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Evidence‐based approaches

Rationale

Indications

Treatment failures of primary malignant tumours of the colon and rectum as well as ovary occur most frequently as regional disease. Extensive tumours may be present intra‐abdominally without evidence of disease at other sites in the body. In view of this, chemotherapy treatment given intraperitoneally has been shown to be effective in treating locally recurrent ovarian and colon cancer (Sewell et al. [230], Wilkes [268]).

Methods of accessing the peritoneal space

There are three methods of accessing the peritoneal space.

Intermittent placement of a temporary indwelling catheter into the peritoneal cavity. This is used for a short time such as for symptom relief or palliation.
Placement of an external catheter such as a Tenckhoff. This is surgically placed through the anterior abdominal wall and the catheter exits through the skin on the abdomen. This is the most widely used method. The Tenckhoff catheter has the advantages of allowing a high flow rate (2 litres in 10–15 minutes) and allowing for manipulation to dislodge fibrin deposits (Wilkes [268]). Problems include occlusion, infection, leakage around the catheter and body image problems.
Placement of an implantable peritoneal port. The port is internal with no care required when not accessed and therefore has a lower rate of infection and may be more acceptable to the patient. However, ports tend to provide a slower flow rate than a catheter (Wilkes [268]).

Procedure guideline 23.11

Cytotoxic therapy: intraperitoneal instillation of cytotoxic drugs

Table 23.8 Prevention and resolution (Procedure guideline 23.11)

Problem	Cause	Prevention	Action
Abdominal pain or discomfort.	Peritoneal irritation following placement of catheter. Incomplete drainage of the dialysate solution.		Observe for a reaction and treat symptomatically.
	Failure to warm dialysate solution to body temperature. Chemical peritonitis resulting from chemotherapeutic agent.	Warm the dialysate fluid.	Ensure that solution is warmed and procedure is followed. Observe for any signs of discomfort and treat symptomatically.
Leakage from around the catheter following administration of the drug.	Peritoneum is not intact or catheter is not entirely within the peritoneal cavity.	Check that the catheter is in the correct place before administration.	Strict aseptic technique required. Dressings to be changed frequently. When skin around the catheter has healed, there should be no further leakage.