RADIATION THERAPY (RADIOTERAPI) By Toto subiakto Pengertian Radioterapi adalah penggunaan partikel energi untuk menghancurkan sel – sel dalam pengobatan penyakit. Sel mati akibat dari reaksi kimia dalam sel yang menyebabkan perubahan DNA dan RNA, mengurangi kemampuan sel untuk berfungsi. Jumlah kerusakan DNA dan RNA sebuah sel tergantung dari radiosensitifitas sel. Ada 4 faktor yang mempengaruhi radiosensitifits sel : kecepatan pembelahan sel fase siklus sel derajat differensiasi sel kadar oxigenasi sel pembelahan sel dengan cepat, apakah itu normal atau yang bersifat kanker, lebih rentan terhadap terapi radiasi. Sel- sel yang sedang dalam kesenjangan fase 2 ( periode setelah sintesis DNA sebelum mitosis) dari siklus sel adalah paling sensitive terhadap raioterapi. Differensiasi sel yang buruk dan sel teroksigenasi baik juga sangat radiosensitive. Umumnya jenis kanker yang paling sensitive pada radioterapi adalah limfoma, seminoma, sel skuamosa daerah orofaring,kulit dan sel epitel serviks. Sel normal yang paling sensitive terhadap radioterapi adalh sel – sel darah yang
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
RADIATION THERAPY (RADIOTERAPI)
By Toto subiakto
Pengertian
Radioterapi adalah penggunaan partikel energi untuk menghancurkan sel – sel
dalam pengobatan penyakit. Sel mati akibat dari reaksi kimia dalam sel yang
menyebabkan perubahan DNA dan RNA, mengurangi kemampuan sel untuk
berfungsi. Jumlah kerusakan DNA dan RNA sebuah sel tergantung dari
radiosensitifitas sel. Ada 4 faktor yang mempengaruhi radiosensitifits sel :
kecepatan pembelahan sel
fase siklus sel
derajat differensiasi sel
kadar oxigenasi sel
pembelahan sel dengan cepat, apakah itu normal atau yang bersifat kanker, lebih
rentan terhadap terapi radiasi. Sel- sel yang sedang dalam kesenjangan fase 2
( periode setelah sintesis DNA sebelum mitosis) dari siklus sel adalah paling
sensitive terhadap raioterapi. Differensiasi sel yang buruk dan sel teroksigenasi
baik juga sangat radiosensitive. Umumnya jenis kanker yang paling sensitive pada
radioterapi adalah limfoma, seminoma, sel skuamosa daerah orofaring,kulit dan
sel epitel serviks. Sel normal yang paling sensitive terhadap radioterapi adalh sel
– sel darah yang dihasilkan dalam sum-sum tulang, folikel rambut dan sel traktus
gastrointestinal. Untuk mengatasi kanker terapi radiasi digunakan sendiri atau
dlam kombinasi dengan pembedahan, kemoterapi dan/ immunoterapi.
Tujuan
o Kuratif, seperti penyakit Hodgkin, kanker seminoma testis, kulit, serviks dan
kanker laring.
o Mengontrol penyakit baik jangka pendek maupun jangka panjang seperti pada
tumor otak, kanker kandung kemih, kanker ovarium dan kanker paru
o Faliatif untuk meningkatkan kwalitas hidup dengan menghilangkan gejala dan
mencegah komplikasi
Indikasi
- Kanker seminoma testis,
- Kanker laring
- Tumor otak
- Kanker kandung kemih
- kanker ovarium
- kanker paru
Kontraindikasi:
- Eritema
persiapan
- talk
- air yang bersih dan steril
- sarung tangan
- obat – obatan :
Prosedur
a. Sebelum melakukan tindakan
Menentukan type dan jumlah radiasi yang digunakan, pengaruh serta
bahayanya
Memperpanjang waktu memulai radiasiterapi, perawat memperhatikan
kondisi klien secara keseluruhan
Perhatikan pada dinding lead atau lead aprons serta melindungi area yang
terkena radioterapi
Menutup area yang akan diberi terapi.
