Canterbury DHB

Context

Lumbar Puncture Procedure

Intrathecal Chemotherapy Bookings

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The registrar in charge of organising intrathecal (IT) chemotherapy is the designated lab registrar (contactable via email or pager 8314). A new one will be designated and made known to other staff when registrars change over.

Organising intrathecal chemotherapy

Responsibility:

Action:

The patient's primary consultant

 

1.

Prescribe IT chemotherapy using the prescription chart.

2.

Fax the IT chemo prescription and the intravenous prescription charts to the Cytotoxic Suite (81037). Original IT prescriptions must be either:

  • dropped off at the pharmacy, or
  • put in the internal mail addressed to the Pharmacy Department (Cytotoxic Unit).

3.

Email the lab registrar and the pharmacist so both are aware.

The lab registrar

 

4.

If appropriate (i.e. due to technically difficult lumbar puncture), book Interventional Radiology (IR). Call the IR suite (81410 or 81082) or outpatient IR bookings (81417) to confirm the IR appointment.

5.

Email the MDU and B6 CNMs for an available time and location for the IT before emailing the Haem OP nurses to contact the patient with the finalised details.

6.

Update the "Outpatient Procedure" calendar with the:

  • patient's name and NHI.
  • location and time of the procedure.

Communicating the IT schedule

Every Thursday or Friday, the lab registrar emails the medical, nursing, and pharmacy staff with details of scheduled ITs for the following week, including the following information:

This email is sent to (at a minimum – others may request to be added):

The "Outpatient Procedure" calendar accessed through CDHB email has the details for all procedures that lab registrars do (i.e. BMA, IT, Hickman line removal). Any staff may email Anne Quick to be added as a viewer, but only lab registrars can edit the dates and times of ITs on this calendar.

At every Friday ward round, the lab registrar informs the whole team about IT chemotherapies for the following week and ensures there are no problems.

Flowchart: Organising Intrathecal Chemotherapy

Book IT chemo flowchart

Method of Lumbar Puncture

See Lumbar Puncture Technique, Supportive Care.

Cytarabine or methotrexate should be injected slowly, provided the lumbar puncture has not been traumatic and the CSF blood tinged. Do not withdraw further CSF after injecting the drug, i.e. do not flush.

Following the procedure, the patient should lie flat for at least 1 hour unless they feel this is unnecessary based on their past experience. There is some evidence that the frequency of post lumbar puncture headaches is reduced if the patients lie on their stomach.

Examination of CSF

The CSF obtained requires examination on each occasion.

The examination on patient should include:

Subsequent samples should state "Cytospin for Department of Haematology only required". Failure to add the word "haematology" may result in the sample going to Cytology.

About this Canterbury DHB document (5074):

Document Owner:

Timothy Vincent (see Who's Who)

Last Reviewed:

March 2020

Next Review:

March 2023

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5074