Instill Question: Solu-cortef instill issue

[ermkenne]

Okay, I am trying a new instillation. It is Solu-cortef, 3 cc sodium bicarb, 25 cc marcaine, and 20,000 units of heparin. The solution is really cloudy, and a precipitate is forming (a solid). I don't know why this is not mixing, and has anyone had any issues, or any suggestions. Do I just instill it or could I add a little sterile water in order to get it to go into solution?

I called an on-call nurse, and my own nurse and no one is returning my call. I am freaking out.

Erin

[ICNDonna]

I would wait for the call before instilling it. Marcaine is fairly thick --- could that be it?

Donna

[ermkenne]

Hello,

I did hear back from the on call nurse. She said that some mixtures with solu-cortef are cloudy. I am a chemist, so I was thinking of chemistry things, and it could be that because of reconstituting the solucortef (starts out in a powder form then a liquid is added to it in the acto-vial) it turns clear, but there could be solubility issues with the other ingredients. Plus there are other salts contained in the ingredient list on the pharmacological data that could crash out due to to the marcaine or the sodium bicarb. I believe I got most of it in (nurse said aim for 90% and try to add sterile water to get any particulates that were not going in). I did that and they did not dissolve in water. I know for a fact that hydrocortisone sodium succinate (solu-cortef) does. I even tried dissolving what was left in the container and dissolve it in tap water and would not go away (did not put this in my bladder). I got everything in the toomey (what attaches to the catheter to go away), and what I could to go in. I had some minor discomfort when I did it (probably stress), but right now I feel soothed by it, feels kind of weird. I hope I can urinate on my own, and not have to re-cath (generally have to with instills). Hopefully it works. I can always work with my doctor if something needs to be added to increase solubility.

Sorry if I am a bit too scientific with this. I was hoping you would reply, since I knew you had experience with solu-cortef, but yours was in DMSO, correct? If so, DMSO is a magical solvent that dissolves almost anything. I use it in my line of work! Kind of sucks being a sciency nerd with this stuff, since I am so critical, but at least I can analyze it!

Let's hope it works (even if it is something expensive!).

Erin

[ICNDonna]

I didn't have solu-cortef at the same time as the DMSO. I found solu-cortef was soothing. It wasn't mixed with anything but the liquid to dilute it. We tried different instillations over the years --- I let my uro know I was willing to experiment. Most of the treatments did help.

Donna

[kadi]

I don't use solu-cortef in my instillations, just Marcaine, Sodium Bicarbonate, Heparin, Sterile Water. If my bathroom is humid - already steamy or if it's a humid day - I notice that the Sodium Bicarbonate doesn't completely dissolve. I've wondered about this, but it hasn't made any difference in how the instillation works.

[ermkenne]

Yeah, temperature can have an effect on how things dissolve. Sometimes if it is warmer it can increase the solubility or decrease it, just depends on the chemicals involved. Plus sodium bicarb. is made a certain way in a liquid so it may crash out if some conditions are not 'optimal' but it will still work.

I kind of did my own experiment to see if the order of what I added made a difference, and it sure did. I added the solu-cortef solution, added sodium bicarb (clear solution) then added marcaine (turned very cloudy, so it is a result of the high viscosity of it), added heparin (still cloudy), but no particulates formed. This made me very happy, it was cloudy, but looked like what the nurse told me. Had to be a nerd about it, but that is just in my nature!

Also, I do not have retention with this instill. I have had it with every other one I tried. I think it was the lidocaine (only different thing), so I have not had to re-cath!

[L. Thomas]

I have never used that particular drug in my instills but I was never able to get Elmiron to dissolve in my instills.

If air gets into the lidocaine vial the mixture in the syringe can become cloudy. Since I use the negative pressure way to fill my syringe I always have air in the vial but rarely does it become cloudy. The few times it did become cloudy the vials were a different temperature than the room. I was told that since it was not being injected I didn't need to be concerned with the cloudiness. BUT you have a different cocktail so don't take my word on it.

[ermkenne]

I was told the same thing about the cloudiness. My nurse told me they experience the same thing, and not to worry about it. It's just because of being a chemist. To me things should go into solution, so it bothers me, . So far it seems to be working okay, and really soothes my bladder when it is in pain. I have NEVER had a rescue instillation do that. I think that I had some sort of reaction to the lidocaine or that was not helping. Last two instills involved that and I think it was the problem. I think the steroid addition is helping, just not sure what the long term effects of that and the heparin are.