Intrathecal Chemotherapy Administration



Canberra Hospital and Health Services

Clinical Procedure

Intrathecal Chemotherapy Administration including Lumbar Puncture (Adults Only)

|Contents |

Contents 1

Purpose 2

Alerts 2

Scope 3

Section 1 – Induction and Training 3

Section 2– Prescribing Intrathecal Chemotherapy 4

Section 3 – Timing of procedures and administration of Intrathecal Chemotherapy 4

Section 4 – Clinical Locations Where Intrathecal Chemotherapy can be Administered 5

Section 5 – Lumbar Puncture 5

Section 6 – Procedure for administering Intrathecal Chemotherapy 10

Section 7 – Post Procedure 13

Section 8 – Unsuccessful Procedure 13

Implementation 14

Related Policies, Procedures, Guidelines and Legislation 14

References 15

Search Terms 15

|Purpose |

To outline the expected practice for safe administration of intrathecal chemotherapy in order to avoid potentially fatal errors, such as the inadvertent administration of inappropriate chemotherapeutic agents including vincristine.

This document describes the processes required perform this procedure including:

• Identification of patients who are appropriate for this procedure

• Identification of patients who are appropriate for sedation during this procedure

• Identification of safety requirements and patients at increased risk during this procedure

• Requirements for staff performing and assisting with this procedure

• Lumbar Puncture procedure

• A summary of the minimum requirements for this procedure.

Back to Table of Contents

This Standard Operating Procedure (SOP) describes for staff the process to

|Scope |

|Alerts |

• The inadvertent intrathecal administration of many other medicines, such as vinca alkaloids (vincristine, vinblastine, vindesine, vinorelbine) is FATAL for the patient.

• Intrathecal chemotherapy is provided in small volume syringes, in comparison to intravenous chemotherapy, which is prepared in large volume (i.e. 50 mL or greater) bags.

• Intrathecal chemotherapy is delivered in distinctive specially labelled containers to distinguish it from intravenous chemotherapy.

• Intrathecal chemotherapy MUST only be administered by a Haematology or Medical Oncology Advanced Trainee or Consultant.

• If there is a discrepancy or any doubt over the suitability of any injection for intrathecal use, do not administer and seek further clarification from senior medical and/or pharmacy staff.

• Infection control is a paramount consideration when performing a Lumbar Puncture.

• Consent must be obtained prior to administration of sedation, in compliance with the CHHS Procedural Sedation guidelines, as well as for the lumbar puncture and the administration of intrathecal chemotherapy.

• Complications or unexpected outcomes should be recorded onto the Riskman incident reporting system as soon as practically possible.

Back to Table of Contents

|Scope |

This procedure is for use by all staff of the Clinical Haematology/Bone Marrow Transplant (BMT), Medical Oncology Units and Oncology Pharmacy within the Canberra Hospital who may be involved with intrathecal chemotherapy prescription, preparation or administration.

Medical Officer

Intrathecal chemotherapy can only be administered by a haematology or medical oncology advanced trainee or consultant who is on the Lumbar Puncture (LP) and intrathecal chemotherapy log, which is kept by the individual units on their staff in the respective departmental secretariat.

• A lumbar puncture must be performed by a competent medical officer – trained Advanced Trainee or consultant with the assistance of an adequately trained staff member

• Only trained Advanced Trainees and Consultants on the LP and intrathecal chemotherapy log can administer intrathecal chemotherapy

Assisting Staff Member

• To assist the Medical Officer and administer prescribed sedation

• To comply with the CHHS Procedural Sedation Guidelines and the CHHS Lumbar Puncture procedure.

Haematology Consultant

• Identify and request procedure for appropriate adult patients that require a Lumbar Puncture Procedure.

Back to Table of Contents

|Section 1 – Induction and Training |

Induction training should be given to all staff, appropriate to their needs with regard to prescribing, checking and practical administration of intrathecal chemotherapy. This should cover potential hazards associated with chemotherapy and particularly the risks associated with inappropriate or incorrect intrathecal drug administration. Consultant staff and experienced Advanced Trainees are responsible for training medical staff. A competency log will be kept on all staff that have been trained within the division and is to be kept by the individual units on their staff. The training log should be kept in the respective departmental secretariat.

Staff involved with chemotherapy MUST be provided with a copy of this document together with accompanying protocols and guidance.

Back to Table of Contents

|Section 2– Prescribing Intrathecal Chemotherapy |

• Intrathecal chemotherapy may only be prescribed by Clinical Haematology/BMT or Medical Oncology, consultant or advanced trainee.

