Download Instillagel

Instillagel®
Staff Characteristics
Clinical Details
Registered Midwife
Clinical Situation for which
medicine is to be used
Surface anaesthesia, lubrication and antisepsis for catheterisation.
Clinical Criteria for inclusion
Women ≥ 16 years requiring catheterisation.
Clinical Criteria for exclusion
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Management of excluded women
and those not wishing to receive
care
Use in pregnancy or lactation
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Known hypersensitivity to any component of the medicine.
Individuals < 16 years of age.
Instillagel® is contraindicated in women with known or
suspected hypersensitivity to local anaesthetics of the amide
type, to chlorhexidine or to any ingredient in the formulation.
The woman is suffering from a urine infection.
The woman has damaged or bleeding mucous membranes.
The woman has heart, liver or kidney problems, or malignant
hyperthermia (a hereditary condition).
The woman suffers from epilepsy.
Refer to medical staff as appropriate.
Document action / refusal in woman’s maternity
handheldrecord.
Pregnancy – During the first 3 months of pregnancy, lidocaine should
be used only if absolutely necessary.
Lactation – can be used during breastfeeding.
Cautions and/or reasons for
seeking further advice from a
doctor
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Woman fits exclusion criteria.
Woman suffers an adverse drug reaction.
Chronic dosing is required.
Woman declines medication.
Cautions and action that will be
taken if a caution applies
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Check for and document any allergies.
Check and document past medical and drug history and current
medication to ascertain potential for overdose.
If a caution applies consult with a doctor.
Document consultation in woman’s maternity handheld record.
Refer to current BNF for latest information on interactions.
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Description of Treatment
Name / Form / Strength of
Medicine
Instillagel® / Gel /
lidocaine hydrochloride 2%&chlorhexidinegluconate 0.05%
Dosage
Fill the urethra with 6mls of Instillagel® using the needle-less,
pre-filled syringe.
Route of administration
Intraurethrally
Frequency of administration
Once only prior to catheterisation
Duration of treatment
n/a
Legal Status
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P –midwife may supply.
Storage requirements
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Store the unopened blister packs below 25°C.
Warnings
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Lidocaine should be used with caution in women receiving
antiarrhythmic drugs.
Follow –up
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Refer if woman develops side/adverse effects or if there is an
inadequate response.
Refer immediately in case of overdose.
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Undesirable effects
Some women may experience a slight stinging after the gel is inserted.
In spite of the proven wide safety range of Instillagel®, undesirable
effects of the localanaesthetic Iidocaine are possible where there is
severe injury to the mucosa and absorption may occur. Examples are
anaphylaxis, fall in blood pressure, bradycardia or convulsions.
• If a serious adverse reaction is suspected please report to the
MHRA Yellow Card Scheme http://yellowcard.mhra.gov.uk/
Overdose
Signs include drowsiness, numbness of the tongue, light-headedness,
ringing in ears, blurred vision, vomiting, dizziness, unusually slow
heartbeat, fainting, nervousness, unusual sweating, trembling and/or
seizures.
• Immediate assessment / treatment is essential – refer to
medical staff.
• Manage in accordance with established treatment guidelines or
see BNF overdose section.
• For further advice contact National Poisons Centres
0844 892 0111.
Advice to be given to the woman
Monitoring arrangements during
and after treatment and follow-up
required.
Records to be kept
References
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Explain treatment and course of action.
Side effects explained.
Verbal consent obtained before administration.
It is good practice to offer the woman the manufacturer’s
Patient Information Leaflet to support any verbal advice
provided.
If the woman suffers a serious adverse drug reaction, seek
immediate medical assistance.
• Monitor for side effects and effectiveness.
• To be reviewed by doctor if inadequate response.
Must be written in the once only medicines and pre-medications
section of the medicine kardex. The person who writes up the
medication must write their designation after their signature e.g.
Midwife Band (*). Also record the administration, date, time and name
of practitioner in the relevant section of the woman’s maternity
handheld record.
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Instillagel SPC 28th February 2010www.clinimed.co.uk
www.instillagel.ca accessed 10th September 2014.