Mitomycin Administration via Nephrostomy Tube Enhances Nursing Competency

A clinical team at Johns Hopkins Nursing developed and implemented a specialized training program and detailed skill checklist in May 2026 to ensure nursing competency and safety during the administration of mitomycin (Jelmyto) for patients with urothelial cancer. They presented results from this checklist at the 51st Annual Oncology Nursing Society (ONS) Congress.

This initiative sought to address the complexities of delivering an antineoplastic therapy that utilizes reverse-thermal technology (RTGel) through a patient’s nephrostomy tube in an outpatient infusion center. By standardizing preparation and administration techniques, the program aimed to foster nurse confidence, improve patient outcomes, and minimize the risk of adverse effects (AEs) associated with this novel therapy.

Main Data

The evaluation of the training program demonstrated that a structured approach to complex medication delivery can result in successful clinical execution without errors. Following the implementation of the didactic and hands-on teaching sessions, nurses reported a significant improvement in their competency and comfort levels while administering mitomycin. The pilot application of the checklist showed that it allowed nurses to review and reference critical steps while developing a new skill set related to the medication's unique preparation requirements.

The clinical application of this competency-based training resulted in a seamless delivery process for the initial patient. The patient successfully received the full course of treatment without any reported delays or complications. Furthermore, the use of the checklist and the closed system transfer helped ensure that there was no drug waste during the administration process, highlighting the efficiency of the intervention.

Trial Details

This project was conducted at an outpatient infusion center at the Sidney Kimmel Comprehensive Cancer Center. The intervention centered on the creation and deployment of a mitomycin skill checklist designed according to manufacturer guidelines. The training included 2 primary components: didactic instruction and hands-on teaching provided by a Clinical Nurse Specialist.

The checklist itself was a comprehensive step-by-step guide that covered the safe handling of hazardous drugs and the technical requirements for using specialized equipment, such as the Uroject device. Because mitomycin is provided by the manufacturer as a gel that must be chilled to reach a liquid state for administration, the trial details focused heavily on the unique preparation and administration techniques required for reverse-thermal technology. Once the liquid is administered through the nephrostomy tube, it returns to a gel-like substance at body temperature, allowing it to conform to the anatomy of the kidney.

Patient Characteristics

The training program and checklist were initially validated through the treatment of an 89-year-old female patient diagnosed with ureteral cancer. This patient required the administration of mitomycin through a nephrostomy tube. The patient remained the primary subject for the evaluation phase of the nursing competency project, completing a full regimen of the therapy under the care of the newly trained nursing staff.

Main Objectives

The primary end points of this project were the development of a detailed training program and the successful completion of a six-dose treatment course for the first patient. The patient received six weekly doses of mitomycin consecutively. Success was measured by the absence of delays in the treatment schedule and the avoidance of drug waste or administration complications. Additionally, the project sought to establish a framework for future training; the results indicated that this checklist-based model could be utilized for the training of new registered nurses and potentially adapted for other antineoplastic therapies that require large-volume subcutaneous injections or other complex administration methods.

Safety

Safety was a central pillar of the intervention, specifically focusing on the safe delivery of antineoplastics and the mitigation of adverse effects (AEs). The checklist prioritized the safe handling of hazardous drugs and mandated the use of a closed system transfer to protect both the staff and the patient during the administration process. By following the manufacturer's recommendations for RTGel technology, the nurses ensured that the medication was delivered at the correct temperature and consistency to reach the targeted tumors in the kidney anatomy. The integration of specialized equipment like the Uroject served as a safety mechanism to ensure the precise delivery of the medication through the nephrostomy tube, thereby supporting the overall goal of safe and effective patient care.

Reference

Covert C, Olsen M. Mitomycin mastery building nursing competency in Jelmyto (mitomycin) administration via nephrostomy tube for urothelial cancer. Presented at: 51st Annual Oncology Nursing Society (ONS) Congress; May 13-17, 2026; San Antonio, TX. Poster 117