NURS-01. INTRACEREBROVENTRICULAR DRUG ADMINISTRATION FOR TREATMENT OF PEDIATRIC BRAIN TUMORS

Abstract

Intrathecal (IT) chemotherapy, given via lumbar puncture (LP) or an intracerebroventricular (ICV) device has become a safe and effective way to deliver chemotherapy into the cerebrospinal fluid (CSF) space. The blood brain barrier makes treating tumors with CSF dissemination difficult with systemic chemotherapy alone. IT chemotherapy is often necessary for tumors which disseminate into the CSF space including embryonal tumors and choroid plexus carcinomas. It is also used for relapsed or recurrent tumors. Giving IT chemotherapy via an ICV device instead of via an LP can be preferable as it requires no deep sedation and allows for more uniform drug distribution. Drugs given IT include methotrexate, cytarabine, hydrocortisone, etoposide, and topotecan. ICV devices can be placed in patients with adequate CSF flow and a flow study can be done if needed to confirm. Accessing the ICV device for administration of chemotherapy is typically done by a physician or nurse practitioner using sterile technique. Our institution has had success using music therapy and child life specialists for assistance with coping during the procedure as patients are awake. The procedure has few complications the most common being infection usually with skin flora. It can also cause nausea and headache. There are few long term risks.