| |
|
Intraperitoneal Access Devices
Epidural and Intrathecal
Epidural and intrathecal catheters are temporarily or permanently placed
percutaneously into the epidural space, through the second and third lumbar
interspace. The epidural space is a potential space between the dura mater
memberane covering the spinal cord and the ligamentum flavum and periosteum of
the vertebral column. It extends from the foramen magnum to the sacral hiatus.
For intrathecal administration, the catheter is advanced below the dura where
cerbral spinal fluid circulates. These devices are used for the :
administration of chemotherapy intrathecally (route of delivery is in the
subarachnoid space : administration of opoid analgesics and anesthetic
medications for chronic intractable pain; : administration of opoid analgesics
and anesthetic medications foracute pain that is inadequately controlled. (ONS
Access Device Guidelines, 2004)
Intraventicular
An intarventricular access device is a dome-shaped , self-sealing reservoir
attached to a catheter. The reservoir is implanted underneath the skin and the
catheter is inserted into the cranium to the ventricle to provide access to
cerebrospinal fluid. The reservoir volume is usually 1.5-2.5 ml. (ONS Access
Device Guidelines, 2004) These devices provide access for the administration of
multiple therapies e.g. chemotherapy, antibiotics, antifungal and
analgesics.They are also used to access cerebrospinal fluid (CSF) for the
measure of measurement of intracranial pressure and sampling of CSF. (ONS
Access Device Guidelines, 2004)
Intraperitoneal
Intraperitoneal access devices are temporarily or permanently implanted into the peritoneal cavity for access to the peritoneum (Smith & Jason). Intraperitoneal catheters include: intravenous cathlons, pigtail catheters, tenckhoff catheters and implanted ports. Aseptic technique is required to prevent catheter related infections and peritonitis (Lee, Lau & Yeong, 2000). Theses devices allow for the administration of intraperitoneal therapies (including chemotherapy and biotherapy), dialysis, palliation of malignant ascites, and diagnostic testing. (ONS Access Device Guidelines, 2004). In the adult palliative patient with malignant ascites, draining peritoneal fluid can provide temporary symptomatic relief of abdominal pressure, nausea, vomiting, pain, dyspnea or orthopnea (Smith & Jayson, 2003).
|
