test 7 isolated limb perfusion

Question 1

Isolated Limb Perfusion (ILP) reason for usage

Answer 1

• recurrent metastatic malignant melanoma

Question 2

Goal of Isolated Limb Perfusion (ILP)

Answer 2

• increase chemotherapy dose to isolated limb w/o systemic toxicity

Question 3

Isolated Limb Perfusion (ILP) perfusion considerations

Answer 3

 Maintain 8-10º C temp gradients
 Blood flow 400-500 ml/min
 Chemotherapeutic agent therapy started when limb temp reaches 39-40ºC
 Chemotherapeutic agents injected on venous side over 1 minute period per dose
 Doses given q 15-20 minutes
 Continuously monitor limb for leakage
 Flashlight availability - because they turn off the lights when giving chemo

Question 4

Termination of Isolated Limb Perfusion (ILP)

Answer 4

 Cooling of limb not required
 Limb must be flushed of chemotherapeutic agent prior to tourniquet removal:
o Clamp venous line and divert all venous blood in reservoir to suction canister
o Add two liters of LMW Dextran to cardiotomy
o Add dextran solution to circuit
o After dextran infused, flush limb with packed red blood cells
o Add crystalloid solution to replace lost volume in circuit
o Divert blood back to pump to oxygenate transfused RBC’s
o Tourniquet slowly released
o Terminate ILP under direction of surgeon
 Reverse anticoagulation using protamine