Sodium Bicarb, anyone?

[Taramc]

Hey out there, I've been thinking I need some Sodium Bicarb in my instills. I figure this because I'm SO DIET SENSITIVE IT'S UNBELIEVABLE OMG OMG! :headbang:

Whew, ok I'm done freaking out.

So, my urologist has no idea how to prescribe sodium bicarb. She wanted me to give her time to figure it out and then she'd mail it, but that didn't happen.

I later said "how about 3cc's?" and she said "what strength? I don't know!"

Ok, anybody out there know? What do your Rx's look like? THANKS!

[sickofmybladder]

I'm not even sure that it has a strength - I will look on my bottles when I get home tonight - but I use 5cc's........ hopefully someone else will answer sooner that is home with their script handy.

[catlover2]

I use Medco mail out pharmacy so I don't know if your prescription needs to include all of this info or not. I use 3cc Sodium Bicarb with 20cc of 1% xylocaine and 6cc with 20cc of 2% xylocaine.

My prescription says use as directed by your doctor.
8.4% Sodium Bicarb Inj, USP
50ml vials
NDC # 0409-6625-02
Manufacturer: Hospira

[Taramc]

Another girl has told me 8.4 percent so that's got to be the strength. Next question: With the big vials (much bigger than 3cc's I'm sure) can we re-use them?

It's not important that I get this info right away. My current instills work ok. I'll just add the Sodium Bicarb the next time I see my uro in a couple months.

Thanks everybody!

[tigger_gal]

I really don't think that if a doctor does not know to prescribe a medication and is asking you the patient how many cc's and what strength, I wouldn't be willing to allow her to treat my IC, or give me an instill. thats actually very scary.

[bunnykinb]

I'll try to look at the bottle if I get to mix the instill tomorrow.

[L. Thomas]

2cc Sodium Bicarbonate 8.4%
8cc Lidocaine 2%
10,000 Units heparin


Instill as needed

[sugar]

I agree w/the earlier post...the dr doesnt know how to prescribe medicine?!? I've been prescribed sodium bicarb in both tablets and the liquid form for instills. In the tablet, I crushed it up and mixed w/sod lidocaine and heparin. The liquid is much easier. I use 5cc of 8.4%.
I would sincerely question if this dr should be treating you for this if she doesnt know what she's doing. That sounds really scary to me too! I would look into finding another dr, an IC Specialist, not just a uro who's heard of IC. But that's just me.
Take care!
Annette

[ICNDonna]

I think it's great that your doctor is willing to work with you on this. Hopefully you will get the information you need here.

Donna

[bunnykinb]

I asked the nurse what my mix was and she said:

heparin 8cc (=40,000 units)
lidocaine 8cc
sodium bicarb 3cc

The sodium bicarb didn't have a percentage either.

[bunnykinb]

My next visit, I asked to be shown how to mix. I had thought the syringes were based on ml not cc. So confusing.

[Kathy in Canada]

Hi,

The sodium bicarbonate helps the lidocaine work better.

My instills are mixed in a new sterile urine specimen cup 1st. Then I draw them up in a 60 ml catheter tipped syringe and use that for the catheterization part. The instills are: 20 cc of sterile water, 2 emptied out (into the cup) Elmiron capsules, 6 cc of 8.4% Sodium Bicarbonate and 12 cc of 2% Lidocaine for injection.

The lidocaine and the sodium bicarbonate come in 50 cc bottles. I use separate syringes for each every time I use them. Even though the sodium bioarbonate has no preservatives, I can finish the bottle until it is empty. The lidocaine has a preservative added. I always wipe the bottle tops with alcohol swabs before I draw up the medication and after (with a new swab). I use a new needle and syringe if I need part of a medication from one bottle and more from a new bottle of the same medication. Or else I draw up some from the new bottle and the rest after from the old bottle if I think there is enough left to make up the amount I need.

I buy sterile water for irrigation in 500 ml bottles. I date the bottle and throw it out after about 3 weeks. I am very careful not to contaminate the lid or the bottle. I just pour the 20 cc of water into the urine specimen cup and then I put the top right back on the sterile water bottle. Make sure when the lid is off that the side that twists on is up not down on the counter, which would contaminate it.

Hand washing is very important when doing any of this and I use a clean towel as well.

I have done instills to myself about 70 times and so far have not had an infection. You have to be very careful that what needs to be sterile, stays sterile. If in doubt, throw it out.

