Unique Plan Description: ONC Intrathecal Chemotherapy
Plan Selection Display: ONC Intrathecal Chemotherapy
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2026-03-18 09:41:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2026-03-18 09:41:00
Available at all facilities: Yes

ONC Intrathecal Chemotherapy
Vital Signs
	Vital Signs
		Prior to beginning IT Chemotherapy and post procedure q 15 min(s) x 1 hour
Laboratory
	Protein CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Glucose CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Cell Count and Diff CSF
		T;N, Stat, spec type = Cerebrospinal Fluid
	Culture Routine
		T;N, Stat, spec type = Cerebrospinal Fluid
	Non Gyn Cytology Request
		T;N, Stat, Fluid, Cerbrospinal, Stat
	Cell Surface Markers
		T;N, Stat, spec type = Cerebrospinal Fluid
	CSF Meningitis/Encephalitis Panel
		T;N, Stat, spec type = Cerebrospinal Fluid
Medications
	methotrexate IntraThecal
		12 mg, Injection, IntraThecal, Once, T;N+120, Infuse Over 1 min(s)
			Comment: Confirm time with IR. Deliver to IR prior to procedure. Do not send with CSTD (Equashield). Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection
		3 mL, EVERY BAG
	cytarabine intrathecal
		50 mg, Injection, IntraThecal, Once, T;N+120
			Comment: Confirm time with IR. Deliver to IR prior to procedure. Infuse Over 2 min(s) Do not send with CSTD (Equashield). Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection
		100 mg, Injection, IntraThecal, Once, T;N+120
			Comment: Confirm time with IR. Deliver to IR prior to procedure. Infuse Over 2 min(s)  Do not send with CSTD (Equashield) Extremely Hazardous Drug / Antineoplastic / PPE Requirements: Chemotherapy gown, double gloves, face mask, eye protection
	hydrocortisone intrathecal
		50 mg, Injection, IntraThecal, Once, T;N+120
			Comment: Confirm time with IR. Deliver to IR prior to procedure.  Infuse Over 2 min(s)
		100 mg, Injection, IntraThecal, Once, T;N+120
			Comment: Confirm time with IR. Deliver to IR prior to procedure.  Infuse Over 2 min(s)
Patient Care
	Obtain Consent/Permit for:
		T;N, or Verify Consent for Chemotherapy/Procedure
	Hazardous Drug Precautions
		
Consults/Follow-up
	Consult Interventional Radiologist

CHEMO Reaction Protocol
Vital Signs
	Vital Signs
		Assess vital signs every 2 to 5 minutes until the patient is stable. Place patient into a recumbent position with elevation of the lower extremities if hypotensive
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		Reassess vital signs every 15 minutes x 2, then q30min x 2, or more frequently as needed, I&O, etc until stable
Activity
	Position Patient
		T;N
			Comment: If hypotensive, keep patient supine with legs elevated or bed in Trendelenburg.
IV Solutions
	Sodium Chloride 0.9% IVPB
		500 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
		1,000 mL, IV Large Volume, IVPB, DAILY, PRN for see comment, 999 ml/hr
			Comment: for reaction to chemotherapy
Medications
	Benadryl
		50 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
		25 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give at first sign of hypersensitivity reaction; symptoms may include: hives, rash, itching, and/or facial flushing.
	Decadron (MH/WH)
		20 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give 1-2 minutes after diphenhydramine if no improvement or if symptoms worsen to include: hypotension, shortness of breath, facial/lip/tongue swelling, and/or any other signs /symptoms of a severe allergic reaction.
	SOLU-Medrol
		125 mg, Injection, IV Push, DAILY, PRN see comment
			Comment: Give if dexamethasone unavailable or ineffective and additional steroids are needed, per provider.
	EPINEPHrine
		0.5 mg, Injection, IM-Intramuscular, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
		0.5 mg, Injection, SUBCUTANEOUS, DAILY, PRN for see comment
			Comment: Give immediately for airway obstruction/anaphylaxis reaction. Or give for hypersensitivity reaction not resolved by diphenhydramine and steroids. May repeat every 10 minutes for up to 3 doses.
	meperidine
		25 mg, Syringe, IV Push, Once, PRN for see comment
			Comment: For chills and rigors
	morphine  IV
		2 mg, Syringe, IV PUSH, Once, PRN for see comment
			Comment: For chills and rigors
Patient Care
	Notify MD
		T;N, Contact the oncologist if any of the reaction protocol medications are administered to the patient.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase