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23.11 Cytotoxic therapy: intraperitoneal instillation of cytotoxic drugs

Essential equipment

  • Sterile gloves
  • Disposable apron and goggles
  • Y‐tube irrigation set

Medicinal products

  • Syringe or infusion bag containing prescribed drug in clinically clean tray (delivered from pharmacy reconstitution unit)
  • Gate clip or equivalent clamp for catheter
  • Catheter drainage bag, if catheter is to remain in position
  • Small dressing pack containing sterile field

Pre‐procedure

ActionRationale

  1. 1.
    Explain and discuss the procedure with the patient.
    To ensure that the patient understands the procedure and gives their valid consent (NMC [178], C).
  2. 2.
    Administer premedication to the patient if prescribed.
    To ensure the patient is relaxed during the procedure. E
  3. 3.
    Check all the details on the container of the cytotoxic drug against the patient's prescription chart.
    To minimize the risk of error and comply with legal requirements (NMC [177], C).
  4. 4.
    Assemble all necessary equipment, including the cytotoxic drug container, and proceed to the patient.
    To ensure that the instillation proceeds smoothly and without interruption. E

Procedure

  1. 5.
    Prior to instillation, pre‐warm the infusion to body temperature.
    To prevent cramping (Wilkes [268], E).
  2. 6.
    Use a Y‐tube irrigation set. The catheter is attached by this Y‐tube to a bottle of dialysate and a drainage bag.
    To ensure minimum intervention in draining the peritoneal cavity. E
  3. 7.
    Instil fluid at the prescribed rate, usually 1–2 litres over 10–15 minutes, but can be extended to 30–60 minutes.
    To ensure the correct instillation at the correct rate (NMC [177], C; Wilkes [268], E).
  4. 8.
    Document administration on the prescription chart.
    To record administration (NMC [177], C).
  5. 9.
    Wait for the prescribed period after administration prior to draining off excess fluid. This may be from 1 to 3 hours.
    To ensure fluid has coated all parts of peritoneal cavity. E
  6. 10.
    Observe regularly for patient comfort and intervene as appropriate. If the patient experiences any discomfort or pain, administer prescribed analgesia.
    To keep patient comfortable and pain free. E
  7. 11.
    Record temperature 4 hourly.
    To observe for pyrexia, a common side‐effect that may indicate a developing infection or a reaction to chemotherapy. E
  8. 12.
    Unclamp the drainage tube and, where necessary, flush the port or pump using appropriate flushing solution. The catheter may be removed after drainage is complete.
    To allow drainage of the drug. E

Post‐procedure

  1. 13.
    Record accurate fluid balance.
    To maintain accurate records (NMC [178], C).
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