Role and responsibility of operating room nurse in preparation operation theatre for HIPEC and cytoreductive surgery in the tertiary health center in north India
Avadhesh Kumar Yadav, Rajendra Kumar Sahu, Ram Niwas Sharma and Dr. Mayank Tripathi
Hyperthermic (or Heated) Intraperitoneal Chemotherapy (HIPEC) is a surgical procedure that’s giving new hope to patients with abdominal cancers. Immediately after removing visible tumors through cytoreductive surgery, surgeons give a dose of heated chemotherapy inside a patient’s abdomen. The technique involves macroscopic resection of disease burden and metastases, followed by infusion of chemotherapy heated to 41°C–43°C into the peritoneal cavity through a special device. After 90 minutes of the infusion, the chemo is washed out and incisions are closed.
Chemotherapy: -In HIPAC (Intraperitoneal) mitomycin-c is the most common drug administrated and platinum-based drugs, cisplatin, carboplatin, and oxaliplatin which have a synergistic effect with heat, and doxorubicin, paclitaxel, docetaxel, and 5-fluorouracil drugs are commonly less used.
The technique of Hyperthermic intraperitoneal chemotherapy Administration: HIPEC is administrated by two classical methods, the open abdomen method, and the closed method.
Skin preparation of patient: Skin preparation is from the mid-chest to midthigh with the preparation of the genitalia and catheterization.
Safety guidelines for administration of HIPEC: A sign the HIPEC is in progress should be placed at the door and the entry of personnel not involved in the procedure should be restricted. N95 grade mask provides the best protection against surgical smoke produced during the use of electrocautery. Doors should be closed during the operation with pressurized closures. The temperature should be 18–26 degrees Celsius and air humidity 45–60 %. The Association for peri-Operative Registered Nurses (AORN) recommends that operating room air exchanges should be maintained at a minimum of 15 air exchanges per hour. Air inflow volume should be 15 % higher than the outflow, airspeed must be lesser than 0.3 m/s. Appropriate PPE (personal protective equipment) consists of an N95 face mask (a simple surgical mask does not provide adequate protection), gloves, protective gown, and overshoes or laggings to provide adequate protection to all involved team members.
Handling of the chemotherapy during HIPEC: it should be prepared in the bio-safety cabinet not in the ward because of the danger from spillage and contamination, while preparing cytotoxic drugs to wear nitrile or neoprene powder-free long cuff gloves and wear a gown non-permeable long sleeve, cuffed and solid fronted and use an aerosol-free mask. Every effort should be taken to avoid any spill. Hospital policies to prevent spills should be adopted by the surgical and operation theatre team members and written procedures must specify the team responsible for spill management. Health care institutions should develop a plan and policy for handling hazardous medications. Collection, labeling, storage, transport, and disposal of contaminated waste should be done as per hospital policy.
Cleaning the operating room after HIPEC: Soap water is adequate to clean the operating room after HIPEC three consecutive times. 70% of isopropyl alcohol is also safe and effective.
Conclusions: All available studies point out that the correct use of specific protective measures is a key factor to minimize exposure. Emphasis has to be also placed on educating and instructing the involved personnel in the hazards and safe use of chemotherapy, the importance of adherence to safety protocols, and the correct use of the recommended personal protective equipment.
Avadhesh Kumar Yadav, Rajendra Kumar Sahu, Ram Niwas Sharma, Dr. Mayank Tripathi. Role and responsibility of operating room nurse in preparation operation theatre for HIPEC and cytoreductive surgery in the tertiary health center in north India. Int J Adv Res Nurs 2021;4(2):211-215. DOI: 10.33545/nursing.2021.v4.i2.D.207