Two key issues in the intra-operative management of the person affected by cancer include:
- cytotoxic precautions.
A hypercoagulable state is common in people with cancer, particularly those with advanced disease and primary brain tumours, and may be due to increased plasma levels of clotting factors, cytokines, or to increased tissue plasminogen activator (tPA).25
The risk for peri-operative deep vein thrombosis (DVT) must be considered and an appropriate level of prophylactic treatment administered. The risk of post-operative DVT is as high as 29% among all patients with cancer, and is even higher among individuals with additional risk factors such as obesity, advanced age, orthopaedic or neurologic surgery and impaired mobility. The use of Low Molecular Weight Heparin (LMWH), graduated compression stockings and Sequential Compression Devices should be considered in all individuals undergoing surgery for cancer.25
The use of neoadjuvant and intra-operative systemic cytotoxic therapy protocols raises unique challenges for the coordination of care and maintenance of safety. Substantial preplanning, multidisciplinary teamwork, protocol development and education are required.39, 40 A risk assessment needs to be undertaken in each unique circumstance to identify and mitigate any risks to safety. Issues identified related to intra-operative cytotoxic risk include:39, 40
- cytotoxic waste management
- use of personal protective equipment cytotoxic fluid disposal (may be several litres)
- cytotoxic laboratory specimens
- cytotoxic blood samples
- communicating with the pathologist regarding post-mortem handling of a corpse
- the need for cytotoxic safety posters on theatre door during procedure
- cytotoxic linen management
- cytotoxic spill management
- communication with pre- and post-operative care providers
- staff education.
Access your relevant state or territory guide for handling cytotoxic drugs and related waste, such as the Queensland guidelines(PDF, 1.14MB), and:
- Complete a risk assessment for the management of a person undergoing a surgical procedure in your facility 48 hours after receiving cytotoxic therapy
- Appraise your local policy and procedure for managing cytotoxic risk in the operating theatre.
Access Perioperative care of the immunocompromised patient41, and describe the intra-operative challenges faced by the following populations and the implications of these on intra-operative staff and:
- A person affected by a haematological malignancy
- An older person
- A person receiving combined chemotherapy and surgery.