Pre‐procedure

ActionRationale

1. 1.Show
   Explain and discuss the procedure with the patient.
   To ensure that the patient understands the procedure and gives their valid consent (Griffith et al. [91], E; NMC [177], C).
2. 2.Show
   Consult the patient's prescription sheet, and ascertain the following:

   1. Drug.
   2. Dose.
   3. Date and time of administration.
   4. Route and method of administration.
   5. Diluent as appropriate.
   6. Validity of prescription.
   7. Signature of doctor.
   8. Allergy status.
   To ensure that the patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (NPSA [167], C).
3. 3.Show
   Position the patient comfortably.
   To gain access to the site. E
4. 4.Show
   Apply apron and necessary personal protective equipment, for example gloves, goggles.
   To protect the practitioner from splashes and spills (HSE [104], C; Polovich [192], E; RCN [201], C).
5. 5.Show
   Wash hands with antibacterial soap.
   To prevent contamination (Fraise and Bradley [77], E).
6. 6.Show
   Open sterile pack and pour antiseptic liquid into gallipot.
   To prepare the area. E
7. 7.Show
   Open intrathecal chemotherapy drugs by cutting plastic pack and place on sterile field.
   To gain access to chemotherapy. E
8. 8.Show
   Open non‐coring winged infusion device and connect a three‐way tap to the tubing.
   To prepare the equipment. E
9. 9.Show
   Clean hands with alcohol gel.
   To prevent contamination (Fraise and Bradley [77], E).

Procedure

1. 10.Show
   Locate the reservoir by slightly depressing the dome several times. There should be free flow of CSF from the ventricle into the dome.
   To ascertain where the reservoir is and that it is functional (RCN [201], C).
2. 11.Show
   Wash hands with antibacterial handwash and put on sterile gloves.
   To prevent contamination (Fraise and Bradley [77], E).
3. 12.Show
   Prepare the skin by cleaning the site.
   To minimize risk of infection (Fraise and Bradley [77], E).
4. 13.Show
   Using the 25 G needle, access the reservoir and remove a small amount of CSF equal to the amount of drug to be instilled.
   To check free flow of CSF and patency of reservoir (RCN [201], C).
5. 14.Show
   Connect syringe containing chemotherapy to three‐way tap and inject slowly. No resistance should be felt.
   To maintain a closed system and administer medication (RCN [201], C).
6. 15.Show
   Compress and release the dome after all medication is given.
   To facilitate medication administration and dispense the drug (RCN [201], C).
7. 16.Show
   The reservoir can now be flushed with the CSF removed at the start of the procedure. Do not flush with 0.9% sodium chloride or heparin.
   Flushing is not required as CSF flows freely through the device (RCN [201], C; E).
8. 17.Show
   Remove the needle and apply pressure with gauze.
   To prevent leakage of CSF or chemotherapy. E
9. 18.Show
   Dispose of sharps and syringe in a purple‐lidded sharps container.
   To maintain a safe environment. E
10. 19.Show
    Once CSF stops leaking, apply a small gauze dressing and tape.
    To minimize risk of infection (Fraise and Bradley [77], E).

Post‐procedure

1. 20.Show
   Assist patient in repositioning if required.
   To maintain comfort. E
2. 21.Show
   Dispose of equipment in appropriate waste bags.
   To maintain a safe environment. E
3. 22.Show
   Wash and dry hands.
   To minimize risk of contamination (Fraise and Bradley [77], E).
4. 23.Show
   Document chemotherapy administration on the prescription chart.
   To maintain records and for continuity of care (NMC [178], C).
5. 24.Show
   Monitor the patient for any side‐effects of the drugs and check reservoir site for any leaks.
   To recognize complications early and report to medical staff (RCN [201], C).