Episode 413: Intrarenal Administration for Upper Urothelial Tract Disease: The Oncology Nurse’s Role
Release Date: 05/01/2026
Episode 413: Intrarenal Administration for Upper Urothelial Tract Disease: The Oncology Nurse’s Role
The ONS Podcast
“We thought, from a nursing standpoint, ‘What is our goal for doing this?’ 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’ve been successful with that. And the third goal is to complete treatment without infection,” ONS member Chris Amoroso, BSN, RN, OCN®, registered nurse at Fox Chase Cancer Center in Philadelphia, PA, told Jaime...
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Episode 412: Pharmacology 101: Cytokines
The ONS Podcast
“They are small, powerful little nuggets. They are actually small signaling proteins that our immune cells use to communicate. They really help regulate immune activation or inflammation and even the growth and survival of immune cells. When cytokines are used therapeutically in oncology, they help to stimulate immune cells such as T cells or natural killer cells to better recognize and attack cancer cells,” Maribel Pereiras, PharmD, BCPS, BCOP, clinical pharmacy specialist at the John Theurer Cancer Center of Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN,...
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Episode 411: An Overview of Myelodysplastic Syndrome for Oncology Nurses
The ONS Podcast
“Not every patient with myelodysplastic syndrome (MDS) is going to progress and die. Only 10%–20% of them will evolve into acute myeloid leukemia. And not all of them need blood transfusions. Some present with low platelet count. It’s not just people who are anemic that have MDS—it’s different depending on what type of MDS they have. These are averages. We’re giving you statistics based on averages, and you’re an individual, so we want to treat you as an individual,” ONS member Sara Tinsley-Vance, PhD, APRN, AOCN®, nurse practitioner and quality-of-life researcher at Moffitt...
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Episode 410: The Evidence for the Environment’s Impact on Cancer Outcomes
The ONS Podcast
“Cancer and environmental disasters in particular, but the worsening of our environment, are really things that are great equalizers. And we recognize that we’re all kind of in this world together. We can really face these issues on a more human level. I think always recognizing that if we look at something, we think, ‘Well, that doesn’t relate to me or that problem is it really isn’t my problem’—it sure is,” ONS member Margaret “Peggy” Rosenzweig, PhD, CRNP-C, AOCNP®, FAAN, ONS scholar-in-residence and distinguished service professor of nursing and Nancy Glunt Hoffman...
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Episode 409: An Overview of Interventional Oncology for Nurses
The ONS Podcast
“Interventional oncology has really evolved into an important component of modern cancer care and is often described now as the fourth pillar alongside medical, surgical, and radiation oncology. The specialty now encompasses a broad spectrum of image-guided procedures that support from cancer diagnosis, treatment, to effectively managing symptoms that are caused by the disease. In other words, what we’re seeing is that across the continuum of care, IO is playing a vital role,” ONS member Evelyn P. Wempe, DNP, MBA, APRN, ACNP-BC, AOCNP®, CRN, NEA-BC, executive director for advanced...
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Episode 408: Radiation Site-Specific Side Effects: Breast Cancer
The ONS Podcast
“A side effect patients might experience is lymphedema. This is an increased buildup of lymphatic fluid in the tissues, either in the breast or in the arm and hand of the affected side. It’s quite problematic for women. They might feel self-conscious. It might feel uncomfortable that the arm feels like it’s throbbing or heavy. Clothing may not fit quite right. So we’re always on the lookout for lymphedema,” Maria Fenton-Kerimian, APRN, AOCNP®, nurse practitioner at Weill Cornell Medicine in New York, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice...
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Episode 407: Pharmacology 101: CAR T-Cell Immunotherapy
The ONS Podcast
“You want to try to act quickly and be able to know what the pathways are for appropriate escalating when a patient is having symptoms that are reflective of cytokine release syndrome (CRS) or neurotoxicity. These toxicities are very manageable and treatable when recognized early. To summarize, choosing the right patient, knowing the toxicity profile for each product, and acting early is really what helps to prevent severe outcomes with chimeric antigen receptor (CAR) T-cell therapy,” Maribel Pereiras, PharmD, BCPS, BCOP, clinical pharmacy specialist at the John Theurer Cancer Center at...
