Episode 297: Intra-Arterial Chemotherapy Administration: The Oncology Nurse's Role

"What you teach patients about that the side effects may be somewhat different, because it's more of a regional treatment with less systemic toxicities, so it's teaching patients about the drugs, the side effects, and the actual procedure itself," Lisa Hartkopf-Smith, MS, RN, AOCN®, CHPN, advanced practice nurse at OhioHealth Center in Columbus and ProMedica Cancer Institute in Toledo, OH, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about the oncology nurse's role in intra-arterial chemotherapy administration. This episode is part of a series about chemotherapy administration, which we'll include a link to in the episode notes. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: " Fireflies and Stardust " by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge about the nurse's role in intra-arterial chemotherapy administration. Episode Notes The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities . Oncology Nursing Podcast: Episode 252: Intraperitoneal Administration: The Oncology Nurse's Role Episode 285: Transarterial Chemoembolization: The Oncology Nurse's Role Additional episodes about chemotherapy administration Clinical Journal of Oncology Nursing article: Evaluation of a Chemotherapy and Medication Education Process for Patients Starting Cancer Treatment ONS Huddle Card: Chemotherapy ONS Courses: ONS Fundamentals of Chemotherapy and Immunotherapy Administration ONS/ONCC Chemotherapy Immunotherapy Administration Certificate™ ONS books: Access Device Guidelines: Recommendations for Nursing Practice and Education (fourth edition) Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) To discuss the information in this episode with other oncology nurses, visit the ONS Communities . To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library . To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org . Highlights From Today's Episode "Intra-arterial chemotherapy has actually been in existence over 70-plus years. It's been around for a long time. There are case reports in the literature as early as 1950 of intra-arterial chemotherapy, one specifically being giving nitrogen mustard, of all things, interactively through a catheter for the treatment of Hodgkin lymphoma." TS 1:43 "Retinoblastoma is a common indication at this point in time for intra-arterial chemotherapy and has very good success rates. Intra-arterial chemotherapy is also used in liver cancers, whether it's an unresectable liver metastasis from adenocarcinoma of the colon or it's unresectable intrahepatic cholangiocarcinoma, as an another example where it's used. And it can also be used in hepatocellular or HCC carcinoma." TS 6:36 "Some of the things, like pretreatment, things that the nurse has to look for in any of those are labs and particularly clotting times. You know, to make sure that a PT and an INR and a platelet count was drawn because this patient is going to have a catheter in their artery and frequently will have heparin, so we need to make sure you know what that is." TS 8:22 "When you're pulling your drug information, your patient drug information sheets, it may not be appropriate to give the Adriamycin® teaching sheet from OncoLink or ChemoCare or ONS because that's generally the side effects of systemic treatment. Whereas if it's going to be given intra-arterially, they are probably not going to have hair loss and mouth sores, and their blood counts may not be affected." TS 10:36 "In some cases, the nurse may be actually administering the medication, and in other cases they're not going to be actually administering it. So, if you have the situation where that intra-arterial procedure is done, like within the operating room or interventional radiology, then typically the radiologist or another physician will be administering it, but the RN may be in the room. It's often not a chemotherapy-qualified RN, it's often interventional radiology RN, so this is really a group effort between oncology nurses and those interventional radiology nurses and operating room nurses." TS 12:03 "But in that case, as far as administration, again, it will probably be the physician, but where the nurse can play the role is with all those steps of verification. So, the dual verification process for chemotherapy needs to not just apply when you're giving it ID and an infusion center or inpatient. But it needs to happen in those off sites like interventional radiology in the operating room. So, the nurse in this suite can work and be part of that dual verification process, you know, comparing the orders with the drug and the patient identifiers. The nurse in that type of situation, in interventional radiology or operating room, can help ensure that safe handling occurs because those employees and physicians may not be as familiar with it. So, making sure that you have the PPE gowns the gloves goggles in the correct ways to dispose of it in those suites." TS 12:43 "With time, just as it would with a venous port, that catheter can move out of place. So, even with the implanted pumps I was mentioning before, those catheters can move, and so we don't routinely check placement of the tip. What can happen is if the tip moves into another place, the patient will have those high doses of chemotherapy going systemic and will experience more side effects." TS 19:22 "Some part of the adverse reactions could be related to the catheter or the pump itself, and then some of the adverse reactions are related to the drug itself." TS 20:06 "So, other things that can happen with catheters and pumps, whether they're temporary or permanent, is always the risk for hemorrhage because it's in an artery. So, if something breaks or some tubing becomes disconnected, then the patient could hemorrhage. So, it's important that everything is always lured locked, connections taped, and that is being checked frequently to make sure that everything is tight and secure so that there's not that risk for hemorrhage from a catheter, an IV tubing, or needle becoming disconnected." TS 21:11 "I honestly think this entire topic is something that's not discussed much, and I wish people knew more about it. I also wish people knew more about one of the areas of this topic—hepatic chemoembolizations, also called TACE [trans-arterial chemoembolization]. There are a lot of patients out there that are getting this in different locations, different hospitals, parts of the country, but because we typically are working in infusion centers are impatient areas, we are often not that knowledgeable about it because it happens somewhere else in interventional radiology or the OR. But our patients are affected by it, and we need to know more about it." TS 26:55