Pada saat material terapi radiasi tidak digunakan maka material tersebut
harus disimpan ditempat yang aman
b. Jika perawat dan anggota keluarga ikut dalam prosedur radiasi maka mereka
harus melindungi diri
c. pada saat klien sedang mendapat radiasi , semua perawat jaga dan fasilitator
harus melindungi diri
d. catat berapa waktu yang dibutuhkan dan berapa material yang terpakai
e. menjaga akses dan mensupport klien serta orang –orang yang ikut serta dalam
terapi radiasi
f. perhatikan prosedur kerja dan bersama pasien membuka segel iodine
1. Perawat memakai sarung tangan elastis ketika memberikan perawatan
2. Cuci tangan sebelum melakukan tindakan, tempat yang diisi air harus didesinfeksi
3. Cuci tangan dengan menggunakan sabun dan memakai air yang mengalir
4. Simpan semua barang- barang pasien didalam tas
5. Jelaskan pada pasien dan keluarga perlunya perlindungan terhadap radiasi
( Smith,2000)
F. Respon akut terhadap Radiotherapi
Kulit : kehilangan lapisan epidermis, eritema, kering, deskuamasi dan
- Gosok daerah sekeliling leher botol dengan alcohol sebelum membukanya
- Susun obat-obtan dalam lemari dengan standar biolodis kelas II, dengan
menggunakan vial asli atau dengan kantong plastic yang memiliki perekat.
- Tutup ujung jarum dengan kasa steril pada saat mengeluarkan oudara dari spuit.
- Beri label setiap obat kemoterapi
- Bersihkan setiap tumpahan dengan segera
- Bawa obat kedaerah pengiriman dalam tempat yang anti bocor.
-
KEMOTERAPI DAN BIOTERAPI INTRAVENA UNTUK MENGOBATI KANKER
Prinsip-Prinsip Pelaksanaan1. Persiapan, penanganan dan pelaksanaan kemoterapi dan bioterapi agent dnan
penanganan cairan tubuh pasien serta terekpose obat-obat berbahaya.2. Metoda pemberian infuse mencakup
a. Piggy-back (short term)b. Free-Flow-Pusc. Terus Menerus (Continuous)
3. Kemoterapi dipertimbangkan sebagai pengobatan dengan kewaspadaan tinggi (ISMP Canada)
Peralatan:Peralatan perlindungan personal yang sesuai :
Sarung tangan dobel Pakaian kemotherapi Kapas alkohol Alas plastic absorbent disposibel Container (bengkok)untuk menampung limbah yang berbahaya (needle atau
pecahan, dll) Pelindung wajah (melindungi dari percikan) Kontainer menampung limbah yang berbahaya Kemoterapi kit Peralatan untuk mencuci mata emergenci
Peralatan emergenci yang mudah diakses misalnya oksigen, infuse set dengan NaCl 0,9%Anaphylaksis kit dekat tempat tidurEktravasation kit dekat tempat tidur (jika diberikan agen vesicants)Agents (obat) dalam kantong tertutup dan tahan bocor
Obat-obatan suportifCairan IV yang sesuai.
Cara Kerja1. Mengkaji status kondisi pasien dan toksisitas obat dengan alat pengkajian yang disetujui2. Memastikan order dari medis dan persetujuan tindakan kemoterapi/bioterapi3. Memastikan cara pemberian dan dosis bandingkan dengan pemberian terakhir4. Mengkaji kelengkapan order meliputi terapi suportif pre dan post terapi misalnya hidrasi, antiementik
4.1 memastikan bahwa dosis sesuai untuk pasien, diagnosis dan rencana keperawatan4.1.1 Jika ragu-ragu, konsultasikan denagn ahli pharmasi atau dokter.
