Re: pain management on the insertion of the catheter
Hi Jnani
To manage the pain on the insertion of the catheter, I have noticed most patients are administered local anesthetic Lidocaine first.
It depends upon the hospital if Lidocaine is used as default or use it for only those patients with pain.
Regarding the use of Lidocaine and lubricant's, Society of Immunotherapy and Cancer dose not recommend the use of Lidocaine or use of excessive lubricants because the use of lidocaine or excessive lubricants during catheterization has been shown to have inhibitory effects on BCG viability Also, with the use of local anesthetic, patients may not be able to feel/report a potentially traumatic catheterization. I
Also, it seems that the experience of the nurse in administering makes difference. Some patients request smaller catheter to reduce the pain. Usually, the standard size of a catheter is 14F and some patient used 10F.
1. Ask for a nurse who had many years of experience in administering intravesical BCG.
2. See if they can use a catheter smaller in its diameter than 14F which is the standard catheter.
3 . If it still hurts and tropical anesthetic is to be used i.e. Lidocaine or lubricant, try not use too much as it will reduce BCG effectiveness.
Incidentally, there are many important tips for BCG treatment are mentioned in the consensus report. For example, the report says it does not require to rotate every 15 minutes, and oral quinolones ( nor prior to BCG and not within 6 hours after BCG instilment) is recommended to reduce the side effects.
jitc.biomedcentral.com/articles/10.1186/s40425-017-0271-0
best
