Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy, Part I: Introduction and Indications.

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat peritoneal carcinomatosis, which often is secondary to gastrointestinal and ovarian cancers. During CRS, the surgeon resects cancerous tumors from the peritoneal cavity. During HIPEC, a chemotherapy agent is introduced into a solution that flows in and out of catheters in the abdominal cavity for approximately 90 minutes. The chemoperfusate is heated to 42° C (107.6° F), which kills cancer cells but is nonthreatening to normal cells. A primary goal of combining CRS with HIPEC is to apply targeted regional chemotherapy directly to the peritoneum to destroy residual micrometastatic disease while the tumor burden is minimal and before cancer cells become entrapped by the body's wound-healing processes. Although HIPEC usually is not curative, it can extend a patient's life expectancy three to five years. This is the first article in a two-part discussion of CRS with HIPEC.

Quimioterapia hipertérmica intraperitoneal transoperatória: o que a enfermagem precisa saber / Intraoperative hyperthermic intraperitoneal chemotherapy: what nurses should know / Quimioterapia intraperitoneal hipertérmica transoperatória: qué necesita saber la enfermería

Objetivo: apresentar o estado do conhecimento científico sobre quimioterapia hipertérmica intraperitoneal transoperatória no tratamento da carcinomatose peritoneal e os cuidados de enfermagem pós-operatórios para pacientes submetidos a essa terapia. Métodos: apresentam-se aspectos técnicos da quimioterapia hipertérmica intraperitoneal transoperatória, suas complicações potenciais e cuidados de enfermagem pós-operatórios envolvidos. Resultados: destaca-se a importância dos cuidados de enfermagem, quais sejam: monitorar sinais vitais, perfusão periférica, débito cardíaco e pressão venosa central; avaliar dor; encorajar tosse e realização de exercícios de respiração profunda; registrar drenagem de ferida operatória e drenos; investigar ruídos intestinais; medir volume residual gástrico; promover mudanças de decúbito; avaliar resultados laboratoriais de exames sanguíneos; instituir balanço hídrico e; aferir peso corporal. Conclusão: a quimioterapia hipertérmica intraperitoneal transoperatória é terapia promissora no tratamento de pacientes com carcinomatose peritoneal. Entretanto, para ser bem-sucedida, a prestação de cuidados de enfermagem é fundamental.

Objective: to present the current state of scientific knowledge about intraoperative hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis, and postoperative nursing care for patients undergoing this therapy. Methods: the study describes technical aspects of intraoperative hyperthermic intraperitoneal chemotherapy, the potential complications and post-operative nursing care involved. Results: emphasis was placed on the importance of nursing care, viz.: monitoring of vital signs, peripheral perfusion, cardiac output, and central venous pressure; pain assessment; encouraging coughing and deep breathing exercises; recording drainage of surgical wound and drains; investigating bowel sounds; measuring gastric residual volume; ensuring change of decubitus; evaluating laboratory blood test results; establishing water balance; and measuring body weight. Conclusion: intraoperative hyperthermic intraperitoneal chemotherapy has been shown to be a promising therapy in treatment of patients with peritoneal carcinomatosis. However, to be successful, the nursing care provided is fundamental.

Objetivo: presentar el estado del conocimiento científico sobre quimioterapia intraperitoneal hipertérmica transoperatoria en el tratamiento de la carcinomatosis peritoneal y los cuidados de enfermería posoperatorios para pacientes sometidos a ella. Métodos: se presentan aspectos técnicos de la quimioterapia intraperitoneal hipertérmica transoperatoria, sus complicaciones potenciales y cuidados de enfermería posoperatorios involucrados. Resultados: se destaca la importancia de los cuidados de enfermería: monitorear señales vitales, perfusión periférica, débito cardíaco, presión venosa central; evaluar dolor; estimular la tos y realización de ejercicios de respiración profunda; registrar drenaje de herida operatoria y drenes; investigar ruidos intestinales; medir volumen residual gástrico; promover cambios de decúbito; evaluar resultados de análisis de sangre en laboratorio; establecer balance hídrico; verificar peso corporal. Conclusión: la quimioterapia intraperitoneal hipertérmica transoperatoria es terapia prometedora en el tratamiento de pacientes con carcinomatosis peritoneal. Sin embargo, para ser exitosa, la prestación de cuidados de enfermería es fundamental.

Care of the open abdomen after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies.

