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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.

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Working Instruction for Intrathecal Chemotherapy

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  1. Working Instruction for Intrathecal Chemotherapy Carenx Wai Yee Leung APN, Department of Clinical Oncology

  2. 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)

  3. 停一停 諗一諗 Stop and Think

  4. 停一停 對一對 Stop and Check

  5. 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

  6. Ward Cubicle A B C D • 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 Door E F G H

  7. 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

  8. 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

  9. 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

  10. 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.

  11. 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

  12. Implementation (3) • Port-A-Cath • lying position

  13. Implementation (4) • Ommaya Reservoir (Intraventricular device) • lying position

  14. 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

  15. 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

  16. 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

  17. 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

  18. The End

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