Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part II : Implementation

Clinical Issues - January 2024

Off-label medication use and prescribing practices Key words: off-label, licensed prescriber, approved, unapproved, US Food and Drug Administration (FDA). Prophylactic, therapeutic, and empiric use of antimicrobial agents Key words: prophylactic, therapeutic, empiric, infection, antimicrobial. Perioperative RN administration of antineoplastic agents Key words: antineoplastic medication, chemotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC), instillation device, perfusionist. Minimum efficiency reporting values, parameters, and testing for air filters in heating, ventilation, and air-conditioning systems Key words: heating, ventilation, and air-conditioning (HVAC); minimum efficiency reporting value (MERV); particle size removal efficiency; air filter; filtration.

Perianesthesia Care of the Oncologic Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Retrospective Study

PURPOSE

This study was to understand the perianesthesia care for patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS  + HIPEC).

METHOD

This is a retrospective study.

DESIGN

The perioperative electronic medical records of 189 CRS  + HIPEC surgical cases at a hospital of Western Pennsylvania from 2012 to 2018 were analyzed to study the characteristics of perianesthesia care for CRS  + HIPEC surgery.

FINDINGS

The patients' median age was 57 (range 21-83) years, and 60% were men. The mean anesthesia time was 10.47 ± 2.54 hours. Most tumors were appendix or colorectal in origin, and the mean peritoneal cancer index score was 16.19 ± 8.76. The mean estimated blood loss was 623 ± 582 mL. The mean total intravenous crystalloid administered was 8,377 ± 4,100 mL. Fifty-two patients received packed red blood cells during surgery. Postoperatively, 100% of the patients were transferred to the intensive care unit. A majority (52%) of patients were extubated in the operating room. Median lengths of hospital and intensive care unit stays were 13 and 2 days, respectively. A majority (73%) of patients had 1 or more postoperative complications and 29% of patients experienced major postoperative complications (Clavien-Dindo grade III or higher) during the hospital stay. Prolonged hospitalization was owing to gastrointestinal dysfunctions and respiratory failure related to atelectasis and pleural effusion.

CONCLUSIONS

CRS  + HIPEC is a major surgery with numerous challenges to the perianesthesia care team regarding hemodynamic adjustment, pain control, and postoperative complications, which demand training and future studies from the perianesthesia care team.

Appendiceal Mucinous Neoplasm: Nurse Education About a Rare and Complex Disease

BACKGROUND

Appendiceal mucinous neoplasms (AMNs) are a rare and complex spectrum of disease involving a mucinous tumor within the appendix, which can range from benign to malignant. If not limited to the appendix, the mucinous tumor can spread diffusely throughout the peritoneum.

OBJECTIVES

Because of the low incidence of AMN, this study describes the diagnosis and treatment process for this disease, which is not well known to most care providers.

METHODS

An extensive analysis of the current literature, including incidence, diagnosis, and surgical treatment, was performed. A review of the pre- and postoperative needs for patients undergoing surgery was also conducted.

FINDINGS

There is minimal information in the nursing literature about AMN and the complexity of surgical management. Nurses play an important role in caring for these patients and their unique needs both before and after surgery.