Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump
CPT4 code
Name of the Procedure:
Chemotherapy Administration, Intravenous Infusion Technique; Initiation of Prolonged Chemotherapy Infusion (More than 8 Hours), Requiring Use of a Portable or Implantable Pump.
Summary
This procedure involves administering chemotherapy drugs directly into a patient's bloodstream over an extended period, typically longer than 8 hours, using a portable or implantable pump. The portable pump allows patients to receive continuous treatment while maintaining mobility.
Purpose
The primary aim is to deliver chemotherapy drugs consistently over a prolonged period, targeting cancer cells more effectively while minimizing side effects. This technique is particularly useful for delivering drugs that require steady blood levels to be effective.
Indications
- Types of cancer such as colorectal, pancreatic, or certain leukemias and lymphomas.
- Patients who need continuous drug administration over an extended period.
- Those who would benefit from maintaining a more constant therapeutic drug level.
Preparation
- Pre-procedure blood tests to check organ function and overall health.
- Imaging tests to locate the best vein for infusion.
- Fasting may be required, depending on the specific medication regimen.
- Discussing current medications and possible adjustments with your physician.
Procedure Description
- Placement of the Central Venous Catheter (CVC): A central line is inserted into a large vein, usually in the chest or arm.
- Pump Setup: A portable or implantable pump is connected to the catheter.
- Medication Preparation: Chemotherapy drugs are prepared in a sterile environment.
- Initiation: The chemotherapy infusion is started, and the pump is adjusted to deliver the medication over the prescribed period.
- Monitoring: Vital signs and pump function are monitored initially to ensure proper operation.
Tools: Central venous catheter, implantable/portable pump, infusion bags, sterile equipment. Anesthesia: Local anesthesia for CVC insertion if not already placed.
Duration
The setup and initiation typically take about 1-2 hours, while the infusion itself spans over 8 hours or longer, depending on the treatment plan.
Setting
- Hospitals
- Outpatient clinics
- Infusion centers
- Sometimes at home (with home health care support)
Personnel
- Oncologist
- Chemotherapy nurse
- Pharmacist
- Possibly a home health care nurse (for home settings)
Risks and Complications
- Infection at the catheter site.
- Blood clots in the catheter.
- Pump malfunction.
- Allergic reactions to chemotherapy drugs.
- Side effects such as nausea, fatigue, or low blood cell counts.
Benefits
- Continuous drug delivery for better therapeutic effect.
- Increased mobility for the patient.
- More consistent and potentially more effective treatment outcomes.
Recovery
- Regular monitoring of blood counts and organ functions.
- Managing side effects with medications and supportive care.
- Follow-up appointments to adjust treatment as necessary.
- Recovery time can vary; patients often can resume normal activities with precautions.
Alternatives
- Intermittent intravenous chemotherapy (in an infusion center).
- Oral chemotherapy.
- Targeted therapy or immunotherapy.
- Pros: Alternatives may involve shorter infusion times or oral administration.
- Cons: Less consistent drug levels, potential differences in efficacy.
Patient Experience
- Patients may feel a prick or slight discomfort when the catheter is inserted.
- The pump might feel cumbersome initially but usually becomes less noticeable.
- It's crucial to manage side effects proactively with anti-nausea medications and rest.
- Pain is generally minimal and managed with over-the-counter pain relievers.