• Intrathecal chemotherapy will only be dispensed after the pharmacist has confirmed that it has been prescribed by a designated advanced trainee registrar or consultant. A list of suitably trained staff will be maintained by Pharmacy and will be updated annually

• The administering Medical Officer must check the relevant treatment protocol which includes the intrathecal therapy for the individual patient and be educated in the standard doses of intrathecal chemotherapy

• The prescription for an intrathecal chemotherapy order should be made available to Pharmacy 24 hours prior to the proposed administration time

• The drug, dose and route of administration MUST be clearly written in full on the CHARM prescription

• The route of administration MUST be written as 'INTRATHECAL' on all prescriptions, the abbreviation 'IT' is NOT acceptable and prescriptions written in this manner will not be dispensed by Pharmacy

• Intrathecal chemotherapy will only be dispensed from written orders. Under NO circumstances will phone orders for intrathecal chemotherapy be accepted

• ONLY methotrexate, cytarabine (Ara-C, cytosine arabinoside) and dexamethasone should be administered intrathecally unless otherwise specified by the consultant.

Back to Table of Contents

•

|Section 3 – Timing of procedures and administration of Intrathecal Chemotherapy |

• Except in an emergency, all intrathecal chemotherapy and lumbar punctures should be administered during the normal working day, preferably in the morning i.e. at times when a full range of specialist expertise, knowledge and support is readily accessible.

• Only in exceptional circumstances (such as CNS leukaemia requiring emergency treatment), should intrathecal chemotherapy be administered out of hours by the consultant or advanced trainee. In these instances, there must be a clear clinical need for the procedure to be undertaken immediately not the next working day.

• The afterhours or weekend administration of an intrathecal dose of chemotherapy requires direct authorisation by the responsible Clinical Haematology/BMT or Medical Oncology consultant. The pharmacist MUST ring the relevant consultant to confirm that the chemotherapy is required out of hours.

• Intrathecal doses of chemotherapy MUST NOT be administered concurrently with any intravenous cytotoxic drug.

• Where possible, intravenous doses of chemotherapy should be prescribed and administered on a day prior to the administration of the intrathecal dose. This is particularly important for regimens which contain an intravenous vinca alkaloid such as vincristine.

• If this is not possible, intrathecal chemotherapy drugs should be administered after drugs to be given by other routes are supplied and given.

• If a regimen involves intrathecal chemotherapy combined with continuous intravenous chemotherapy, it is only acceptable to administer intrathecal chemotherapy once the infusional chemotherpay has commenced.

• Only the intrathecal chemotherapy should be taken into the room for administration.

• All other chemotherapy should be removed from the immediate location of the procedure.

Back to Table of Contents

|Section 4 – Clinical Locations Where Intrathecal Chemotherapy can be Administered |

• Administration of intrathecal chemotherapy should generally only be performed in clinical areas where staff are familiar with the procedure and emergency resuscitation equipment is available.

• For inpatient procedures, the Medical Officer performing the procedure is responsible for ensuring the area is appropriate and procedural requirements are met.

• In cases where the lumbar puncture needle has to be placed under radiological imaging guidance, the intrathecal chemotherapy may be administered in the Radiology Department. In this circumstance, the administration of the intrathecal chemotherapy remains the DIRECT responsibility of the Clinical Haematology/BMT or Medical Oncology advanced trainee or consultant and must under NO CIRCUMSTANCES be delegated to Radiology staff.

• The same process for prescribing, delivery and sign off of the intrathecal chemotherpay as outlined in this document will occur in Radiology.

• Under NO circumstances can intrathecal chemotherapy be administered in the Emergency Department.

Back to Table of Contents

|Section 5 – Lumbar Puncture |

Lumbar punctures will be performed only after the completion of appropriate actions:

• Adequate patient assessment and preparation

• Notification of appropriate staff and area involved in the performance of the procedure

• Patient has provided informed written consent to procedure

• Correction of coagulopathy is advised (full coagulation profile and fibrinogen levels should be checked) as well as correction of thrombocytopenia (platelets>50). Anticoagulation should be ceased prior to the procedure at a time determined by the haematology or medical oncology treating team.

5.1 Prior to procedure

All patients require an Identification band and/or Allergy Band to be applied prior to the procedure.

