Cancer treatment typically includes radiation, chemotherapy, bone marrow transplantation, and surgical removal of cancerous infiltrates with adjuvant chemotherapy and/or radiation therapy. Perioperative nurses at Altru Health System, Grand Forks, ND, embraced a new challenge of combining chemotherapy with a surgical procedure. The procedure, heated intraoperative intraperitoneal chemotherapy (HIIC), also known as hyperthermic intraperitoneal chemotherapy, intraperitoneal chemohyperthermia, and continuous hyperthermic peritoneal perfusion, was introduced at Altru Health System by Robert Sticca, MD. This procedure offers the community a different treatment option for intraperitoneal carcinomatosis.
Heated intraoperative intraperitoneal chemotherapy allows surgeons to treat microscopic residual disease after performing macroscopic cytoreductive surgery. (1) This offers a chance for a cure in select patients. (2) The benefits of HIIC include the following.
* Chemotherapy treatment is accomplished in one session rather than in repeated sessions.
* Direct contact of a higher concentration of chemotherapy with cancer cells (ie, 75 to 100 times greater concentration) is achieved than with systemic chemotherapy treatment.
* Heat itself kills cancer cells.
* Heat improves penetration of chemotherapeutic agents into remaining cancer cells after surgical debulking.
* High concentration chemotherapy is administered while the patient is anesthetized, which prevents the side effects of nausea and vomiting.
HISTORY
Heated intraoperative intraperitoneal chemotherapy was pioneered at the Washington Cancer Center, Washington, DC, by Paul Sugarbaker, MD in the early 1980s. Cancer cells are more sensitive to heat than normal cells, so using heat improves cancer kill rates. Dr Sugarbaker combined chemotherapy with heat and discovered that heat potentiated the effectiveness of chemotherapy.
Dr Sticca performed the first HIIC procedure at Altru Health System on Aug 15, 2003. He since has performed six more HIIC procedures, and all the patients are still alive without evidence of intraperitoneal reoccurrence. Approximately 25 to 30 facilities throughout the United States and multiple institutions in Europe currently are performing this procedure.
INDICATIONS FOR SURGERY
Intraperitoneal carcinomatosis is cancer that has spread throughout the peritoneal cavity. It generally is a cancer that originates from the gastrointestinal tract (ie, colon, gastric), although almost any tumor can metastasize to and spread through the peritoneal cavity. Candidates for HIIC have intraperitoneal carcinomatosis but do not have distant metastasis or liver cancer. Absolute indications for HIIC are pseudomyxoma peritonei and malignant peritoneal mesothelioma. These rare diseases represent approximately 1,000 to 2,000 of the cancer cases in the United States annually. (2-4) Unofficial applications of HIIC include treating colorectal, gastric, and ovarian cancer, and ongoing research indicates significant survival benefits. (2-4) Patients with these types of cancers may undergo this procedure; however, distant metastases disqualify them as surgical candidates. (2-4)
Patients must be otherwise in relatively good health because the procedure is lengthy and extensive.
Hyperthermic intraoperative intraperitoneal chemotherapy is administered after a major abdominal procedure and may be accompanied by massive fluid shifts, moderate blood loss, plasma electrolyte changes, and changes in coagulation parameters (1)(p4)
OVERVIEW OF THE SURGICAL PROCEDURE
The goal of the HIIC surgical procedure is to remove as much visible cancer as possible, leaving tumors no larger than 2 mm. Heated intraperitoneal intraoperative chemotherapy is most effective for tumors less than 2 mm based on experimental evidence that has shown that heated chemotherapy will penetrate up to 2 mm in depth, thereby eradicating tumors smaller than 2 mm in size. Leaving tumors that are larger than 2 mm lessens the chance for cancer elimination. This portion of the surgical procedure is known as debulking or cytoreductive surgery (Figure 1). Debulking can take eight to 12 hours, depending on the extent of the cancer and the number of tumors.
[FIGURE 1 OMITTED]
The HIIC portion of the procedure can be performed using an open or closed approach. The open, or coliseum, technique requires manual distribution of the chemotherapeutic solution on the peritoneal surfaces. This can result in aerosolization of the chemotherapy solution, which increases perioperative staff members' potential for direct contact with the chemotherapeutic solution. The closed technique is performed by inserting catheters into the patient's abdomen after the debulking procedure, temporarily closing the patient's abdomen, and then circulating the chemotherapeutic solution through the patient's abdomen via the catheters. This eliminates the risk of aerosolization and direct contact with staff members. For safety reasons, at Altru Health System, HIIC is performed using the closed approach.
