Name of the Procedure:

Injection, foscarnet sodium, per 1000 mg (HCPCS code: J1455)

Summary

The injection of foscarnet sodium is used to treat severe viral infections. This medication is administered directly into the bloodstream through an intravenous (IV) line.

Purpose

This procedure is primarily used to treat and control viral infections caused by cytomegalovirus (CMV) in patients with compromised immune systems, such as those with HIV/AIDS or post-organ transplant patients. The goal is to reduce the viral load and alleviate symptoms associated with the infection.

Indications

• Cytomegalovirus (CMV) retinitis in patients with AIDS
• Herpes simplex virus (HSV) infections that are resistant to other treatments
• Candidates should typically have a confirmed diagnosis of a foscarnet-sensitive viral infection and be unable to tolerate or have not responded to other antiviral therapies.

Preparation

• Patients may need to undergo blood tests to assess kidney function (as the drug can affect renal function).
• Ensure proper hydration before the infusion to minimize risk to the kidneys.

Procedure Description

1. Patient Assessment: Verify the patient’s medical history and ensure all pre-procedure tests are completed.
2. IV Line Placement: A healthcare provider inserts an intravenous line into a vein, typically in the arm.
3. Medication Administration: Foscarnet sodium is infused through the IV line over a set period. The dosage and rate of infusion are monitored and controlled by the healthcare provider.
4. Monitoring: During the infusion, the patient is monitored for any adverse reactions or side effects.

Tools and Equipment: IV line, infusion pump, monitoring equipment. Anesthesia Details: Generally, no anesthesia or sedation is required.

Duration

The infusion process typically takes 1 to 2 hours, depending on the specific dose and infusion rate prescribed.

Setting

The procedure is usually performed in a hospital or outpatient clinic.

Personnel

• Registered Nurse (RN) to administer the infusion and monitor the patient
• Physician to oversee the procedure and manage any complications
• Potential involvement of a pharmacist for drug preparation and dosage verification

Risks and Complications

• Common risks: Fever, nausea, headache, electrolyte imbalances.
• Rare risks: Renal impairment, seizures, severe allergic reactions.
• Complications can often be managed with supportive care and adjustments to the infusion protocol.

Benefits

• Effective control of severe viral infections, leading to symptom relief.
• Potential for a significant improvement in health and quality of life within days to weeks of starting treatment.

Recovery

• The patient may need to stay in the clinic or hospital for a short period after the infusion for observation.
• Hydration and electrolyte levels may require monitoring.
• Routine follow-up appointments to monitor the infection and kidney function.

Alternatives

• Other antiviral medications (e.g., ganciclovir, cidofovir) may be considered.
• Pros and Cons: Foscarnet is often used when other antivirals fail due to resistance or intolerance. Compared to alternatives, foscarnet might be more effective but also has a higher risk of renal side effects.

Patient Experience

• During the Procedure: Patients may feel a slight sting when the IV is inserted and could experience mild discomfort during the infusion.
• After the Procedure: Patients might feel tired or nauseous and should plan for rest following the infusion. Pain management typically includes over-the-counter medications and ensuring adequate hydration for kidney protection.