A “Team Time Out” for “Positive Identification” is to occur prior to the procedure. The dedicated staff members involved in the procedure will confirm the following in accordance with ACT Health Patient Identification and Procedure Matching Policy and Procedure:

• Informed consent has been obtained

• The patient’s identity – this is to be checked against the patient identification band and through positive identification e.g. verbal

• The procedure to be performed and sedation agent to be given

• The procedure side/site is marked if applicable

• That all relevant documentation and imaging data are available

The patient must be dressed in a hospital gown for this procedure to allow for ready access to ECG monitoring, airway management and resuscitation if required.

All patients receiving sedation require IV access. If blood products are required during the procedure, a second IV access is preferred.

Patient may require peripheral blood tests prior to the procedure. These are to be ordered by the requesting Medical Officer.

Patients require baseline observations to be performed and recorded prior to the procedure (BP, Pulse, SpO2, RR and Sedation Score) and weight. Refer to Vital Signs and Early Warning Scores Procedure.

5.2 Indications

• Diagnostic indications

o Infectious disease

o Inflammatory process

o Malignant process

o Metabolic process

• Therapeutic indications

o Delivery of chemotherapy

o Central nervous system prophylaxis for acute lymphoblastic leukaemia and high grade/high risk non-Hodgkin's lymphoma

o Treatment of primary involvement or spread of some tumours, such as leukaemia and lymphoma, to the central nervous system.

5.3 Relative contraindications to procedure

• Cardiorespiratory compromise, where positioning for the procedure is likely to worsen the patient’s clinical condition

• Signs of cerebral herniation, including signs of increased intracranial pressure, potentially increased intracranial pressure or focal neurological signs. If there are concerns, a CT should be performed prior to lumbar puncture to assess risk.

• Coagulopathy will increase risk of a haematoma. Assessment for thrombocytopenia, anticoagulant therapy or coagulation defect is required. Correction of thrombocytopenia or coagulopathy must be undertaken prior to procedure being undertaken if required. No specific cut offs are determined, if unsure, consultant haematologist should be consulted prior to performing procedure.

• Infections: local skin infection, febrile, rigors, sepsis or severe infection.

If any concern exists, the patient’s condition should be discussed with the Consultant Haematologist or Medical Oncologist prior to proceeding.

There must be a minimum of two staff to perform the procedure

• A Medical Officer who has been deemed competent to perform the procedure or is training to do so under supervision

• A second staff member who is adequately trained to be solely responsible for the administration of medication, monitoring and care of the patient.

All staff using sedation during the procedure are to be familiar with and comply with the Procedural Sedation guidelines.

5.4 Patient assessment, preparation, and consent:

5.4.1 Written Consent

Refer to Consent and Treatment Policy. Written Consent is to be obtained (these apply for inpatients or outpatients) and documented

• By the consultant at the time of consultation and when initiating booking of the lumbar puncture, or

• By the medical officer performing the lumbar puncture/intrathecal chemotherapy at the time of procedure.

Written informed consent for the procedure is to be obtained prior to the procedure including details of the procedure and possible risks. If sedation or intrathecal chemotherapy is to be administered, written consent must also be obtained for this if not done previously.

Note:

Consent must be obtained prior to administration of sedation, in compliance with the CHHS Procedural Sedation guidelines and Consent and Treatment Policy.

5.4.2 Assessment

All patients should be assessed by the Medical Officer before the procedure including

• Prior illnesses and conditions

• Medication history

• Medication allergies (recorded on Haematology & Oncology Procedural Sedation Form and ensure allergy band is present)

• Relevant pathology results for the procedure and patient condition e.g. platelet count, coagulation profile, Renal and Liver Function

• Blood glucose level for diabetic patients

• Last food/fluid intake

• Accurate weight (in compliance with TCH Procedural Sedation guidelines)

• Vital signs

5.4.3 Patient preparation

Patient education

• Adequate preparation and education of the patient and/or carer should be provided by the Medical Officer wherever possible.

5.4.4 Fasting

• Patients are to fast from food and fluids for a minimum of 4 hours prior to sedation.

5.4.5 Other preparations prior to Lumbar Puncture

• Sedation- considerations for patients potentially requiring sedation

o An anaesthetic consultation is required if the patient is to be sedated and has any serious medical conditions or is morbidly obese. (As per TCH Procedural Sedation Guidelines)

o Reversal agents for the chosen form of sedation and/or pain relief must be available within the ward or area where the procedure is being performed.