The surgeon lays input and drainage catheters in the patient's abdomen after debulking has been performed but before he or she performs any anastomoses. The surgeon closes the patient's abdomen with a #1 polypropylene running stitch from superior and inferior aspects of the incision. A cardiothoracic profusionist who is certified in chemotherapy administration circulates heated dialysate throughout the patient's abdomen until the solution reaches 42[degrees]C (107.6[degrees]F). Concentrated chemotherapy solution (ie, mitomycin C, cisplatin) then is added to the circulating heated dialysate solution to achieve the desired concentration of chemotherapy. The perfusionist circulates the chemotherapy solution in the patient's abdomen for 90 minutes using a heater/cooler unit. He or she drains the chemotherapy solution from the abdomen and disposes of it as cytotoxic waste. The surgeon then reopens the patient's abdomen and irrigates with copious quantities of saline, which, when removed from the abdomen, also is handled as cytotoxic waste. The surgeon then performs necessary anastomoses of remaining bowel segments (Figure 2), after which he or she closes the abdomen.
[FIGURE 2 OMITTED]
NURSING CONSIDERATIONS
Perioperative nursing considerations for patients undergoing HIIC are many. The entire surgical procedure can last six to 18 hours, so perioperative team members take proper precautions to ensure the patient's safety and prevent intraoperative patient injuries. Before the patient is
brought into the OR, the circulating nurse places a heating/cooling blanket on the bed under the sheet (Figure 3). The circulating nurse places antiembolism stockings and sequential compression devices on the patient's legs. The circulating nurse then pads the patient's elbows and heels, and the anesthesia care provider pads the patient's head. Team members work cooperatively to place the patient in an anatomically neutral position.
[FIGURE 3 OMITTED]
FLUID REPLACEMENT. Fluid replacement during the debulking procedure is essential. The circulating nurse inserts an indwelling urinary catheter with a temperature probe and urometer for accurate measurement of urinary output. The anesthesia care provider administers IV fluids to maintain the patient's urinary output at 100 mL every 15 minutes during chemotherapy circulation. He or she also may administer fluid challenges and medications (eg, furosemide, renal dose dopamine, mannitol) to maintain urinary output. Administering IV fluids also helps flush chemotherapy medications out of the body, which helps prevent renal failure.
The circulating nurse places a temperature-regulating blanket on top of the patient's lower and upper extremities to maintain core body temperature in conjunction with the heating/cooling blanket during the procedure (Figure 4).
[FIGURE 4 OMITTED]
During the debulking portion of the procedure, the patient is warmed to maintain his or her core body temperature between 35[degrees]C and 37[degrees]C (95[degrees]F and 98.6[degrees]F). The patient is cooled during the HIIC portion of the procedure to maintain a temperature between 37[degrees]C and 39[degrees]C (98.6[degrees]F and 102.2[degrees]F). The circulating nurse turns the room temperature down in addition to using the cooling blanket and blowing ambient air over the patient via the temperature-regulating blanket to ensure that the patient's temperature does not rise above 39[degrees]C (102.2[degrees]F). The anesthesia care provider uses esophageal and bladder probes to closely monitor the patient's temperature throughout the procedure.
HEAT STROKE SYNDROME. Heat stroke syndrome may occur during heated chemotherapy circulation. The symptoms of heat stroke syndrome are
* decreased urinary out-put,
* hypotension,
* peripheral vasodilation, and
* tachycardia. (1)
If measures are not taken to reverse these symptoms, the patient's core body temperature may continue to rise even after the heated perfusate is removed. Emergency procedures (eg, packing ice around the patient's head, flushing the abdominopelvic cavity with cool saline) may be necessary if heat stroke syndrome occurs.
RISKS TO PATIENTS
In addition to the standard risks of any surgical procedure, such as postoperative hemorrhage or infection, there are several risks unique to this procedure that the surgeon discusses with the patient preoperatively. These include chemotherapy toxicity to kidneys, lungs, liver, and bone marrow, as well as organ damage secondary to the hyperthermia. Although with current technology these complications are rare, careful intraoperative and postoperative monitoring is necessary to avoid them.
