Digestive tract cancer patients receiving chemotherapy require thorough nursing care. ④ Before chemotherapy, doctors prescribe drug prevention and treatment, administering antiemetic drugs 1 to 2 hours prior to chemotherapy. The drug's effect lasts 6 to 8 hours, maintaining a 24-hour plasma concentration, effectively reducing nausea and vomiting.
2.2 Protective measures for bone marrow suppression: High-dose chemotherapy drugs can cause bone marrow suppression, leading to adverse consequences for patients. The lowest point of myelosuppression caused by most chemotherapy drugs occurs between 7 to 14 days, with recovery taking 5 to 10 days. During chemotherapy, regular blood tests should be conducted, leukocyte drugs administered when necessary, implementing protective isolation for patients, oral and perianal care, nutritional support, and prevention of bleeding and infection.
2.3 Phlebitis protection: A warm compress using a mixture of 654.2, magnesium sulfate, and glucose can prevent phlebitis. Begin by preparing gauze (containing 654.2 10mg, 25% magnesium sulfate 10ml, 50% glucose 20ml) soaked in the solution, applying it 2 to 3cm above the puncture site, replacing every 2 to 4 hours. Magnesium sulfate dilates blood vessels, improving microcirculation and alleviating local inflammation, while glucose and magnesium sulfate provide hypertonic detumescence. 654-2 relaxes smooth muscles, improves microcirculation, and relieves pain, reducing phlebitis.
2.4 Protection against drug extravasation: Reports indicate an incidence rate of peripheral venous extravasation of chemotherapeutic drugs ranging from 0.1% to 6.0%.
2.4.1 Reasonable vascular choice: ① Establish an intravenous use plan, protecting large veins, selecting small blood vessels for routine blood transfusions and non-chemotherapy drug infusions, alternating distal to proximal ends for non-chemotherapy drugs, avoiding joints during chemotherapy; ② For patients with frequent vomiting, prefer intravenous catheters; ③ Before chemotherapy, assess vascular suitability (including blood vessel location, blood return situation, vein patency), informing patients and their families of the results to confirm successful puncture and avoid blaming nurses in case of drug extravasation; ④ Lower extremity veins have slower blood flow, prone to thrombosis, thus generally not recommended.
2.4.2 Skilled local heat application during puncture: ① Promote venous distension to increase puncture success rates; if puncture fails, do not reuse the same vein distally to prevent drug extravasation from previous punctures; ② Use small needles at a slow angle for fragile blood vessels, ensuring no backflow of blood before advancing further; ③ Utilize transparent applicators for easy observation.
2.4.3 Health education: Inform patients about the causes, consequences, and management principles of chemotherapeutic drug extravasation to improve self-care abilities, reminding them to minimize bathroom trips during chemotherapy infusion to reduce body activity and pressure, preventing interference with venous return and drug extravasation.
2.4.4 Management system: ① Institutionalized health education implemented by responsible nurses; ② Standardized operations inspected by highly qualified trained nurses; ③ Institutionalized visits to patients every 15 to 30 minutes relying on systematic implementation; ④ Enhanced shift changes including bedside systems, documenting drug names, locations, times, margins, and local puncture situations.
2.4.5 Treatment for chemotherapeutic drug extravasation: ① Immediately stop infusion and retain intravenous needles; ② Withdraw residual liquid 3 to 5ml; ③ Apply local lidocaine and dexamethasone closure; ④ Elevate affected area for 24 to 48 hours, avoiding local compression to promote venous return; ⑤ Apply local 50% magnesium sulfate wet compress; ⑥ Functional exercise: Guide patients in reasonable elbow grip, palm outreach, and internal rotation motions to avoid ankylosis and severe muscle atrophy; ⑦ Close observation for no less than 10 days, as local ulcers caused by extravasation generally occur within 3 to 10 days.
For longer durations of 3 months, discuss malignant tumor patients with recurrent disease. Continuous progress and repeated chemotherapy inflict physical damage and psychological pressure on patients. Nurses must strengthen their sense of responsibility, improve quality and technical skills, providing meticulous care to support patient confidence and ensure chemotherapy compliance and treatment continuity.