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

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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