The incidence of postoperative surgical complications is 25% to 30% in most studies. (24) The most common complication is the occurrence of small bowel fistulas caused by the extensive dissection during the surgical debulking portion of the procedure. The overall mortality for this procedure has been quite low in most published reports (it, 0% to 5%). (2-5)
IMPLEMENTATION OF HIIC SURGERY
The introduction of chemotherapy into the surgical setting posed numerous challenges for perioperative team members at Altru Health System. An HIIC procedure implementation team was created that included representatives from the perioperative, occupational health, employee health, and oncology departments.
CYTOTOXIC PRECAUTIONS POLICY. Implementation team members reviewed the hospital's policy on cytotoxic precautions. All departments affected by this procedure were contacted to obtain their input. The team discovered that this policy was not being followed and had not been updated for several years. Each department was asked to review the policy and send a representative to the next HIIC meeting to allow the team to address concerns.
The patient care supervisor and quality improvement coordinator contacted hospitals currently performing the HIIC procedure to learn from their experience. Unfortunately, it was determined that several facilities still were using the open method, and others had not yet addressed safety concerns. With assistance from staff members in the oncology and employee health departments, implementation team members gathered research evidence concerning chemotherapy aerosolization, personal protective equipment (PPE) requirements for administration of chemotherapy, spill procedures, cytotoxic waste clean up, and decontamination of instruments that come in contact with chemotherapy. (6-8)
Team members used this research evidence to develop a policy on chemotherapy precautions in surgery, which was discussed at the next HIIC meeting. Representatives from the cancer center, central processing department, environmental services (ES), laboratory, laundry, oncology department, pathology department, pharmacy, perioperative department, and surgical intensive care unit (SICU) were present. The primary concerns addressed were cytotoxic waste, cytotoxic laboratory specimens, cytotoxic blood samples, and communicating with the pathologist regarding postmortem handling of the corpse, which also is considered cytotoxic, should the patient expire.
Team members created stickers to indicate cytotoxicity, which staff members would place on the patient's chart and on all specimens or cytotoxic waste leaving the perioperative suite. They also created chemotherapy safety posters to be placed on the OR door during the procedure (Figure 5). The laundry services department required that cytotoxic laundry be placed in a water-soluble bag and then inside a cytotoxic linen bag (Figure 6). Postchemotherapy garbage would be double red-bagged and kept separate from prechemotherapy garbage.
[FIGURES 5-6 OMITTED]
A serious concern that team members had to address was disposal of the several liters of cytotoxic fluid produced during the procedure. This waste could not be flushed into the sewer system; therefore, team members determined that a fluid waste solidifier should be purchased so the cytotoxic fluid waste could be solidified and incinerated. Environmental services personnel would remove the solidified fluid waste, along with the other postchemotherapy garbage, at the conclusion of the procedure. The solidified fluid waste, sharps, and any tubing would be placed in yellow cytotoxic rigid containers to be removed by ES personnel at the conclusion of the procedure. Should a cytotoxic spill occur, perioperative personnel would follow the recommended steps outlined in the hospital's policy on cytotoxic precautions.
* Perioperative personnel wearing PPE would contain any spills less than 5 mE, after which they would clean the area thoroughly with a phenolic solution.
* The circulating nurse would notify ES personnel about larger spills.
* Environmental services personnel would arrive in the OR to contain and decontaminate spills greater than 5 mL or 5 g (Figure 7).
[FIGURE 7 OMITTED]
It is important for the circulating nurse to have contact numbers for the ES and safety officers.
POWERED AIR-PURIFYING RESPIRATORS. Staff members were trained on the use of the powered air-purifying respirators (PAPR), which are available in the OR for use if a cytotoxic spill occurs. These respirators have blowers that force ambient air through air-purifying elements to the inlet covering (Figure 8).
[FIGURE 8 OMITTED]
A protocol was established to ensure communication with SICU and the oncology-nursing unit. When scheduling an HIIC procedure, perioperative scheduling personnel would notify these units to make appropriate staffing arrangements. Postoperatively, HIIC patients would be transported directly to SICU and would remain on cytotoxic precautions for 48 hours. Linen and garbage protocols, similar to those established for the perioperative area with the exception of solidifying fluid waste, were developed. Urine could be disposed of in the sewer, after which the hopper would be flushed twice to ensure adequate removal.
A nurse from the oncology nursing unit certified in chemotherapy administration would be assigned to the OR suite during procedures requiring chemotherapy administration until the perfusionists could obtain certification. The policy on chemotherapy precautions in surgery was updated and approved by both the occupational health and employee health departments.