5. Cek ulang dosis secara perhitungan matematis oleh perawat yang telah teregistrasi dihubungkan dengan body surface area. 6. menentukan obat-obat yang bersifat vesicant dan yang berpotensi iritan.7. Menentukan metoda pemberian infuse ( mengacu pada chart pemberian obat-obat sitotoksisk)
7.1. Piggy-back (short term), menentukan selang infuse yang sesuai dengan larutan dan infuse piggy-back kemoterapi serta dosis yang membutuhkan selang khusus.
7.2. Free-Flow Push, dapatkan selang infuse yang sesuai dengan larutan dan hubungkan syringe yang berisi obat ke port tertutup pada pasien.
7.2.1. pemberian agent IV push, diperbolehkan larutan infuse IV untuk melarutkan obat tersebut.
7.3. Continue infusion (24 jam atau lebih) , infuse continue umunya menggunakan suatu line PICC atau alat penyabang (cagak) sebab konsentrasi obat pada infuse. Misalnya doxorubicin, fluorouracil, cisplatin)
7.4. Vesicants:7.4.1. Hindari infuse vesicants lebih lama dari 30 – 60 menit7.4.1.1. Pemberian infuse vesicants untuk waktu lebih dari 30- 60 menit melalui CVP7.4.2 Jangan menggunakan infuse IV perifer untuk pemberian vesicants secara
continue.
8. Prioritaskan segera untuk mengantungan infuse dengan benar8.1. Identifikasi dua identitas spesifik pasien (misalnya nama dan tanggal lahir)8.2. PPengembalian darah dan kepatenan IV8.2.1. Kepatenan vena dan pembilasan dilakukan dengan menggunakan minimal 10 ml larutan IV yang sesuai antara pemberian setiap agent baru.
9. Sebelum, selama dan setelah infuse, monitor tanda-tanda vital setiap 20 – 30 menit pada dua jam pertama, khusussnya pada pemberian antineoplastik dengan potensial anafilaksis tinggi.
10. Untuk pemberian Vesicants10.1.
Fundamentals of Administration
A. Pretreatment
Follow institutional guidelines regarding documentation of assessment and provision of care. Appendices 1 and 2 in the original guideline document provide sample flow sheets.
Nursing assessment and case review
Patient history
Review recent treatment(s), including surgery, radiation therapy, prior cytotoxic therapy, hormonal therapy, and complementary therapies (e.g., acupuncture, chiropractic, nutritional).
Review and document medical, psychiatric, and nononcologic surgical history.
Document drug, food, and environmental allergies.
Obtain an accurate list of all medications that the patient uses, including prescription, over-the-counter, herbs, and vitamins. More than 40% of the American public use complementary and alternative medicine. Patients may disclose use of these products only when directly questioned in a nonjudgmental fashion (Oliveira, 2001; Reuters Health, 2000).
Age-specific concerns: The elderly often have multiple comorbidities for which they take multiple medications. Be aware of the potential for drug interactions with chemotherapy agents (Hood, 2003).
Signs and symptoms of underlying disease process and any previous treatments
Symptom screening during the pretreatment phase is crucial to successful symptom management.
Poorly controlled symptoms impact the quality of life for the patient and can interfere with delivery of chemotherapy and other treatment modalities (Dodd, Miaskowski, & Paul, 2001; Houldin, 2000).
Screening tools
Assess performance status by using scales such as the Karnofsky, Zubrod, or Eastern Cooperative Oncology Group (see Table 3 in the original guideline document).
Assess pain using an age-appropriate scale (e.g., numeric 0–10 scale, facial expressions, visual analog).
Assess for fatigue using an appropriate scale, such as the Brief Fatigue Inventory (Mendoza et al., 1999), the Piper Fatigue Scale (Piper et al.,1998), or the Schwartz Cancer Fatigue Scale (Schwartz, 1998).
Patient data
Obtain and document the patient's actual height and weight; compare with previous visits.
Compare current and previous lab values. Age-specific concern: Assess for age related changes in pulmonary, renal, and cardiac function in the elderly.