You can look at some of my other posts on how I do the catheterization and mix the meds.

Good luck,

Kathy

[catlover2]

1 ml= 1 cc. They are the same thing.

[Judy777]

What percentages of Marcaine and Heparin are you using in your instills?

My instill cocktail is 10cc of 2% Lidocaine, 4ml (40,000 USP Units) of Heparin and 5cc of Sodium Bicarbonate the Sodium Bicarb is 8.4% strength and my script was written for the 50mL injectable vial.

The Sodium Bicarb is a very important part of the instill. The purpose of the sodium bicarb is that it allows the Lidocaine and Heparin to penatrate further into the bladder muscle, which would help you get the most benefit from the instills.

Hope this helps,

Judy

[bunnykinb]

Heparin comes in a certain percentage too? ML=CC?

[justice4j]

Hi,

Sodium Bicarbonate 8.4% comes in 50 cc multi-dose vials and yes you can reuse the 50 cc vials by wiping the rubber stopper with an alcohol wipe before it is drawn up into the syringe.

Heparin is measure in UNITS rather than %.


If you want to easily measure/draw up all three meds into one syringe, here's how:

Draw the same cc's of AIR as MEDs that you need.

Swab off the rubber stopper (unless it's a single use vial and then you merely pop the plastic top off without touching the rubber stopper)

Insert the AIR from the syringe into the Bicarb and withdraw the amount of cc's that you are prescribed.

With the Bicarb already in the syringe, draw up the next amount of cc's of AIR for the Lidocaine

Swab off the Lido stopper. Insert the needle into the stopper and push the AIR only into the Lido bottle

Withdraw the prescribed amount of Lido

Heparin probably is in a single dose vial, so all you need to do is withdraw the prescribed UNITS.

I'm very thankful that I had 17 years experience as an RN. Trying to learn how to coordinate drawing up instillations while you are in IC pain must be difficult until you have some practice.

[Taramc]

....especially when it comes to dealing with all this medical equipment! My uro gave me one needle syringe and one 40ml syringe that attaches to the catheters, and one specimen cup.

She prescibed catheters and the medicine, but the two syringes have been boiled and re-used over 100 times by now. They're getting melty! And the specimen cup has been reused at least 50 times. The label's all scraped off, there's a permanent film of Elmiron on the inside of it..lol.

I figure I'm sterile cuz I'm boiling. Then I instill in the bathtub. Nobody told me we're supposed to drain our pee out before instilling, ya know? It took me over 8 months to figure out I'm supposed to insert the catheter and drain first. I was just attaching the cath to the syringe and shoving it in, though I peed first.

Here's how things were at my doctor's office: They did one instill on me, I got my first urethral spasm relief for 3 whole days, I went back and said I wanted to take some home, then they gave me the stuff and I was on my own from there on. It surprises me to know people actually get 'instill training'! They gave me a pamphlet "how to catheterize" and I swear you guys... they drew the urethra up too high! I practically poked a new hole in myself!

Oh well. I'm fine with my urologist because she has a good rep, and I'm too lazy to switch doctors over an illness nobody seems to know much about, anyway. I've learned what I need online, thanks to YOU! When it came time for my hydrodistension, I said "I want pictures, and please do biopsies to check for mast cells." She wouldn't have done the biopsies unless I said to.

They came back full of inflammatory cells, eosinophils and mast cells, but then she wouldn't diagnose me with IC! That didn't bother me, I know what I have. I even said on the radio that my results came back + for IC. And I knew it thanks to THIS BOARD :)

Well, and the fact a few chocolate chips will flare me for 2 hours, but I don't want to talk about that lol. I've just had one of those WEEK LONG FLARES, got over it yesterday. Was my period week, go figure.

Here, remission... come over here...that's right... remission... here! -Tara

[bunnykinb]

Is the sodium bicarbonate a prescription or can that be over the counter?

[Taramc]

I'm sure it's prescribed. By people who know how to prescribe it lol.

Thank you for letting me know it improves the effectiveness of the Marcaine (or whatever 'caine' you guys are using) :)

BTW a myspace friend of mine is trying that Canadian instill called "Cystistat". It's not approved in the U.S. The price... you ready for the price? $800.00 for 4 instills!!!

Don't they want us to get better? I guess not! GEEZ!

[sugar]

You need a script for sodium bicarb. It's available in both tablet and liquid form. I've prefered the liquid. Otherwise, you have to crush up the tablets, mix w/water, etc. Not as hygenic, in my opinion.
Thanks!

