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Download Working Instruction for Intrathecal Chemotherapy
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Working Instruction for Intrathecal Chemotherapy Carenx Wai Yee Leung APN, Department of Clinical Oncology The Principle of 3 checks and 5 rights The medication container should be checked three times during medication preparation. 1st- checking Before taking the medication out from the container 2nd- checking After removing the medication from the container 3rd- checking the medication before disposal/ putting it away/ giving the unit dose to patient 5 rights – to ensure accuracy when administrating medications. patient, drug, dose, route, time (frequency of administration) Planning (1) Patient Ensure patient understand the procedure and valid consent is available Items Drug : MAR-ITC should sent to ADU one day before the IT injection Procedure Trolley Time Normal working hours (Monday- Friday) Environment Warm, privacy Identify the protected area and make sure the hanging sign “ Intrathecal chemotherapy in progress” is available Door Ward Cubicle IT chemotherapy must only be administered in an area where no other cytotoxic injections are A/V. Questions? If “A” bed’s patient is going to receive IT chemotherapy, no cytotoxic injections would be A/V in bed B, C , D, E ,F ,G, H If “C” bed’s patient is going to receive IT chemotherapy, no cytotoxic injections would be A/V in bed B,D, F, G, H Planning (2) Nurses Familiar with procedure Trained staff (IT procedure)- required to independently verify the patient identification and drug checking procedure Familiar with patient’s condition Should be protected from other duty Procedure trolley (1) Dressing set + OT towels Masks, sterile gloves, disposable gown Waste paper bag Skin anti-septic lotions, e.g. Povidone iodine & 70% Alcohol Local Analgesic – Lignocaine 2% Syringes 5ml for normal saline or CSF collection 2.5ml for local analgesic Procedure trolley (2) Needle or related device Lumbar puncture: lumbar puncture needle, manometer Port-A-Cath/ Ommaya Reservoir: Non-coring needle 0.2μm Filter (Perifix) Specimen bottles- biochemistry, glucose, cell count, cytology Normal Saline 0.9%- 100ml Dressing Spray and pressure dressing Intrathecal drug Implementation (1) Ensure patient understand the procedure and valid consent is available Check the drug (+expiry hour) against MAR (1st check) when drug is available. Post up the warning sign “Intrathecal Chemotherapy in Progress” Check the drug against MAR independently (2nd check) by patient bed side. Implementation (2) Wear appropriate PPE (Gloves, mask, disposable gown) Assist doctor to set up the trolley skin antiseptic lotions local analgesic drug Final check independently against MAR and patient (3rd check-5 rights) before unit dose given to patient. Assist the patient in proper positioning Implementation (3) Port-A-Cath lying position Implementation (4) Ommaya Reservoir (Intraventricular device) lying position Implementation (5) Lumber puncture Left lateral near the edge of the bed with hips and knees well flexed Sitting up leaning over bed table to flex the spine Implementation (6) Provide constant support and observation throughout the procedure When the procedure is over, seal and apply pressure dressing to puncture site Ensure specimen tubes are properly labeled Arrange patient in a comfortable position after procedure Advise patient to lie flat for at least two hour or as indicated by doctor Implementation (7) Observe complications Headache- may relieve by lying flat or analgesic, inform doctor immediately if severe and increasing Back pain-may relieve by lying flat or analgesic, inform doctor immediately if severe and increasing CSF leakage-reported immediately Fluctuation of neurological observations- inform doctor if any fluctuation in level of consciousness, pulse, RR, BP, pupil reaction If patient is anaesthetized for the procedure: Respiratory rate and pattern, Heart rate, Color, Airway, Conscious level Implementation (9) Record patient condition Encourage fluid intake if no contraindication To replace lost fluid Ensure comfort and safety Send Specimen for analysis if necessary Remove the dressing within 24 hours post the procedure To minimize risk of infection
