Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Contributors: Mohamed Adam, Lee-lynn Chen, Sharon Gleeson

PREOPERATIVE PHASE

Day of Surgery:

  • Patient interview
  • Review labs
  • Assess concerns of airway, IV access, general health
  • Discuss anesthetic concerns with the patient
  • Check consent
  • Establish Anesthesia Care Plan

INTRAOPERATIVE PHASE

Exploratory LAP/CRS:

  • Placement of epidural
  • Assure safe transfer of patient to OR table
  • Assure safe induction and access/secure patient airway
  • Establish/secure appropriate vascular access for fluid management
  • Establish means of monitoring patient hemodynamic status fluid responsiveness
  • Placement of NG Tube
  • Establish means of maintaining appropriate thermodynamics (bladder and nasopharyngeal temp probe)
  • Tolerate mild hypothermia to 35 degrees Celsius (in anticipation of hyperthermia during HIPEC)
  • Assess and maintain appropriate urine output
  • Initiate/maintain pain management plan
  • Consider obtaining baseline labs

HIPEC:

  • Evaluate and correct labs:
    • Pre-emptive use of FFPs and Cryo (guided by TEG)
  • Reevaluate need for central line access/establish if necessary
  • Optimize and assure acceptable O2 supply/tissue perfusion
  • Establish and maintain optimal fluid status and acceptable urinary
  • Volume status – guided by SPV/PPV
  • Optimize and assure acceptable body temperature—No Bair Hugger and potentially use of cooling blanket

Reconstructive/Closing/End:

  • Monitor/maintain acceptable lab levels (including TEG)
  • Establish/maintain normothermia
  • Monitor/maintain acceptable fluid responsiveness/urine output – guided by SPV/PPV
  • Establish/maintain effective pain management
  • Monitor/maintain acceptable O2 supply/tissue perfusion
  • Evaluate need for post-op ventilation
  • Assure safe disposal of chemotherapy contaminants
  • Provide/assure ongoing care of above
  • Provide safe transfer of patient to ICU/PACU

POST-OPERATIVE PHASE

ICU Patients:

  • Assure safe transfer of patient to ICU

PACU Patient Care:

  • Evaluate adequacy of patient’s independent ventilatory status 
  • Assure adequate 02 supply/tissue perfusion
  • Maintain acceptable management of pain
  • Report pertinent data/post-op concerns to post-op nurse

 

Tags: 
Hyperthermic
Intraperitoneal
Chemotherapy
HIPEC
Clinical Area: 
Gen Surgery
Type: 
ERAS Pathway

 

This information is meant to serve as an educational resource. Clinicians should use their own professional judgment in the care of any individual patient as the guidance contained in this document may not be appropriate for all patients or all situations.