64 - Safe Workflow Process for the Pressurized Intraperitoneal Aerosolized Chemotherapy

Description: Description of Team
An interdisciplinary team was formed which included the General oncology surgical provider, perioperative leadership, clinical nurse specialists (oncology and perioperative), clinical nurse educators, pharmacy, Safety department, and supply chain.
Preparation and Planning
The aerosolized chemotherapy would be delivered using a wand connected to a pressure injector through a laparoscopic port. This type of aerosol delivery provided a risk of exposure to the operating room team. The interdisciplinary team identified lack of workflow safety process, supplies, and knowledge deficit of the pressure injector. A gap analysis was performed to analyze the current chemotherapy workflows. The team developed a preparation and delivery method of the hazardous agent (chemotherapy) to reduce the possibility of staff exposure. Due intraoperative aerosol delivery of the hazardous agent, the surgical team would be required to step out of the operating room. The video integrated system representatives were consulted to remove any visual barriers to monitor the patient and visualize the delivery of hazardous drug to the peritoneal cavity through the laparoscopic camera. Another safety factor considered was the removal of aerosol particles from the peritoneal cavity post-delivery of hazardous drug agent. The interdisciplinary team reviewed available literature review and aerosol particle removal specifications of close aerosol waste system (CAWS) equipment and supplies.
Assessment
the pressurized intraperitoneal aerosolized chemotherapy (PIPAC) surgical procedure has been performed in Europe for a few years. This procedure provides a surgical chemotherapy option for terminal patients with abdominal cancer. These cases are being performed at a few hospitals across the US including UChicago Medicine. Due to the low amount of these procedures, there was limited amount of literature review material to develop a checklist and other needed aerosolized chemotherapy workflow processes to reduce exposure.
Implementation
In May, 2025, UChicago performed their first PIPAC surgical case with subsequent cases a few months later. The cases went well overall and aerosol agent was delivered without exposure to operating room team. The obstacles were as follows: the timely preparation and delivery of hazardous drug to the operating room, the pressure injector tubing air removal, and the CAWS was reviewed and changed to a disposable supply versus the use of a CAWS equipment unit.
Outcome
In May, 2025, the first PIPAC surgical case was performed at Uchicago Medicine.
To date, the UChicago to date has completed additional PIPAC procedures with future procedures scheduled. The use of the PIPAC checklist and an equipment tip sheet provided aerosol hazardous agent workflow safety resources for the intraoperative perioperative nurse and surgical team.
Implications for Perioperative Nursing
The PIPAC surgical procedures can be performed using a comprehensive checklist and aerosol hazardous agent workflow safety process. These can limit the risk to the intra-procedure perioperative nurse.