Managing Hemorrhagic Cystitis in BMT Patients Using Continuous Bladder Irrigation

­Background: Hemorrhagic cystitis is a complication that may arise following Stem Cell Transplantation (SCT) as a result of bladder inflammation, injury, and clot formation that may progress to renal failure. It occurs in approximately 30 percent of SCT patients as a result of the toxic effects of antineoplastic alkalinic agents including Cyclophosphamide, Ifosphamide, Busulfan, immunosuppressant therapy, radiation therapy, graft versus host disease (GVHD), and viral, bacterial, and fungal infections. The treatment of choice for hemorrhagic cystitis is continuous bladder irrigation (CBI) to instill solutions and medications directly into the bladder. Nursing interventions during CBI require extensive knowledge about the disease and multiple conditions that cause bladder hemorrhage. Currently, there is no formal training program about CBI for nurses on the SCT unit; nursing staff obtain bladder irrigation information from guidelines available from the institutional intranet website and from peers.

Purpose: The purpose of this project is to prepare new nurses in the SCT unit to provide evidence-based care for patients experiencing CBI treatment, to educate them on the etiology of hemorrhagic cystitis treatments used to aid in the healing of the bladder, and to prevent or intervene when complications arise. Recently, a need for education was identified due to a surge of new nursing staff hired to the SCT unit.

Intervention: The clinical educator developed an educational program consisting of four modules about managing patients with hemorrhagic cystitis with CBI for nurses in the SCT unit. Malcolm Knowles’ theory of andragogy was used to guide the program as it considers needs educators must address when teaching an adult audience.

Results/Evaluation: A post-test was administered at the end of the CBI educational program to evaluate knowledge improvement and program evaluation. The CBI educational program will also be included as part of the annual SCT staff competency and added to orientation program for the new SCT nurse.

Discussion: Nurses in SCT units need to be vigilant for complications such as hemorrhagic cystitis.  Development of such educational programs improves nursing knowledge and strengthens clinical practice in an area that requires expert nursing care to support positive patient outcomes.