Heated intraoperative intraperitoneal chemotherapy—The challenges of bringing chemotherapy into surgery

AORN Journal,  Dec, 2004  by Patricia Foltz,  Cheryl Wavrin,  Robert Sticca

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Team members created stickers to indicate cytotoxicity, which staff members would place on the patient's chart and on all specimens or cytotoxic waste leaving the perioperative suite. They also created chemotherapy safety posters to be placed on the OR door during the procedure (Figure 5). The laundry services department required that cytotoxic laundry be placed in a water-soluble bag and then inside a cytotoxic linen bag (Figure 6). Postchemotherapy garbage would be double red-bagged and kept separate from prechemotherapy garbage.

[FIGURES 5-6 OMITTED]

A serious concern that team members had to address was disposal of the several liters of cytotoxic fluid produced during the procedure. This waste could not be flushed into the sewer system; therefore, team members determined that a fluid waste solidifier should be purchased so the cytotoxic fluid waste could be solidified and incinerated. Environmental services personnel would remove the solidified fluid waste, along with the other postchemotherapy garbage, at the conclusion of the procedure. The solidified fluid waste, sharps, and any tubing would be placed in yellow cytotoxic rigid containers to be removed by ES personnel at the conclusion of the procedure. Should a cytotoxic spill occur, perioperative personnel would follow the recommended steps outlined in the hospital's policy on cytotoxic precautions.

* Perioperative personnel wearing PPE would contain any spills less than 5 mE, after which they would clean the area thoroughly with a phenolic solution.

* The circulating nurse would notify ES personnel about larger spills.

* Environmental services personnel would arrive in the OR to contain and decontaminate spills greater than 5 mL or 5 g (Figure 7).

[FIGURE 7 OMITTED]

It is important for the circulating nurse to have contact numbers for the ES and safety officers.

POWERED AIR-PURIFYING RESPIRATORS. Staff members were trained on the use of the powered air-purifying respirators (PAPR), which are available in the OR for use if a cytotoxic spill occurs. These respirators have blowers that force ambient air through air-purifying elements to the inlet covering (Figure 8).

[FIGURE 8 OMITTED]

A protocol was established to ensure communication with SICU and the oncology-nursing unit. When scheduling an HIIC procedure, perioperative scheduling personnel would notify these units to make appropriate staffing arrangements. Postoperatively, HIIC patients would be transported directly to SICU and would remain on cytotoxic precautions for 48 hours. Linen and garbage protocols, similar to those established for the perioperative area with the exception of solidifying fluid waste, were developed. Urine could be disposed of in the sewer, after which the hopper would be flushed twice to ensure adequate removal.

A nurse from the oncology nursing unit certified in chemotherapy administration would be assigned to the OR suite during procedures requiring chemotherapy administration until the perfusionists could obtain certification. The policy on chemotherapy precautions in surgery was updated and approved by both the occupational health and employee health departments.