Transcript Working Instruction for Intrathecal Chemotherapy

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