment irrigation for 1-2 hours is beneficial. A chemotherapy spill kit must be on hand at all times during chemotherapy administration Report all spills and exposures to your supervisor and Facilities Management to initiate clean up actions. PPE must be worn when cleaning cytotoxic spills

Resources Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (2009) Fundamentals of Administration. Polovitch, M., White, J. & Kelleher, L. (Eds.) pp. 53-63 Oncology Nursing Society: Pittsburgh, Pa. Safe Handling of Hazardous Drugs (2003). Polovitch, M. (Ed). Oncology Nursing Society: Pittsburgh, Pa. A Chemotherapy Handbook: Clinical Guide to Antineoplastic Therapy (2007). Guallatte, M. (Ed), pp 31-46. Oncology Nursing Society: Pittsburg, Pa.