Preprocedure medical baseline data were gathered on all staff members who would be participating in the HIIC procedure. These will be tracked annually. Employees were given the option to decline participating in the procedure if they were immunocompromised, of childbearing age, pregnant, or breast-feeding.
INSERVICE PROGRAM
Mandated cytotoxic precautions inservice programs were organized for all perioperative staff members, including anesthesia care providers, residents, perfusionists, scrub persons, and circulating nurses. Dr Sticca presented a thorough discussion concerning the HIIC procedure to staff members.
During the inservice program, the safety officer questioned the spill procedure and what was being done to ensure employee safety. An HIIC team meeting was convened, and safety measures were outlined. At this meeting, days before the first procedure was performed, it was discovered that ES personnel were not trained in the cleanup of cytotoxic spills. An ES employee was chosen to undergo training in preparation for the first procedure. Training was organized for the remaining ES personnel, and the procedural steps for cleaning up a cytotoxic spill were defined and outlined.
The safety officer also wanted ES personnel to be responsible for cleaning the room after the procedure. Although this initially occurred, ES personnel now clean only the OR bed and floor after the procedure. The circulating nurse and scrub person clean the rest of the equipment (ie, back table, electrosurgical unit, temperature-regulating blanket unit, Mayo stand, ring stand) with a phenolic solution. Under the direction of the safety officer, a cytotoxic waste management system was created and the hospital cytotoxic precautions policy has been updated. As a result of performing HIIC procedures, many problems regarding chemotherapy administration at Altru Health System were identified and resolved.
POSITIVE OUTCOMES
The HIIC procedure was implemented with coordinated efforts of numerous personnel throughout Altru Health System. Altru Health System has completed seven HIIC procedures successfully thus far. Providing a safe perioperative environment for all patients and employees was the number one priority. Unsafe scenarios were meticulously and methodically analyzed and addressed, resulting in the creation of a comprehensive policy on chemotherapy precautions in surgery. This policy brought to light issues that needed to be addressed. This process was the catalyst for implementing quality improvement initiatives throughout Altru Health System, including
* handling cytotoxic agents (eg, spill procedure, purchasing PAPR hoods) and
* handling substances containing cytotoxic agents (eg, cytotoxic laboratory specimens, cytotoxic garbage, cytotoxic blood and body fluids, decontamination of instruments and equipment in contact with cytotoxic agents).
Staff members at Altru Health System were provided with the necessary educational information and training concerning the HIIC procedure and cytotoxic safety precautions. Perioperative staff members received additional education in the proper procedures for handling chemotherapy in surgery and the care of patients undergoing the HIIC procedure.
Home Study Program
Heated intraoperative intraperitoneal chemotherapy--The challenges of bringing chemotherapy into supply
The article "Heated intraoperative intraperitoneal chemotherapy--The challenges of bringing chemotherapy into surgery" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.
Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Dec 31, 2007.
Complete the examination answer sheet and learner evaluation found on pages 1067-1068 and mail with appropriate fee to
AORN Customer Service
c/o Home Study Program
2170 S Parker Rd, Suite 300
Denver, CO 80231-5711
or fax the information with a credit card number to (303) 750-3212.
You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.
BEHAVIORAL OBJECTIVES
After reading and studying the article on heated intraoperative intraperitoneal chemotherapy, nurses will be able to
1. discuss the origin of heated chemotherapy,
2. describe the steps of the heated intraoperative intraperitoneal chemotherapy (HIIC) procedure,
3. explain nursing considerations pertinent to caring for a patient undergoing HIIC,
4. describe possible patient risks during and after HIIC, and
5. discuss how staff member education in preparation for implementing an HIIC program affects positive patient outcomes.
AORN HomeStudy
This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.
A minimum score of 70% on the multiple-choice examination is necessary to earn 2.4 contact hours for this independent study.
Purpose/Goal: To educate perioperative nurses about introducing heated intraoperative intraperitoneal chemotherapy into the OR.
