Chapter 23: Administration of systemic anticancer therapies
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23.9 Cytotoxic therapy: intrapleural instillation of cytotoxic drugs
Essential equipment
- Sterile chest drain pack containing gallipot, disposable towel, forceps, disposable scalpel and sterile low‐linting gauze
- Suture material: silk
- Cleaning solution: chlorhexidine gluconate 0.5% in 70% alcohol
- Sterile gloves and gown
- Syringes: 2 × 10 mL
Medicinal products
- Local anaesthetic: lidocaine 1%
- Sterile water: 1 litre bottle
- Needles: 1 × 21 G, 1 × 23 G
- Chest drain: check appropriate size to be used for insertion
- Sterile dressing
- Tape
- Chest drain tubing
- Chest drain bottle
- Chest drain clamps × 2
- Low‐vacuum suction pump, if required
Pre‐procedure
ActionRationale
- 1.Explain and discuss the procedure with the patient.
- 2.Administer premedication to the patient if prescribed.To relax the patient. E
- 3.Prepare the required equipment and cytotoxic drug. Wear protective clothing.
Procedure
- 4.Assist the doctor with the instillation and provide support for the patient. Place the patient in a sitting position, leaning forward over a strong surface or table which is locked in position.
- 5.At the end of the instillation, clamp the drainage tube and leave for the desired period.
- 6.Observe regularly for patient comfort. Administer analgesic as required.To keep the patient comfortable and free from pain. E
- 7.Record the patient's respirations and colour at least every 15 minutes for 1 hour, then every hour until stable, then 4 hourly or as frequently as the patient's condition dictates. Record temperature at least 4 hourly.
Post‐procedure
- 8.When ready to remove the drain, ensure the patient is in a comfortable position, and is aware of any limitations about movement.To prevent discomfort or dislodgement of the drainage tube. E
- 9.Unclamp the chest tube.To allow drainage of the drug instilled. E
- 10.Record the colour and amount of fluid drained.