• Blood products

o If supportive blood products or treatments are required prior to the lumbar puncture, these are the responsibility of the Medical Officer requesting the procedure or the Medical Officer performing the procedure.

o The procedure may need to be rescheduled if these have not been organised prior to the booked procedure time.

• Pathology request form

o Sample of CSF for laboratory analysis should be collected in all patients.

o Tests required vary based on indication for lumbar puncture, but as a minimum should include cell count and differential, glucose, protein, microscopy, cell culture and sensitivities.

o It is the responsibility of the Medical Officer performing the procedure to ensure appropriate tests are requested and specimens are sent to the laboratory for analysis.

• Intrathecal chemotherapy

o The ward/doctor must notify Pharmacy of the expected administration time, no less than one hour prior to its administration

• Allergies

o The patient should be asked for any allergies or reactions to medications. Available documentation should also be reviewed for this information.

5.4.6 Materials

|Procedure component |Equipment required |

|IV Cannulation and Blood Sampling |IV starter Kit Tourniquet |

| |Vacuette Blood Tubes |

| |Cannula |

| |Normal saline for injection 10 mLs, 10 mL syringe |

| |SmartSite bung |

| |Chlorhexidene gluconate swab- skin antisepsis Alcohol swab- IV access antisepsis |

|Sedation |4x 10 ml syringes |

| |2 x saline ampoules, Sedation drugs (if required), Pain relief drugs (if required), Syringe |

| |labels |

| |Drawing up needles, Combi stoppers, Procedural sedation form, Observation equipment |

| |Oxygen mask- Hudson mask |

|Procedural Trolley |Lumbar puncture kit |

| |Sterile green drapes |

| |Fenestrated drape |

| |Lumbar puncture needle of desired gauge |

| |1 x 10mL syringe |

| |1 x 25G needle 1 x 23G needle |

| |2% Lignocaine ampoules x 2 |

| |Chlorhexidine solution |

| |Sterile gauze |

|PPE Trolley |Sterile Gown (chemotherapy gown if required) |

| |Sterile gloves |

| |Protective eye wear |

| |Cytotoxic sharps bin (if required) |

|Patient bed |Underpad (bluey) |

| |Slide sheet |

5.4.7 Patient Discharge

The patient may be discharged home, if required, following comprehensive discharge instructions being provided to the patient and carer. This is the responsibility of the discharging staff member.

5.5 Clinical Documentation

Summary of forms and documentation to be completed for a lumbar puncture:

• ACT Pathology Request Form- ready prior to procedure - goes with CSF specimen to pathology- (Consultant/Registrar responsible)

• Lumbar Puncture Consent form- prior to or at time of procedure- (Consultant/Registrar responsible) is filed in the patient medical records.

• Haematology and Oncology Procedural Sedation Form- post procedural medical and nursing orders must be clearly documented- (Medical Officer/Registered nurse conducting lumbar puncture responsible).

• Patient progress notes- procedure documented (Consultant/Registrar responsible). Minimum details include indication for procedure, date, time, how the procedure was performed, and any drugs administered, how the patient tolerated the procedure and any complications.

Back to Table of Contents

|Section 6 – Procedure for administering Intrathecal Chemotherapy |

• Intrathecal chemotherapy is provided by Pharmacy in small volume syringes (each syringe is usually made up to 2mLs) and will be delivered in distinctive specially labelled containers not used for any other purpose.

• Intrathecal chemotherapy will be stored in the Oncology Pharmacy and can be delivered or collected by the concerned nurse in the designated treatment area in the ward immediately prior to the administration time

• Out of hours, the prescribing and administering doctor will go to Pharmacy to collect the intrathecal chemotherapy

• It is NOT desirable to store intrathecal chemotherapy drugs outside the Pharmacy between issue and administration

• The pharmacist, the administering doctor, and the nurse will all confirm the patient name and URN, the drug, the dose and the intrathecal route and sign the CHARM order. The patient's medication chart will be checked to ensure that all intravenous chemotherapy ordered for that day has been administered

• Immediately before the dose is administered labelled syringes containing intrathecal chemotherapy MUST again be checked by two people - the administering doctor and chemotherapy trained nurse, pharmacist or a second haematology or oncology advanced trainee or consultant - and matched to the patient name and URN

• The syringes MUST also be matched against the written drug orders for name of patient and drug, URN, dose, route of administration and also checked for the expiry date

• Some patients may choose to check the name and dose of the drug(s) prescribed on the chart with those on the label of the syringe. They should be enabled to do this if they so wish.

