Patient Care and Monitoring TLS

1. Monitor daily the at-risk patient who presents with normal lab values daily for serum uric acid, electrolytes (Na, K, Ca, Mg, Cl, PO4), BUN, creatinine, and urine output.

2. Monitor for signs of fluid overload during aggressive hydration.

3. Continue hydration and prophylaxis until 2 to 3 days after cytotoxic therapy.

4. In patients undergoing urinary alkalinization with sodium bicarbonate, assess the urine pH every 6 hours and maintain above 7.

5. For patients who present with or develop signs of TLS, monitor these parameters every 6 hours until stable.

6. Order an ECG for patients with hyperkalemia and monitor serially until resolution.

7. Adjust the dose of allopurinol and other renally eliminated medications for patients who develop renal dysfunction.

8. In patients receiving rasburicase, monitor the hemoglobin and hematocrit for signs of hemolysis.

Table 99-16 Risk Factors for Chemotherapy Extravasation

Presence of multiple venipunctures (common in cancer patients) Poor needle insertion technique

Poor catheter location (dorsum of the hand, antecubital fossa)

Inability to communicate symptoms (children, sedated patients, language barrier between patient and nurse)

Presence of peripheral neuropathy

Nurse experience and training

Young age or elderly patients (small or fragile veins)

Gross obesity

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