Review diagnoses, tumor type, grade, and staging.
Obtain treatment records from past encounters to determine symptom management strategies that were employed.
Assess cultural and spiritual issues that may affect the treatment plan.
Assess how the patient and family are coping with the cancer experience.
Determine the need for referral to a social worker, spiritual care provider, dietitian, physical therapist, and other member of the multidisciplinary team as needed. Age-specific concerns: When caring for pediatric patients, consult play therapists and child-life specialists. If a school-age youth is going to be out of school for a prolonged time, explore options for continued study available through the appropriate school district (e.g., home study, online programs).
Information and learning needs of patient and family (Houldin, 2000)
Determine the preferred language.
Assess speaking fluency and reading literacy.
Assess level of understanding of the disease and treatment.
Identify the patient's preferred learning style.
Provide information regarding
Drugs, side effects, and symptom management
When and how to call the nurse and/or doctor
Follow-up care and labs
How to access support services.
Treatment plan (Santell, Protzel, & Cousins, 2004)
Read the written orders in their entirety, then scrutinize each line for
Name of drug ordered
Drug dose
Method of determining dose
Route of administration
Rate of administration
Frequency and/or date(s) of administration
Premedications
Hydration, if applicable
Protocol or reference
Assess orders for completeness (e.g., hydration, premedications).
Review the patient's actual height and weight; double-check the patient's BSA.
Have two individuals independently recalculate the drug dose and compare to the ordered dose (American Society of Health-System Pharmacists [ASHP], 2002). Follow institutional policy for who can double check doses (e.g., two registered nurses (RNs), RN and pharmacist).
Verify that the dose is appropriate for the patient, diagnosis, and treatment plan. If in doubt, clarify. Consult a pharmacist and/or physician.
Determine the vesicant and irritant potential of the drug(s).
Assess the patient's prior experience with cytotoxic therapy (e.g., adequacy of symptom management, delayed side effects, willingness to proceed).
Immediately before administration, verify the order, the drug names, calculations, expiration dates and times, appearance of the drugs, and accuracy of two different patient identifiers (Joint Commission on Accreditation of Healthcare Organizations [JCAHO], 2004).
Treatment
Patient preparation
Explain to the patient and family/caregivers who will administer the chemotherapy, the route, and the planned sequence of events.
Describe the plan for symptom management. Provide information regarding (Vandegrift, 2001)
Premedications
Hydration
Intake and output assessment
Laboratory monitoring
Diet during chemotherapy
Potential side effects of chemotherapeutic and adjunct medications
Baseline vital signs as indicated.
Staff preparation
Review all physician orders.
Have a spill kit, extravasation equipment, and emergency drugs/equipment available as needed (Otto, 2004). Age-specific concerns: If administering chemotherapy to a child, patient-specific dosing information and emergency equipment must be available. Calculate emergency drug doses before they are needed.
Obtain monitoring equipment as indicated.
Obtain infusion pumps and other devices as needed. Age-specific concerns: Use a volumetric pump to administer chemotherapy to pediatric patients (Frey, 2001; Infusion Nurses Society [INS], 2000).
Routes of administration
Oral: The role of oral chemotherapy agents is expanding, with many new drugs in development, reflecting a new paradigm in which cancer is treated as a chronic disease with long-term management (Bedell, 2003).
Advantages
Ease and portability of administration
Increased sense of patient independence
Disadvantages
Inconsistency of absorption
Potential loss of drug in the event of emesis
Potential for drug/herb/diet interactions
Issue of medication adherence
Cost/reimbursement concerns (Birner, 2003)
Potential complications
Drug-specific
Related to drug-drug interactions
Related to swallowing difficulties
Nursing implications
Age-specific concerns: Young children may require liquid preparations. For elderly patients, evaluate ability to swallow pills intact, plus ability to self-manage medication regimen (Hartigan, 2000).
