Cisplatin hydration: review and optimization of clinical practice
CHI de Villeneuve-Saint-Georges Lucie & Raymond Aubrac, 40 allée de la Source, 94195 Villeneuve-Saint-Georges
Renal toxicity is a prominent component of the toxicity profile of cisplatin (CDDP) chemotherapy; as a result hydration is always indicated in co-administration. In our centre, numerous and heterogeneous hydration lines are recorded on CHIMIO® (prescription software), and consequently unused. To this end, a homogeneous hydration protocol (HP) on the hospital is created by pharmacists with oncologist’s collaboration.
We reviewed practice in our centre by an inventory on CHIMIO® software of the chemotherapy protocols involving CDDP. The HP is based on a literature review and adapted to the medical service management. Working group consists of one pharmacist and two oncologists.
Results - Discussion
On CHIMIO® software, 51 active CDDP-protocols are listed on 5 departments, whith 36 different hydration protocols. From the literature [*], 3 HP are created according to the CDDP posology (HP1 20-30, HP2 30-70, HP3 70-100 mg/m²/day). Both HP are based on: oral hydration one day before and one day after CDDP (1.5L alkaline water), polyionic G5% + 3g Mg (MgSO4 15%) pre-CDDP and post-CDDP. Included in the day hospital management, HP1 and HP2 are adapted by low hydration (0.5 to 2L) on short duration (1 to 2 hours). On the other hand, HP3 is used in hospital services only, with longer hydration (periods of 12h pre-CDDP and 16h post-CDDP), particularly because of the addition of 1L of NaCl 0,9% after polyionic, to reduce damage kidney and maintain CDDP stability. Furosemide usage may be appropriate in patients with pre-CDDP diuresis less than 800mL [*].
Optimization of the patient management and improvement of practices are increased with the HP instauration. Indeed, thanks to their systematic prescription by oncologists on the software, nurses are more involved in the therapy, especially with visualization and validation of CHIMIO® administrations on the whole cure.
[*] G. Saint-Laurant, J. Madelaine et al., Hydratation des patients sous cisplatine : enquête de pratiques et élaboration d’un protocole. Thérapie 2005 : 60 (5) : 499-505.