CASE SCENARIOS
Patients Who Underwent Heated Intraoperative Intraperitoneal Chemotherapy (HIIC) at Altru Hearth System, Grand Forks, ND
June 17, 2003 (first procedure)/Aug 28, 2003 (HIIC): A 73-year-old man was taken to surgery for a right colon mass discovered on computed tomography (CT) scan and colonoscopy. After opening the patient's abdomen, the surgeon discovered that the patient had colorectal cancer with bowel perforation and infiltration into his right lateral abdominal wall The surgeon performed a right hemicolectomy and consulted with Robert Sticca, MD, who resected the right abdominal wall mass. Two months later, the patient returned to surgery and underwent an omenectomy, partial colectomy, resection of multiple peritoneal masses, cholecystectomy, and HIIC using mitomycin C. The patient underwent five days of intra-abdominal chemotherapy using fluorouracil starting the first postoperative day. He experienced no side effects. The patient was discharged to home on the ninth postoperative day. The patient returned to his normal level of activity within four weeks of surgery and currently continues an active lifestyle working daily on his farm. Follow-up CT and positron emission tomography scans have not shown any reoccurrence in abdominal cavity, but unfortunately, he has developed lung metastases for which he is receiving chemotherapy.
June 30, 2003 (first procedure)/Aug 21, 2003 (HIIC): A 75-year-old woman presented with acute, right lower quadrant abdominal pain and underwent an exploratory laparotomy during which a gelatinous mass that had spread throughout her abdominal cavity and an enlarged appendix were discovered. The mass was biopsied, sent for frozen section, and identified as pseudomyxoma peritonei, which usually arises from the appendix. The surgeon proceeded with a right hemicolectomy and appendectomy, but at that time HIIC had never been performed at Altru Health System. Two months later, the patient underwent a second surgery in which all remaining tumor was removed, along with her uterus and ovaries. The patient received mitomycin C during the HIIC portion of the procedure. The procedure lasted seven hours and 15 minutes. Fifteen months later, the patient is doing well with no evidence of recurrence on CT scan and colonoscopy.
Aug 15, 2003 (HIIC only): A 44-year-old married man with three young children presented with vague abdominal pain and abdominal distention. ACT scan showed ascites and a pelvic mass. A biopsy was performed, which showed mesothelioma. The patient's prognosis before HIIC was four to six months to live. The patient underwent an 18.5 hour HIIC procedure during which his spleen, gallbladder, part of his pancreas, 80% of his colon, 30% of his small bowel, and 50% of his stomach were removed. The chemotherapeutic agent used was cisplatin. The patient was transferred from the OR with a potentially reversible colostomy. He remained in the hospital for one month, during which time he developed borderline renal failure. Fifteen months after discharge his renal failure is improved and he is functioning well at home. Currently, he has no evidence of recurrence and his prognosis is good.
Patricia Foltz, RN, BSN, is the patient care supervisor and quality improvement coordinator at Altru Health System, Grand Forks, ND.
Cheryl Wavrin, RN, BSN, was the surgery quality improvement coordinator at Altru Health System, Grand Forks, ND, at the time this article was written.
Robert Sticca, MD, FACS, is surgical oncologist, program director, and vice chairman for the department of surgery at the University of North Dakota, Grand Forks, ND.
Editors' note: The authors acknowledge the administrative staff members of Altru Health System for their support during implementation of this program.
NOTES
(1.) A D Stephens et al, "Hyperthermic intraoperative intraperitoneal chemotherapy tutorial," http://www.surgicaloncology.com/hiicman .htm (accessed 22 Oct 2004).
(2.) V J Verwaal et al, "Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer," Journal of Clinical Oncology 21 (October 2003) 3737-3743.
(3.) B W Loggie et al, "Cytoreductive surgery with intraperitoneal hyperthmic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin," American Surgeon 66 (June 2000) 561-568.
(4.) "S W Sutton et al, "Intraoperative modality of treatment for peritoneal carcinomatosis: Use of hyperthermic interperitoneal chemoperfusion," Perfusion 17 (November 2002) 441-446.
(5.) N J Petrelli, "Management of peritoneal surface malignancy," Surgical Oncology Clinics of North America 12 (July 2003) xxi.
(6.) National Institute for Occupational Safety and Health, Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings, NIOSH publ no 2004-165, http://www.cdc.gov/niosh/docs/2004-165 (accessed 26 Oct 2004).
(7.) "Controlling occupational exposure to hazardous drugs," in OSHA Technical Manual, Occupational Safety and Health Administration, http://www.osha.gov/dts /osta/otm/otm_vi/otm_vi_2.html (accessed 5 Oct 2004).
(8.) "ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs," American Society of Health-System Pharmacists, http://www.ashp.org/ahfs/d _agents/a7390010.cfm?cfid=2844891&CFToken =39593405 (accessed 5 Oct 2004).