Patient education is key to promoting medication regimen adherence. Provide verbal and written instructions, including name of the medication, dose/schedule, how taken, and safety (storage and handling).
a. Subcutaneous (SQ) or Intramuscular (IM) injection (see Table 12 in the original guideline document for maximum volumes for intramuscular injections for children) (Camp-Sorrell, 2004; Goodman, 2000)
1. Advantages a. Ease of administration b. Decreased side effects
1. Disadvantages a. Inconsistency of absorption b. Requires adequate muscle mass and tissue for
absorption
2. Potential complications a. Pain/discomfort b. Infection c. Bleeding
3. Nursing implications a. Monitor platelet count and ANC. b. Use smallest needle possible; some solutions may
come with pre-prepared syringes (follow manufacturer's instructions).
c. Follow institutional policy for site antisepsis and documentation.
d. Assess previous injection sites for signs and symptoms of infection or bleeding.
a. Intra-arterial: Delivers medication directly into an organ (e.g., brain, liver, head and neck, pelvis) or tumor by means of three types of access devices. Refer to the Oncology Nursing Society (ONS) Access Device Guidelines and Recommendations for Practice (Camp-Sorrell, 2004) for more detailed information.
4. Types of devices a. Short-term percutaneous catheters inserted via
femoral or brachial artery (frequently placed by interventional radiologists)
b. Long-term catheters placed during surgery and used as an external catheter or attached to an implanted pump
c. Implanted ports for long-term therapy
1. Advantages a. Increased exposure of tumor to drug results in
greater tumor response with less systemic side effects.
b. This therapy is considered a local treatment, as the drug's first major site of action is the target lesion, thereby avoiding the first pass effect.
2. Disadvantages a. Less systemic circulation of the chemotherapy
increases the risk for distant metastasis. b. Requires surgical procedure or special radiography
equipment for catheter or port placement. c. Requires specialized nursing education for arterial
pumps. d. When treatment is given by percutaneous catheter,
the patient may have sharply limited mobility for three to seven days.
3. Potential complications a. Bleeding b. Embolism c. Pain d. Pump occlusion or malfunction e. Hepatic artery injury f. Arterial catheter leak or break g. Skin reaction to tape or dressing h. Catheter migration/dislodgment
4. Nursing implications
a. Monitor for signs/symptoms of bleeding, including monitoring prothrombin time (PT)/partial thromboplastin time (PTT).
b. Monitor catheter site for infection, bleeding, signs of catheter migration/dislodgment, including epigastric pain, nausea/vomiting/diarrhea, edema, diminished peripheral pulse, and inability to infuse.
c. Monitor for signs of occlusion, including inability to flush or withdraw fluid, abdominal pain, or change in color/pulse/temperature of involved extremity. If patient is going home with infusion, provide patient education regarding pump and catheter care. Follow pump manufacturer's recommendations for implanted pumps (Barber & Fabugais-Nazario, 2003; Hagle, 2003).
c. Intrathecal/intraventricular (Camp-Sorrell, 2004; Gullatte, 2001) 1. Advantages
a. Affords more consistent drug levels in cerebrospinal fluid
b. Bypasses the blood-brain barrier c. Also can be used to sample cerebrospinal fluid and
to administer opiates and antibiotics
2. Disadvantages a. Requires lumbar puncture or surgical placement of
c. Accessing the Ommaya reservoir is a sterile procedure. Medication to be instilled must be preservative free.
d. Do not use a Vacutainer® (Beckton Dickinson & Co., Franklin Lakes, NJ) to withdraw cerebrospinal fluid (CSF): Rapid withdrawal of fluid could
damage the choroids plexus of the ventricle. Avoid air embolism.
a. Intraperitoneal (Camp-Sorrell, 2004; Goodman, 2000). 4. Advantages
a. Provides direct exposure of intra-abdominal metastases to the drug(s)
b. Also may instill radioactive or colloid materials intraperitoneally
5. Disadvantages: Requires placement of a peritoneal catheter or intraperitoneal port
6. Potential complications a. Abdominal pain b. Distention c. Bleeding d. Ileus e. Intestinal perforation f. Infection
1. Nursing implications a. Warm chemotherapy to body temperature (Otto,
2004). b. Check patency of catheter or port according to
institutional policy. c. Instill solution according to protocol: Infuse drug,
reposition patient for maximum surface exposure to drug, and drain if ordered.