• All the MET criteria must be followed based on the clinical condition of the patient.

• Patient’s platelet count and coagulation parameters should be checked prior to doing a lumbar puncture. Anticoagulation should be ceased appropriately prior to doing above intervention.

• Lumbar puncture in a newly diagnosed acute leukaemia particularly acute promyelocytic leukaemia should be checked with the concerned consultant.

Alert:

If there is a discrepancy or any doubt over the suitability of any injection for intrathecal use, do not administer and seek further clarification from senior medical and/or pharmacy staff.

6.1 Positioning

• Either lateral recumbent or sitting position should be assumed

• Lateral recumbent position is preferred, to obtain opening pressures and to reduce risk of post lumbar puncture headache

• It can be performed in either left or right decubitus or upright position

• The patient should be instructed to adopt the foetal position or arch “like a cat” with their back flexed, to widen the gap between the spinous processes.

• The lumbar spine should be perpendicular to the table if in sitting position or parallel to the table if in lateral recumbent position.

6.2 Landmarks

• Draw a line visually between the superior aspects of the iliac crests that intersect the midline at the L4 spinous process.

• The needle can be inserted in the interspace between L3 and L4 or L4 and L5 as these points are below the termination of the spinal cord.

• Palpate the landmarks before preparing the skin and applying local anaesthetic as they may obscure landmarks.

• Use a skin marking pen to indicate proper position.

6.3 Preparation

• Don sterile gloves and gown

• Clean the overlying skin with an appropriate disinfectant (chlorhexedine-based or povidine-iodine). Apply in widening concentric circles.

• Cover the area with sterile drapes.

6.4 Analgesia and Sedation

• Local anaesthesia as a minimum is appropriate

• After the skin has been cleaned and draped, local anaesthetic can be infiltrated subcutaneously

• If required, intravenous sedation may be used.

6.5 Lumbar puncture

• After confirming landmarks, insert the needle with stylet firmly in place, at the superior aspect of the inferior spinous process, in the midline, approximately 15 degrees cephalic, aiming at the patient’s umbilicus

• The bevel of the needle should be in the sagittal plane, to spread, rather the cut fibres of the dural sac.

• If properly positioned, the needle should pass through the skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space and into the subarachnoid space.

• A popping sensation may be felt when the needle passes the ligamentum flavum.

• After this point, withdraw the stylet in 2-mm intervals to assess for CSF flow.

• If the attempt is unsuccessful and bone is encountered, withdraw the needle to the subcutaneous tissue, without exiting the skin and redirect the needle.

• CSF will flow once subarachnoid space has been entered.

• If the lumbar puncture was traumatic, the CSF may be discoloured with blood.

• The blood should clear as CSF is collected, unless the cause of blood is a subarachnoid haemorrhage.

• If CSF flow is poor, rotate the needle 90 degrees, a nerve root may be obstructing the opening.

6.6 Opening pressure

• This can only be obtained in lateral recumbent position.

• Connect the manometer supplied in the lumbar puncture kit to the hub of the needle prior to obtaining any other samples.

• A measurement is made after the column of fluid stops rising

• Opening pressure should be performed on diagnostic lumbar punctures or during other procedures if requested.

6.7 Specimen collection

• Allow CSF to drip into the collection tubes. Do not aspirate CSF; small amounts of pressure can cause a haemorrhage.

• The amount of fluid varies depending on the indication for lumbar puncture. Minimal samples should always be collected and sent to the laboratory for analysis.

• If intrathecal chemotherapy is to be administered, the volume collected should approximate the volume of intrathecal chemotherapy to be administered.

• If opening pressure was undertaken, the CSF in the manometer should also be collected.

6.8 Intrathecal chemotherapy

• The chemotherapy drugs should be administered with a SLOW push, NOT with a rapid push. Start with either Methotrexate and Cytarabine and end with Dexamethasone.

• Removal of needle

• After collection of samples and administration of chemotherapy (if required), replace the stylet and remove the needle after the last chemotherapeutic agent has been administered.

• Dressing

• The site should be cleaned and a dressing applied.

6.9 Administration of Intra-Ventricular Chemotherapy using a Ventricular Reservoir System (e.g. Ommaya Reservoir)

• The catheter position must be checked by CT scan post insertion prior to administration of any therapy.

• Approval for use by Neurosurgical Unit Medical staff after insertion must be documented in the patient's Unit Record.