[justice4j]

Absolutely correct! The Bicarb comes in 50 cc vials, isn't expensive and is a sterile source if sterile technique is practiced - wiping the rubber stopper each time, etc.

[bunnykinb]

Do you buy your alcohol prep pads at the pharmacy or does that need a prescription too?

[sickofmybladder]

My sodium bicarb says on the bottle "One time use" - I was not using them at all for multiple instillations - until my new uro said I could mix 3 at a time (1 weeks worth) and keep in the fridge -

Those of you that are re-using (and wiping the top off with alcohol) - does yours say One time use? I only ask because my insurance will not cover the sodium bicarb - so obviously I would like to run this by my doctor if there is a way to stretch it out even further.

[sugar]

I checked my 50ml vial of 8.4% sodium bicarbonate. It says at the top "single use". However, my uro had instructed me that it can be used more than once as long as I did the following: Prior to each use, wipe off the rubber top where the needle goes in thoroughly w/an alcohol soaked cotton ball or cotton pad (I've seen alcohol pads sold at drugstores...using alcohol on a cotton ball does the same thing and is cheaper.) I've also been told to swab the tops of any other meds, even if I'm just removing the plastic cap. Then, make sure you are using a fresh needle, and that your hands are cleaned and sterilized first(My routine is to wash w/antibacterial soap, followed by an application of hand sanitizer (which is primarily alcohol). Then, making sure the fresh needle doesnt touch anything else, proceed to withdraw the meds from each bottle. I use 5cc of sod bicarb per daily installation, so naturally a 50ml bottle lasts 10 days.
These are instructions per my uro. I'd advise you to check w/your dr first about any questions. I had lots of questions when I started my instills.
Take care!
Annette

[bunnykinb]

That answers my question on the alcohol wipes.

Does everyone use a wipe for the urethral area prior to cathing? My uro told me to use an alcohol prep pad, but that stings me. Any suggestions?

[L. Thomas]

I do not use an alcohol wipe. I have been doing instill since '04. I haven't had a UTI so far. BUT you need to follow your MD's order. Maybe talk to him and see if you can use something else..betadine maybe?

I reuse the sodium bicarbonate too. I was told to try keep from puncturing the vial "stopper" in the same place. Sort of hard to do when you use 1 bottle for 25 instills.

[justice4j]

NOOOO! The thought makes me HURT!

[L. Thomas]

Heparin comes in a certain percentage too? ML=CC?

Heparin comes in units. The vial will be labeled 10,000 units, 20,000 units, 40,000 units 100,000 units etc. So it doesn't come in %.

[L. Thomas]

....especially when it comes to dealing with all this medical equipment! My uro gave me one needle syringe and one 40ml syringe that attaches to the catheters, and one specimen cup.

She prescibed catheters and the medicine, but the two syringes have been boiled and re-used over 100 times by now. They're getting melty! And the specimen cup has been reused at least 50 times. The label's all scraped off, there's a permanent film of Elmiron on the inside of it..lol.

I would see if I could get a prescription for some more catheters and syringes. They are covered by my insurance. The catheters are billed at $4 and I pay $1. The 30cc syringe is billed at $1 and I pay $0.10. The needles are not covered by my insurance. My durable goods supplier provides them at his cost ($15 per 100).

Obviously she will allow you to reuse the supplies but when they get "sticky" the material is worn out and probably cannot be cleaned properly. Cleaning with alcohol and boiling will cause that. My urogynecologist allows me to use a catheter 4 times but I use a new syringe and needle with each instill.

[sugar]

I tried using alcohol once and only once....NO NO NO NO NO!!! Please dont do it. It burned so bad it wasnt funny..it took me a while to rinse and get the sting out.
The wipes I use are called "Benzalkonium Chloride Towlette". They seem like the same type that you use prior to giving a urine sample at a drs office and they dont sting at all. I buy them in boxes of 100 from www.homecaredelivered.com. I think a box is $3-4. As I got a few utis when I first started doing instills, I actually wash the entire area well w/ a gentle soap (I use a mild baby soap), rinse well, then use the wipe, front to back. Then disinfect my hands again and proceed w/the instill.
Hope that helps!
Annette

[bunnykinb]

Ok, I like the suggestions. The supplier's samples for catheters came in a package with the gloves, benz... stuff, lubricating jelly, and the saline solution for the hydrophilic caths.

Thanks