a. Intrapleural: Instills sclerosing agents such as nitrogen mustard, bleomycin, or 5-fluorouracil (5-FU), or sterile talc into the pleural space (Goodman, 2000); also may instill radioactive colloidal materials
2. Advantage: Scleroses the pleural lining to prevent recurrence of effusions
3. Disadvantages a. Requires insertion of a thoracotomy tube b. Physicians must administer the intrapleural agents.
3. Potential complications a. Pain b. Infection
1. Nursing implications
a. The effusion must be completely drained from the pleural cavity before instillation of the drug (thoracentesis).
b. Following instillation, clamp the tubing and reposition the patient every 10-15 minutes for two hours, or as ordered (Otto, 2004).
c. Assess for and treat pain and anxiety.
a. Intravesicular (Goodman, 2000) 2. Advantage: Provides direct exposure of superficial,
localized cancers of the bladder surfaces to drugs, such as thiotepa, mitomycin, epirubicin, doxorubicin, and mitoxantrone
3. Disadvantages: Requires placement of a Foley catheter 4. Potential complications
a. Urinary tract infection b. Cystitis c. Bladder contracture d. Urinary urgency
4. Nursing implications a. Maintain sterile technique during Foley insertion. b. Follow physician orders or protocol for schedule of
repositioning the patient and clamping and unclamping the catheter after instilling the chemotherapy.
f. IV (Camp-Sorrell, 2004; Goodman, 2000) 1. Advantages
a. Consistent absorption b. Required for vesicant and many other agents
3. Disadvantages a. Requires considerable nursing and patient time in a
healthcare facility b. Interferes with patient's activities; sclerosing of
veins over time c. May require surgical procedure for central line
placement
4. Potential complications a. Infection b. Phlebitis c. Infiltration d. Extravasation (INS, 2000) e. Local discomfort
f. Drug-specific concerns
1. Nursing implications will be discussed in the following section.
1. IV cytotoxic administration: Most cytotoxic agents are given intravenously. Refer to Access Device Guidelines: Recommendations for Nursing Practice and Education (Camp-Sorrell, 2004) for a complete discussion of obtaining IV access.
a. Peripheral IV access 4. Existing IV site
a. Avoid using a site that is more than 24 hours old. b. Assess the insertion site for signs of inflammation
and infiltration, and consider the patient's statements about comfort. Use another access site if there is any doubt about the integrity of the IV site.
c. Assess blood return and patency.
1. New IV site: Avoid use of steel needles for vesicant administration (O'Grady et al., 2002). Select the smallest gauge and shortest length catheter to accommodate the prescribed therapy (INS, 2000). Consider use of dermal anesthesia to minimize pain during IV insertion.
a. In adults (Camp-Sorrell, 2004; Goodman, 2000) i. Identify an appropriate IV site by assessing
the patient's arms carefully. Veins of choice are smooth and pliable; the large veins of the forearm are preferred.
ii. Avoid establishing an IV site in the following.
Injured or sclerosed veins Areas of flexion Small, fragile, tortuous veins An extremity with altered venous
return or lymphedema An extremity with decreased
sensation or paresthesia The lower extremities
i. Perform venipuncture per institutional policy and procedure.
ii. Establish blood return and patency. iii. Secure the IV device appropriately, in a
manner that allows a clear view of the site. iv. If venipuncture is unsuccessful, utilize the
opposite arm for the next attempt. If it is not
possible to use the opposite arm, select a site proximal to the first venipuncture.
a. In children, select an appropriate site, following institutional policies and the guidelines that follow (Hankins, Lonsway, Hedrick, & Perdue, 2001).
