Prior to administering IP chemotherapy, the nurse verifies that the order is correct by identifying the “five rights”: right patient, agent, dose, route, and frequency. The nurse also ensures that the appropriate supportive medications are ordered for safe administration. The Joint Commission has issued a Sentinel Event Alert regarding tubing and catheter misconnection errors.[13] Several strategies are recommended to prevent/reduce wrong-route errors. One strategy is to educate staff about ways to reduce this risk. Next, always trace a tube/line from the patient to the point of origin before connecting the infusion. As part of the handoff process, recheck connections and trace all tubes/lines to the point of origin when caring for a new patient.
Nurses need to educate patients and families about the importance of connecting the tubing to the correct site. Also, some institutions label the lines, that is, IV vs IP. At MSKCC, prior to initiating IP chemotherapy, two nurses will trace the IP chemotherapy agent and tubing to the patient's IP port and connect the tubing in order to verify the correct route of administration. Both nurses verify the connection of the tubing to the correct site to reduce/prevent tubing misconnection errors. As with any other chemotherapy treatment modalities, staff should wear PPE (personal protective equipment) when administering chemotherapy.
TYPE OF IP ACCESS
IP therapy is administered via a Tenckhoff peritoneal dialysis catheter or an IP port. At our center, we administer IP chemotherapy via an IP port. Two different types of ports are currently used to administer IP therapy. We use an IP implantable port with a fenestrated catheter (14.3 French). Others have recommended the use of a venous implantable port connected to a single lumen venous catheter (9.6 French). See Figure 1 for pictures of both devices.
When comparing ports, note the difference in port size and lumen size of the catheter. Also, the fenestrated end has multiple holes (openings) vs the blunt, open-ended catheter. It has been suggested that use of peritoneal catheters with fenestrations and Dacron cuffs is associated with a greater incidence of bowel adhesions and erosion into the bowel.[2] IP ports do not have Dacron cuffs at this time. To date there is no study regarding the type of implantable port to be used for IP chemotherapy.
The following three studies are based on our experience at Memorial Sloan-Kettering Cancer Center using a fenestrated IP catheter. Black et al.[14] reviewed medical records of all patients who had a fenestrated catheter placed from May 1997–May 2006 at our center.[14] They reviewed 342 patients and identified only nine (3%) who had chemotherapy discontinued because of catheter complications. Other complications included catheter-related infections (three patients), inflow obstruction (five patients), and inability to access the port (one patient). Makhija et al.[15] analyzed the charts of 301 patients and identified 30 (10%) who had catheter-related complications. A total of 19 patients (6.3%) had inflow obstruction and 11 (3.6%) experienced infection. The investigators reported that 93% of the patients completed their planned therapy. Davidson et al.[16] reviewed 227 patient charts and found that 8.8% (20 patients) had inflow obstruction, 5.3% (12 patients) had catheter-related infections, and 3.5% (eight patients ) had a bowel perforation.