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Episode 406: Drug Resistance Biomarkers and Their Impact on Cancer Treatment Choices
The ONS Podcast
“Our goal of precision oncology has been to shift to tailored therapies that can help to improve treatment efficacy and ultimately improve patient outcomes. Resistance biomarker testing can help the care team to detect these genomic changes that the tumor may have acquired during therapy that makes the cells resistant to therapy. This information can be extremely helpful when we’re talking about making choices about second-line or subsequent-line therapy,” ONS member Danielle Fournier, DNP, APRN, AGPCNP-BC, AOCNP®, advanced practice RN at the University of Texas MD Anderson Cancer...
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Episode 405: Long-Term Multiple Myeloma Considerations for Oncology Nurses
The ONS Podcast
“The disease is increasingly managed as a chronic condition rather than a diagnosis with an immediate terminal outcome. Particularly, with earlier and more effective and sustained treatment options, we can make this disease a very chronic, long-term, livable condition. I want to make sure that patients are aware that this is not a death sentence. This is something that patients can live with for the long term,” Ann McNeill, RN, MSN, APN, nurse practitioner at the John Theurer Cancer Center at Jersey Shore University Medical Center in Neptune, NJ, told Lenise Taylor, MN, RN, AOCNS®,...
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Episode 404: Tailor Patient Treatment Education for Non-Oncology Indications
The ONS Podcast
“We print education sheets that we have, and we say, ‘Just ignore this part that says cancer. You’re getting this med but for a different indication.’ And then you have to really point out what our goals of care are. You’re using the information that, as oncology nurses, we like and love, but we’re having to cross it out and say, ‘Just read this portion and just do this here.’ And that can be challenging for the nurse and probably confusing for the patient,” ONS member Brandy Thornberry, RN, OCN®, outpatient infusion and VAD supervisor at Logan Health in Kalispell, MT,...
info_outline“We thought, from a nursing standpoint, ‘What is our goal for doing this?’ 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’ve been successful with that. And the third goal is to complete treatment without infection,” ONS member Chris Amoroso, BSN, RN, OCN®, registered nurse at Fox Chase Cancer Center in Philadelphia, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about intrarenal administration for upper urothelial tract disease.
Music Credit: “Fireflies and Stardust” 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’s 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
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Highlights From This Episode
“In an office setting, it’s 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—again, because it’s rare.” TS 2:33
“We 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’re ready to start, we’re cleaning the ends of the nephrostomy tube and the IV tubing with a chlorhexidine solution. We’re 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’re watching throughout the procedure to make sure that there’s 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, ‘I can feel something there,’ or we see leakage, we stop that infusion immediately, emphasizing that it has to be gravity, never on a pump.” TS 7:30
“We go over all the bacillus Calmette-Guérin (BCG) precautions because this is the drug that we’re giving. As if we were doing traditional intravesical therapy such as placing a catheter up into the bladder, we’re still giving patients BCG. So, we need them to follow the special precautions. We ask every patient, regardless of the drug we’re 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’re giving this for upper tract disease, it’s 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’s traditional intravesical or intrarenal.” TS 14:20
“The induction phase is the first six installations. So, the first time we give this drug, we’re doing it once a week for six weeks. And during those six weeks, we’re communicating with the patient. We’ll do a follow-up phone call and ask, ‘How are you feeling? Any issues?’ And we do get to know our patients really well. ... If they call, we’re going to send them for a urine culture and make sure there’s 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’ve done those six, we’ll wait about four to six weeks, and then we’ll do a cystoscopy and ureteroscopy in the operating room to make sure we have the response we’re looking for. Again, letting the patients know because sometimes they don’t understand that this is going to continue—it’s not six treatments and done.” TS 23:08
“You can’t think of this as the same as bladder cancer. This is in the upper tract. We can’t approach it as if it was non-muscular invasive bladder cancer. The diagnosis is different. It’s harder to diagnose. Again, we’re not visualizing the ureters in a routine office cystoscopy. ... You can’t resect it out. When I was talking to our surgeon, he said, ‘You can’t resect the urothelial disease in the ureters like you would in a bladder tumor.’ You can’t go and just pick it apart. It’s a little bit more complex than that. You can’t go in and resect out lesions in the ureter itself.” TS 36:20