Congress Abstracts 2006

145

NURSING CARE AND MANAGEMENT OF PATIENTS RECEIVING INTRAPERITONEAL CHEMOTHERAPY. Keith Marin, RN, BSN, Natasha Loving, RN, BSN, and Paula Muehlbauer, RN, MSN, OCN^®, National Institutes of Health, Bethesda, MD.

Intraperitoneal (IP) chemotherapy allows a high concentration of drug to be in direct contact with tumors and surrounding tissues. This technique is used in patients with peritoneal carcinomatosis who underwent surgical debulking and continuous hyperthermic peritoneal perfusion (CHPP). It is essential for oncology nurses to understand this treatment to help decrease risks of adverse events, increase chemotherapy exposure to peritoneal surfaces and increase patient comfort during and post- infusion.

Established standards do not exist for treating gastrointestinal peritoneal carcinomatosis. Clinical trials have evaluated surgical debulking, CHPP, and IP chemotherapy. Few studies focus on nursing care and management required for the patient undergoing post-operative IP chemotherapy. Potential risks are decreased healing and intra-abdominal infection. Potential benefits include preventing or delaying intra-abdominal tumor progression. The nurse assists the patient in reaching the best outcome while limiting discomfort.

The nurse instructs the patient regarding the procedure and potential complications. Peritoneal contents are emptied via a Tenkoff catheter attached to a drainage bag allowing increased chemotherapy exposure to peritoneal surfaces. Chemotherapy is infused through an inline warmer which helps alleviate abdominal cramping. Other comfort measures include head-of-bed elevation and frequent position changes. Anxiolytics and pain medications are used before and during the procedure. The patient is monitored for discomfort, respiratory distress and vital sign changes throughout. Post infusion, patients are encouraged to walk to alleviate discomfort and increase chemotherapy contact with peritoneal surfaces.

Patients are evaluated at regular intervals for three years. Overall, treatment has been well tolerated and clinical outcomes look promising.

IP chemotherapy infusion is proving to be a viable treatment for individuals with peritoneal carcinomatosis. It is labor intensive often requiring 1:2 nurse to patient ratios. The nurse must understand this process and be cognizant of potential complications. This treatment has resulted in good responses at this institution and potentially will be an additional therapeutic option.