A patient with a mucinous appendiceal cancer presents to the surgeon complaining of abdominal discomfort and nausea. Having undergone a prior right hemicolectomy, the patient has been disease free and on surveillance with clinical and carcinogenic antigen (CEA) monitoring. The CEA was noted to be elevated and a computed tomography scan revealed peritoneal nodules throughout the abdomen with a presumptive diagnosis of pseudomyxoma peritonei (progressive peritoneal implants from a mucinous primary). Several therapeutic options were offered and the patient selected to undergo cytoreductive surgery (CRS) with the potential to receive hyperthermic interoperative chemotherapy (HIPEC). Extensive resection was performed, including removal of the entire greater omentum, partial gastrectomy, and total pelvic exenteration with end colostomy and ileal conduit. Reassessment of the peritoneal cavity after the resections revealed almost complete cytoreduction. HIPEC was performed with mitomycin C and, after drainage and abdominal washing, the intestinal segments were anastomosed and the abdominal wall closed. Seven days postoperatively, an acute abdomen with septic shock developed as a result of a leak from the ileocolonic anastomosis. The patient returned to the operating room and an exploratory laparotomy, a small bowel resection, a resection of the ileocolonic anastomosis, and an abdominal washout were performed. Edema of the bowel caused by peritonitis resulting from the anastomotic leak necessitated delayed closure of the abdominal wall. A temporary abdominal closure using the ABThera™ Open Abdomen Negative Pressure Therapy system was applied and the abdomen was eventually closed.

Introduction of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) to the surgery program.

Heated Intraoperative Intraperitoneal Chemotherapy (HIPEC) offers a chance for extended survival, or cure, to patients facing specific types of invasive abdominal cancer. This article will explore the perioperative facets of implementing a peritoneal malignancy program that includes the HIPEC procedure. In exploring this procedure, experiences will be shared with the intent of optimizing patient care for potential surgical programs and perioperative staff. The examination will illustrate the respective program development areas such as training, budgetary requirements and patient care considerations. Further, the dialogue will investigate patient selection, preoperative preparation and intraoperative considerations. Lastly, the article will reveal the specific shortterm and long-term patient outcomes starting with the immediate postoperative phase.

Patient health and well-being while waiting for renal transplantation: part I.

This is the first article in a series of three articles concerning renal transplantation. This first article will address the patient's health and well-being while waiting for renal transplantation and the role of the multidisciplinary team in the promoting of this. The subsequent articles will address pre- and post-renal transplant care and the long-term complications of renal transplantation.

[Wound care management of ulceration in a palliative care patient]. / Pflege und Behandlung von Ulzerationen am Beispiel einer Palliativpatientin.

The wound care management of a palliative care patient with sinusitis pinoidalis is documented. The treatment is validated by the expert's opinion. There is only little evidence-based treatment of such a lesion. In our experience, photo documentation is helpful in decision-making during the treatment process. In addition, healing of larger defects seems to improve upon frequent and extensive liquid cleansing.

Malignant mesothelioma: risk factors and current management.

Malignant mesothelioma is a cancer of the pleura and peritoneum often associated with asbestos exposure. Although rare its incidence is increasing, principally as a result of the long latency period of the disease. This article presents a review of mesothelioma, looking at the disease process, risk factors, causes, and current management strategies--namely surgery, chemotherapy, and radiotherapy. Some of the nursing implications are discussed along with the resources currently available to patients with mesothelioma in the UK.

Heated intraoperative intraperitoneal chemotherapy--the challenges of bringing chemotherapy into surgery.

Heated intraoperative intraperitoneal chemotherapy (HIIC) was introduced at Altru Health System in August 2003 to offer the community a different treatment option for intraperitoneal carcinomatosis. The closed technique is performed to eliminate the risk of aerosolization and direct contact of the toxic chemotherapeutic agent with staff members. Implementing the HIIC procedure resulted in the creation of a comprehensive policy on chemotherapy precautions in surgery, which was the catalyst for implementing quality improvement initiatives throughout Altru Health System.

Nursing a patient with a malodorous fungating non-healing wound.

Mr Lunn, who is 59 years old, was admitted to hospital with an acute bowel obstruction secondary to an adenocarcinoma of the descending colon. During a laparotomy and colocolonic bypass Mr Lunn was found to have large plaques of cancer in the mesentery, omentum and liver, and a diagnosis of carcinomatosis was made. He declined treatment with chemotherapy. After discharge from hospital, Mr Lunn was referred to the district nursing team for assessment and nursing care of his surgical wound.

The deontological decision-making model as a bioethical tool.

Ethical decisions are difficult to handle and truly challenge everyone involved in the process. Nurses must appreciate the difficulty encountered when dealing with ethical decisions and begin their own investigations of other available decision-making models to choose one that best fits their own ethical beliefs and values.