i. If possible, do not use the feet or dominant hand of an infant or toddler as an IV site.
ii. The veins of the scalp of a child younger than 12 months old can be used as an IV site; however, do not use a scalp vein to administer a vesicant.
iii. Stabilize the extremity, if necessary, while inserting and securing the IV.
a. Central venous catheters (CVCs): CVCs include percutaneous subclavian catheters, tunneled subclavian catheters, and peripherally inserted central catheters (PICCs). (A midline catheter is considered a peripheral line because it ends in the middle of the upper arm.) An implanted port, although technically a CVC, is unique and will be addressed later. Note: Most CVCs require the use of syringes larger than 10 cc to minimize pressure (pounds per square inch [psi]) on delicate catheter walls (Camp-Sorrell, 2004). Follow manufacturer's and institutional guidelines carefully to avoid catheter rupture. After CVC insertion and before administering the agent, perform the following.
4. Verify that the catheter's placement is correct prior to initial use per institutional guidelines.
5. Inspect exit site for evidence of erythema, swelling, drainage, and leakage.
6. Inspect ipsilateral chest for signs of venous thrombosis (Mayo & Pearson, 1995).
7. Aspirate the line to verify blood return. If blood return is not evident,
a. Flush the catheter with saline, gently using the push-pull method.
b. Reposition the patient as appropriate. c. Ask the patient to cough. d. Explain to the patient why delaying therapy is
necessary. Although patients may report that lack of blood return from their catheter is common, do not administer cytotoxic therapy.
e. Obtain a physician's order for a declotting procedure; follow institutional protocol.
f. Use x-rays or dye studies to confirm proper CVC placement and rule out catheter malfunction or migration in the absence of a blood return.
a. Implanted ports: Implanted ports are available that allow venous, peritoneal, arterial, and epidural access. Ascertain which type is being used. Some patients have more than one type.
1. Assess initial line placement by using the results of x-ray or fluoroscopic dye studies.
2. Choose a noncoring needle (Goodman, 2000) with a length that is appropriate to the
a. Depth of the port b. Size of the patient (i.e., the amount of SQ tissue or
fat located above the port).
2. Prepare the patient's skin according to institutional policy. 3. Access the port, ensuring proper placement of the needle in
the reservoir. 4. Establish blood return and patency. If blood return is not
evident, repeat steps listed for CVCs. (Blood return is not expected with epidural or peritoneal access devices.)
5. Inspect the needle insertion site for needle dislodgment, leakage of IV fluid, drainage, or edema.
6. Examine the ipsilateral chest for venous thrombosis. 7. Apply an occlusive dressing to stabilize the needle. The
dressing should be transparent, to allow a clear view of the insertion site. Experts disagree about other dressing characteristics that are desirable (Camp-Sorrell, 2004). When working with children, padding the undersides of the butterfly wings of the access needle may be necessary if the needle does not lie securely on the skin.
a. Piggy-back or short-term infusion 1. Verify blood return and IV patency prior to hanging the
infusion. Do not pinch the IV catheter to determine blood return because of the resulting dramatic change in pressure within the vein. Preferred methods of verifying patency are the following.
a. Use a syringe inserted at the injection port closest to the patient to gently aspirate the line, while pinching off fluid from the bag.
b. Use a gravity check by removing the bag from the pump, lowering it below the patient's IV site, and watch for blood return.
1. Attach the secondary tubing to the appropriate injection port, using a needleless, Luer lock connector (INS, 2000).
2. Initiate flow rate according to the physician's orders and observe the patient closely for any reactions.
3. When administering a vesicant drug by short infusion using a peripheral vein,
b. Avoid using an IV pump in order to decrease pressure on the veins.
c. Monitor the site for signs of extravasation every 5-10 minutes for infusions less than 30 minutes. If an infusion is longer than 30 minutes, check blood return every 10-20 minutes.
d. Avoid infusing vesicant agents peripherally for more than 30-60 minutes.
