{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Episode 413: Intrarenal Administration for Upper Urothelial Tract Disease: The Oncology Nurse\u2019s Role","description":"\u201cWe thought, from a nursing standpoint, \u2018What is our goal for doing this?\u2019 What we wanted was first, education of the patient. Can we successfully educate the patient to prepare them? Can we alleviate as much anxiety as possible so that they feel comfortable coming in and having this done? The second goal is to preserve kidney function throughout the treatment. To date, we\u2019ve been successful with that. And the third goal is to complete treatment without infection,\u201d ONS member Chris Amoroso, BSN, RN, OCN\u00ae, registered nurse at Fox Chase Cancer Center in Philadelphia, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS\u00ae, manager of oncology nursing practice at ONS, during a conversation about intrarenal administration for upper urothelial tract disease. Music Credit: \u201cFireflies and Stardust\u201d by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by May 1, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center\u2019s Commission on Accreditation. Learning outcome: Nurses caring for people with cancer require knowledge of the different routes for drug administration, including intrarenal administration via a percutaneous nephrostomy. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast\u2122 episodes: Episode 141: Care Coordination for Urothelial Cancer Episode 133: Treatment Advancements for Advanced or Metastatic Urothelial Cancer ONS Voice articles: A Primer on Urothelial Cancer Chemo Combo May Be a Bladder Cancer Treatment Alternative During BCG Shortage Nurses Are Key to Patients Navigating Genitourinary Cancers Clinical Journal of Oncology Nursing articles: Avelumab First-Line Maintenance Therapy: Managing Patients With Advanced Urothelial Carcinoma Percutaneous Nephrostomy Infusion: Nursing Considerations for Treatment of Upper Urinary Tract Urothelial Carcinoma ONS Learning Libraries: Cancer of the Genitourinary Tract Safe Handling of Hazardous Drugs To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode \u201cIn an office setting, it\u2019s not something we can really visualize. Patients will present with hematuria or flank pain, obstructions in the ureter, some hydronephrosis, they may be having a lot of urinary tract infections. And a routine cystoscopy in the office is not going to visualize the ureters. We can do biopsies like a ureteroscopy, a computerized tomography urogram, or a urine cytology. And those are usually the main ways of diagnosing upper tract disease\u2014again, because it\u2019s rare.\u201d TS 2:33 \u201cWe ask patients to get into a comfortable position where they can sit or lay for an hour without too much movement. The movement of their body position can interfere with the flow of the medication going in. ... When we\u2019re ready to start, we\u2019re cleaning the ends of the nephrostomy tube and the IV tubing with a chlorhexidine solution. We\u2019re instilling this using micro drip tubing. The tubing has to be microchipped so we can accurately control the flow. The IV bag with medication is hung about 10 inches above kidney level. And the reason we do that is because we do not want to increase the intrarenal pressure. ... We want a slow infusion via gravity over about an hour. We\u2019re watching throughout the procedure to make sure that there\u2019s no leakage, no discomfort, really just watching the patient and having that communication with the patient. Are they feeling anything different? Do we notice a difference in the flow rate? Is it slowing down? And if so, why is it? Did the patient change position? If we have any [instance] where the patient says, \u2018I can feel something there,\u2019 or we see leakage, we stop that infusion immediately, emphasizing that it has to be gravity, never on a pump.\u201d TS 7:30 \u201cWe go over all the bacillus Calmette-Gu\u00e9rin (BCG) precautions because this is the drug that we\u2019re giving. As if we were doing traditional intravesical therapy such as placing a catheter up into the bladder, we\u2019re still giving patients BCG. So, we need them to follow the special precautions. We ask every patient, regardless of the drug we\u2019re giving them, to sit down to urinate, pour two cups of bleach in the toilet, let it sit for about 15 minutes, then close the lid and flush twice. Even though we\u2019re giving this for upper tract disease, it\u2019s still being excreted into the urine. So, precautions need to be followed. Sitting down to urinate to avoid splashing of the drug, putting the two cups of bleach in every time they urinate for a duration of six hours, closing the lid, and then flushing that toilet twice. The same precautions, whether it\u2019s traditional intravesical or intrarenal.\u201d TS 14:20 \u201cThe induction phase is the first six installations. So, the first time we give this drug, we\u2019re doing it once a week for six weeks. And during those six weeks, we\u2019re communicating with the patient. We\u2019ll do a follow-up phone call and ask, \u2018How are you feeling? Any issues?\u2019 And we do get to know our patients really well. ... If they call, we\u2019re going to send them for a urine culture and make sure there\u2019s nothing there. ... After those six weeks, we make sure the patient understands that this is not one course and done. We want to continue to do this to give them the best chance at preventing recurrence. After we\u2019ve done those six, we\u2019ll wait about four to six weeks, and then we\u2019ll do a cystoscopy and ureteroscopy in the operating room to make sure we have the response we\u2019re looking for. Again, letting the patients know because sometimes they don\u2019t understand that this is going to continue\u2014it\u2019s not six treatments and done.\u201d TS 23:08 \u201cYou can\u2019t think of this as the same as bladder cancer. This is in the upper tract. We can\u2019t approach it as if it was non-muscular invasive bladder cancer. The diagnosis is different. It\u2019s harder to diagnose. Again, we\u2019re not visualizing the ureters in a routine office cystoscopy.  ... You can\u2019t resect it out. When I was talking to our surgeon, he said, \u2018You can\u2019t resect the urothelial disease in the ureters like you would in a bladder tumor.\u2019 You can\u2019t go and just pick it apart. It\u2019s a little bit more complex than that. You can\u2019t go in and resect out lesions in the ureter itself.\u201d TS 36:20 ","author_name":"The ONS Podcast","author_url":"http:\/\/onsvoice.libsyn.com\/website","html":"