working instruction for intrathecal chemotherapy carenx wai yee leung apn, department of clinical...
TRANSCRIPT
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
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
Doo
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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 iodi
ne & 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 coun
t, 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