• Only a Clinical Haematology/Bone Marrow Transplant or Medical Oncology Advance Trainee or Consultant, who is proficient in accessing the reservoir should administer chemotherapy via this route.

6.10 Post care

• All sharps, infectious and chemotherapy waste should be disposed of according to the ACT Health Waste Management Plan.

• Ensure all specimens are appropriately labelled and dispatched to Pathology with an appropriate pathology request form.

Back to Table of Contents

|Section 7 – Post Procedure |

Patient should be monitored for complications from the procedure. The patient and nursing staff should notify a Medical Officer if any concerns exist. This includes headache, back pain, ANY neurological symptoms (or signs) or bleeding.

Possible complications include:

• Herniation

• Cardiorespiratory compromise

• Local or referred pain

• Headache

• Bleeding

• Infection

• Subarachnoid epidermal cyst and

• Leakage of CSF.

Staff should follow Section 5 of the Admission to Discharge operational procedure on the Policy Register in relation to the discharge process.

Back to Table of Contents

|Section 8 – Unsuccessful Procedure |

• Obesity, osteoarthritis, ankylosing spondylitis, kyphoscoliosis, previous lumbar surgery and degenerative disc disease may make the procedure more difficult.

• If unable to successfully obtain CSF and enter the subarachnoid space, alternative arrangements should be made for the procedure to be re-attempted, including a more experienced Medical Officer or radiology guided procedure.

• No more than 2 attempts should be undertaken by a single practitioner.

• Occasionally in difficult cases this should be done under imaging guidance.

• Any unused/ residual chemotherapy must be returned to pharmacy immediately to be discarded. The pharmacist will check that this occurs.

Back to Table of Contents

|Implementation |

This procedure will be communicated to staff through:

• CACHS Clinical Governance Committee

• Haematology Unit Meeting

• Medical Oncology Unit Meeting

Back to Table of Contents

|Related Policies, Procedures, Guidelines and Legislation |

Policies

• Health Directorate Nursing and Midwifery Continuing Competence Policy

• Consent and Treatment

• Medication Handling Policy

Procedures

• Anticoagulation Management

• Aseptic Non Touch Technique

• Admission to Discharge Canberra Hospital and Health Services

• Central Venous Access Device (CVAD) Management – Children, Adolescents and Adults (not neonates)

• Clinical Handover

• Clinical Record Documentation Consent and Treatment

• Critical Bleeding Massive Transfusion – Adults

• Fresh Blood Products Administration (Adults, Paediatrics and Neonates)

• Healthcare Associated Infections Clinical Procedure

• Immunoglobulin Authorisation and Administration Adults, Paediatrics and Neonates

• Nursing and Midwifery Continuing Competence Policy

• Procedural Sedation

• Patient Identification and Procedure Matching

• Patient Identification – Pathology Specimen Labelling

• Vital Signs and Early Warning Signs

Guidelines

• CHHS Fasting Guidelines – Elective and Emergency Surgery

• Waste Management Plan

Legislation

• Health Records (Privacy and Access) Act 1997

• Human Rights Act 2004

• Work Health and Safety Act 2011

Back to Table of Contents

|References |

1. Bayside Health Administration of Intrathecal Chemotherapy Guideline, Dr Sharon Avery, 2006

2. Ellenby MS, Tedtmeyer K, Lai S and Braner D. Lumbar Puncture. New England Journal of Medicine. Sept 2006; 355: e12.

3. Johnson K and Sexton D. Lumbar puncture: Technique, indications, contraindications, and complications in adults. UpToDate Feb 2016.

4. Gilbar P and Carrington C. Inadvertent intrathecal administration of vincristine. Committee of Specialty Practice in Oncology, The Society of Hospital Pharmacists of Australia (SHPA). COSA Abstracts, 168 (2004).

5. Angela Stefanou and Michael Dooley. Simple method to eliminate the risk of inadvertent intrathecal vincristine administration. JCO 21:2044, 2003.

6. Updated National guidance on the safe administration of intrathecal chemotherapy. Department of Health. Available at .uk

Back to Table of Contents

|Search Terms |

Intrathecal, Chemotherapy, Lumbar Puncture, Intra-Ventricular Chemotherapy

Back to Table of Contents

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:

|Date Amended |Section Amended |Divisional Approval |Final Approval |

|24/01/2018 |Complete Review |ED CACHS |CHHS Policy Committee |

| | | | |

This document supersedes the following:

|Document Number |Document Name |

|CHHS13/470 |Intrathecal Chemotherapy Administration |

| | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download