Dados do Trabalho

Título

CASE REPORT: OUTPATIENT INFUSION OF THE R-DA-EPOCH PROTOCOL WITH AN ELASTOMIC INFUSION PUMP TO PROMOTE COMFORT IN THE HOME ENVIRONMENT, THUS SEEKING GREATER ADHERENCE AND ACCEPTANCE OF TREATMENT WITHOUT PSYCHOSOCIAL TRAUMA IN THE PATIENT.

Apresentação do caso

A 29 year old woman, arrived at the outpatient oncology department with mediastinal mass, dyspnea and weight loss. Biopsy was requested by thoracoscopy, a Blade compatible with Diffuse Large B-Cell Lymphoma, staging by PET showed disease limited to mediastinal bulky mass. In a young woman, this picture raises the hypothesis of Primary Mediastinum Lymphoma, requested revision of the slide. Port-a-Cath type catheter implanted because of the possibility of protocols with dacarbazine and doxorubicin. Implanted in femoral vein due to the impossibility of subclavian by partial thrombosis of vena cava. Started R-CHOP scheme, first line for LDGCB, until blade revision. After the result, discussed with the patient, opted to change to R-DA-EPOCH, shown in the literature to be more effective for this condition. Protocol requires hospitalization for 5 days for intermittent infusion of drugs.

Discussão

The medical staff, pharmacy and nursing after a multidisciplinary meeting decide to perform for the first time the ambulatory protocol with a portable elastomeric infusion pump installed in the patient for the continuous infusion of the chemotherapeutic in a home environment, allowing the treatment next to the family, avoiding periods of hospitalization, reducing the risk of infections and thromboembolic process by improper handling. Infusion scheme: 1) ondansetron, dexamethasone 30 minutes before chemotherapies D1 to D5. 2) etoposide 50 mg / m2 08 hours daily infusion D1 to D4 peristaltic infusion pump. 3) doxorubicin 10 mg / m 2 and vincristine 0.4 mg / m 2 per day distinct elastomeric infuser for 24 hours with exchange in D2, D3 and D4, withdrawn at the end of D5. 4) cyclophosphamide 750mg / m2 final bolus of D5. 6) GCSF 300 mcg 7 days in a row. 7) Item 2 and 3 infused parallel with polifix 3-way. 8) Central puncture with 20x19 hubber needle fixed with transparent film-coated chlorhexidine, keeps the puncture for 5 days. 9) Exchange of 2 infusers and storage bags every 24 hours, respecting the stability of the medication informed by the manufacturer, and dressing of polyfix fixation with simple transparent film. 10) Analysis of the skin around the puncture.11) Patient instructed to respond if any changes are noted.

Comentários finais

We performed 6 cycles of outpatient protocol, following step by step, with reevaluation PET with complete metabolic response. Patient highlights benefit of going home every day and doing activities such as dining, watching a movie, rather than being hospitalized.

Palavras-chave

R-DA-EPOCH ; protocol with an elastomic infusion; comfort