High Dose Chemotherapy & Hemorrhagic Cystitis

[SteffersRN87, BSN, RN]

Hello all!

I am required to do a nursing research / evidence-based practice project specific to my specialty area to be able to advance in my hospital's clinical ladder program. I currently work outpatient oncology & BMT. We do a lot with the BMT process, including chemo mobilization. Currently, our standard orders to prevent hemorrhagic cystitis for high dose Cytoxan is continuous bladder irrigation for 24 hours and for Ifosfamide it is Mesna. I know that Mesna is indicated for both drugs. I was wondering if some of you could relay your current practice standards for prevention of hemorrhagic cystitis. Does anyone know of any reasons why CBI may be consistently used with Cytoxan? I am trying to get to the point of preventing infection (UTI) in an already vulnerable neutropenic population.

Thank you!

Stephanie

[blondy2061h, MSN, RN]

For high dose cytoxan we give high dose IV fluids (often 500ml/hr, and I've seen up to 1L/hr) with ATC Lasix. Patients hate it, but I would find it preferable to CBI.

[silveryscrape]

We also do aggressive hydration with lasix, seems to work very well. I have worked on a unit that required foley insertion for the infusion/post infusion period ~48 hrs or so, but we didn't do CBI - the rationale was to make sure of output even overnight, which lasix will manage. I have heard, for what it's worth, that CBI in the absence of active bleeding can be very irritating to the bladder - never saw the research on that one, but there you go.

[DavidFR, BSN, MSN, RN]

IV Mesna plus hyper-hydration (one litre over 3 hours repeatedly). IV Lasix if necessary (low urine output and/or weight gain, provided systoilc BP 100 or over)

[luvbug9956]

I agree with the above posters. We did not institute CBI unless our patients showed initial signs of hemorrhagic cystitis (first sign of blood in the urine). I would think that infection rates would increase drastically with prophylactic CBI...

[TiffanyRN!!]

Hi my daughter is getting ready to have a BMT in 2 wks but she is gonna have low dose chemo because she has Fanconi Anemia and its a special protocol with them because they r sensitive to it. But I was told by the Dr. that she will be on Mesna and Iv fluids afterward to help with the hematuria and flush the kidney also some kind of diuretic because the B/P may rise and G-csf to help increase WBC's to help prevent infection.

[ohiomom]

We don't use cbi for prevention. We too use high rate fluids and mesna.

We do have patients who get HC. Most are easily treated with cipro, since the cystitis is secondary to BK virus. Occasionally we get someone who needs cbi...