Infusion therapy with anti-emetics
Certain medical conditions or medical treatments are known to induce nausea and vomiting as side effects. For example, patients receiving general anesthesia often suffer from post-operative nausea and vomiting, called PONV. Likewise, patients receiving chemotherapy as anticancer treatment often develop concomitant nausea and vomiting, called CINV (chemotherapy-induced nausea and vomiting) or radiotherapy induced nausea and vomiting called RINV. Such nausea and vomiting can be distressing, but may also lead to severe complications such as metabolic derangements, esophageal tears, or wound dehiscence, etc. Anti-emetic therapy aims to reduce or prevent nausea and vomiting such as PONV and CINV, by the IV administration of anti-emetic drugs.
Prescription
Prescription
Depending on the emetogenic risk classification of a given chemotherapeutic agent, international guidelines strongly recommend the initial combination of an anti-emetic substance to the treatment regime. 5-HT3 receptor antagonists such as Ondansetron or Granisetron belong to the most effective prophylactic substances.
For PONV, the risk increases with number of risk factors given for each patient and scoring systems for assessment and respective use of anti-emetics have proven to significantly reduce the institutional rate of PONV.
Antiemetics
Nausea and vomiting are distressing and burden some experiences in patients, who suffer from them after a medical interventions. Depending on the stressors inducing nausea and vomiting there are three types: PONV, CINV, RINV. Antiemetics are used to treat nausea and vomiting. The choice of antiemetic depend on the cause (e.g. surgery, chemotherapy).
Patient Access
5-HT3-receptor antagonists such as ondansetron or granisetron can be given as IV injection or slow infusion, either using a peripheral intravenous catheter or a hypodermic needle and syringe. Ondansetron may also be given as intramuscular injection.
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Preparation
Preparation
Both anti-emetics come as solution in a glass ampoule or miniplasco and need to be withdrawn. Dilution is optional. Thus, the typical risks of drug preparation including sharps injury, contamination with glass particles (if using the ampoule version) and incompatibility with dilution solutions occur and have to be taken into account, both for handling as well as for selection of appropriate devices.
Application
Application
Depending on the type of application either as injection or slow infusion, ondansetron or granisetron have to be transferred into either a syringe or an infusion container with a carrier solution. If given as slow infusion along with chemotherapy or anesthesia, the infusion line might be included into the infusion regime using manifolds or 3-way stopcocks.