Examination
Heated intraoperative intraperitoneal chemotherapy--The challenges of bringing chemotherapy into surgery
1. Absolute indications for heated intraoperative intraperitoneal chemotherapy (HIIC) are
a. gastric carcinoma and ovarian cancer with distant metastasis.
b. gastric carcinoma and pseudomyxoma peritonei.
c. mesothelioma and malignant neoplastic disease of the large intestine with liver metastasis.
d. pseudomyxoma peritonei and malignant peritoneal mesothelioma.
2. Cytoreductive surgery is
a. a therapeutic technique during which red blood cells are removed so that no tumors larger than 2 mm remain.
b. destruction of living celts primarily by the disintegration of the outer membrane.
c. removing as much visible cancer as possible, leaving tumors no larger than 2 mm.
3. The closed technique of HIIC surgery
1. requires inserting catheters into the patient's abdomen after the debulking procedure.
2. includes temporarily closing the patient's abdomen.
3. entails injecting the chemotherapeutic solution into the patient's abdomen via catheters.
4. requires manual distribution of the chemotherapeutic solution on the peritoneal surfaces.
5. eliminates the risk of aerosolization and direct contact with staff members.
6. increases the potential for direct contact of chemotherapy with perioperative staff members.
a. 1, 3, and 5
b. 2, 4, and 6
c. 1, 2, 3, and 5
d. 1, 2, 3, 4, 5, and 6
4. To prevent renal failure during chemotherapy circulation, the anesthesia care provider administers fluid and medications to keep the patient's urinary output at
a. 25 mL every 15 minutes.
b. 50 mL every 15 minutes.
c. 75 mL every 15 minutes.
d. 100 mL every 15 minutes.
5. If measures are not taken to reverse heat stroke syndrome, the patient's core body temperature may continue to rise even after the heated perfusate is removed.
a. true
b. false
6. The primary concern addressed by HIIC implementation team members at Altru Health System was
a. dealing with cytotoxic waste.
b. ensuring exact temperature of the heated chemotherapeutic solution.
c. preprocedure assessment of staff members.
d. the potential for intraoperative patient death.
7. Environmental services personnel are responsible for containing and cleaning any spills greater than 5 mL or 5g.
a. true
b. false
8. Powered air-purifying respirators (PAPR)
a. deliver compressed gas under positive pressure to a preset pressure.
b. deliver inhaled medications or anesthetic gases.
c. force ambient air through air-purifying elements to an inlet covering.
d. vaporize or disperse a liquid in a fine spray.
9. Urine of an HIIC patient cannot be disposed of in the sewer because it is considered a cytotoxic waste.
a. true
b. false
10.At Altru Health System, after an HIIC procedure,
1. a phenolic solution is used for cleaning.
2. environmental services (ES) personnel clean the OR bed and floor.
3. ES personnel clean the anesthesia machine and equipment.
4. the circulating nurse and scrub person clean the equipment (eg, back table, electrosurgical unit).
a. 1 and 3
b. 3, and 4
c. 1, 2, and 4
d. 1, 2, 3, and 4
Learner Evaluation
Heated intraoperative intraperitoneal chemotherapy--the challenges of bringing chemotherapy into surgery
Objectives
To what extent were the following Home Study Program objectives achieved?
1. Discuss the origin of heated chemotherapy.
2. Describe the steps of the heated intraoperative intraperitoneal chemotherapy (HIIC) procedure.
3. Explain nursing considerations pertinent to caring for a patient undergoing HIIC.
4. Describe possible patient risks during and after HIIC.
5. Discuss how staff member education in preparation for implementing an HIIC program affects positive patient outcomes.
Content
To what extent
6. did this article increase your knowledge of the subject matter?
7. was content clear and organized?
8. did this article facilitate learning?
9. were your individual objectives met?
10. did the objectives relate to the overall purpose/goal?
Test Questions/Answers
To what extent
11. were they reflective of content?
12. were they easy to understand?
13. did they address important points?
Learner Input
14. Will you be able to use the information from this Home Study in your work setting?
a. yes b. no
15. I learned of this Home Study via
a. the Journal I receive as an AORN member.
b. a Journal I obtained elsewhere.
c. the AORN web site.
d. SSM Online.
16. What factor most affects whether you take an AORN Journal Home Study?
a. need for contact hours
b. price
c. subject matter relevant to current position
d. number of contact hours offered
What other topics would you like to see addressed in future Home Study Programs? Would you or someone you know be interested in writing an article on this topic?
Topic(s): --
Author names and addresses: --
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