1. 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

2. What is Mitomycin? Pharmacologic Category: Antineoplastic Agent Dosing
40mg is retained in the bladder for two hours;you must have the patient rotate every 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

3. 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

4. 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

5. 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 minutes for 2 hours (to distribute medication in bladder)
Dispose of soiled equipment in Yellow Chemotherapy waste container

6. 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

7. 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 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

8. 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 Oncology Nursing Society: Pittsburg, Pa.