1. Once the short infusion is complete, check vein patency and flush the line with a compatible IV solution.
a. Continuous infusion i. Follow guidelines for checking blood return
and IV patency. ii. The cytotoxic agent may be connected
directly to the IV catheter, or into a compatible line of maintenance solution, according to institutional policy.
iii. Secure all connections with locking devices. iv. Monitor the IV site throughout the infusion
according to institutional policy and procedure. Monitor the patient closely for any reactions, such as signs or symptoms of hypersensitivity (Otto, 2004). Age-specific concerns: For pediatric patients with continuous infusions, monitor the IV site hourly or according to institutional policy (Shutak, 2000).
v. When administering a vesicant, (Chu & DeVita, 2005; Vandergrift, 2001)
DO NOT use a peripheral IV site for continuous vesicant administration.
Use a central venous access catheter or implanted access device to administer any vesicant infusing for longer than 30-60 minutes.
Check for blood return and patency periodically, according to institutional policy.
i. Once the infusion is complete, check vein patency and flush the line with a compatible IV solution (Otto, 2004).
a. IV push: Refer to physician orders and/or pharmacy guidelines for suggested IV push rates, diluents, and other drug-specific details (Goodman, 2000; Vandergrift, 2001).
i. Free-flow method (side-arm technique) Attach the syringe with the drug at
the injection port closest to the patient.
Aspirate the line in order to verify IV patency.
Allow IV solution to flow freely. Slowly administer the chemotherapy
agent as an IV push, allowing the flush solution to dilute the drug. Unless otherwise indicated, administer the agent at a rate of 1-2 ml/minute.
When administering a vesicant, verify blood return every 2-5 ml.
Once the IV push is completed, check vein patency and flush the line with a compatible IV solution.
i. Direct push method: Some institutions may require that certain cytotoxic agents be administered as an IV push directly into the IV device (Goodman, 2000; Temple & Poniatowski, 2005; Vandergrift, 2001).
Select an appropriate vein and prep the skin according to policy.
Establish a patent IV, flushing the new line with sterile IV solution (typically normal saline [NS] or 5% dextrose in water [D5W])
Verify blood return by aspirating the line gently.
Detach the flush syringe, and attach the syringe containing the cytotoxic agent. Maintain sterile technique and minimize blood loss.
Slowly administer the agent, aspirating for blood return every 2-5 ml.
Upon completion of the IV push, disconnect the cytotoxic syringe. Avoid blood loss; the blood will contain the cytotoxic agent.
Connect a syringe containing sterile flush solution; gently flush the catheter.
Cap or discontinue the IV access device, as indicated.
4. Prosedur Pemberian Obat Kemotherapi
Memastikan identitas pasien, obat, dosis, rute dan waktu pemberian sesuai petunjuk
dokter
Kaji riwayat obat
Mengatisipasi dan merencanakan kemungkinan terjadinya efek samping atau toksiksitas
sistemik.
Membahas data laboratorium dan pemeriksaan lainnya
Memastikan persetujuan tindakan untuk terapi
Memilih peralatan yang sesuai
Terdapat tiga golongan besar
B. Tujuam
C. Indikasi dan Kontraindikasi
1. pengertian2. tujuan3. indikasi/kontra indikasi4. persiapan : alat, lingk,pasien5. prosedur kerja6. hal – hal yang perlu diperhatikan/ kritikal thinking7. daftar literatur
Referensi
Gale.D & Charette.J (2000) ; Rencana asuhan keperawatan oncology : alih bahasa I Made Kariasa .SKp , EGC, Jakarta.
Smith.S, Duell.d & Martin.B ( 2000) ; Clinical Nursing Skills Basic To Advance Skills: Third Edition . United Stated of America
Baggott.C.R, Kelly.K.P, Fochtman.D. & Folley.G.V. (2002) Nursing Care of Children and Adolescents With Cancer. Third Edition. WB. Sounder Company. Philadephia, Pennsylvania