Cisplatin Pre & Post Hydration

[DowntheRiver]

What are your orders or facility policy on Cisplatin Pre & Post Hydration, including Potassium and Magnesium? Do some do just Potassium, or are they always Potassium and Magnesium?

For low doses, some order sets say 250-500 mL pre, 250-500 mL with Cisplatin added, and 250-500 mL. Most do 500 mL pre, 500 mL with Cisplatin, and 500mL post for a total of 1500 mL which seems pretty reasonable. Example Cisplatin dose: 23mg Q1W

For higher doses, order sets say 1000 mL pre, 500 with Cisplatin added, and 1000 mL post. Total volume 2500 mL. Example Cisplatin dose: 93mg Q3W

The 2500 mL just seems like a lot of fluid to me in one sitting. The patient is also there ALL DAY. We typically also hydrate these patients at least one other time a week with a liter bag. I've seen some nurses run pos hydration concurrently with Cisplatin and am curious if others do the same? I'm not a new nurse, not even new to Oncology, but new to infusion/chemo/immuno. I've discussed with co-workers and we're pretty much divided, most newer/inexperienced nurses think it's too high while the more experienced nurses think it is fine. I trust my nurse managers and fellow co-workers, but maybe someone can give me an explanation in different terms where it will "click" for me?

Thank you for input.

[DavidFR, BSN, MSN, RN]

Not shocked at all by the hyper-hydration, and in fact, we go further.

Depending on the protocol, 1 - 2 litres pre-hydration. The patient must have urinated a litre minimum before we proceed. Our cisplat goes in 250 mls usually giving us a final volume of 340 mls. We used to pass Mannitol concurrently but that's now been stopped as it's no longer deemed beneficial.

We give 2 litres post hydration supplementing in potassium, magnesium and calcium.

Obviously we modify in the case of frail elderly patients or known cardiac failure.

Cisplat is highly nephrotoxic and you have make the kidneys work hard. In 11 years using it I've very rarely seen patients go into overload. Some need a bit of Lasix to help them offload, but not often. We usually end up with a final diuresis of 4 or 5 litres which is the goal. Given that alot of the patients are fit young men with testicular tumours, they can usualy take it.

So no, your level of hydration doesn't shock me. In fact it's rather tame!

[DowntheRiver]

On 7/11/2020 at 9:57 PM, DavidFR said:

Not shocked at all by the hyper-hydration, and in fact, we go further.

Depending on the protocol, 1 - 2 litres pre-hydration. The patient must have urinated a litre minimum before we proceed. Our cisplat goes in 250 mls usually giving us a final volume of 340 mls. We used to pass Mannitol concurrently but that's now been stopped as it's no longer deemed beneficial.

We give 2 litres post hydration supplementing in potassium, magnesium and calcium.

Obviously we modify in the case of frail elderly patients or known cardiac failure.

Cisplat is highly nephrotoxic and you have make the kidneys work hard. In 11 years using it I've very rarely seen patients go into overload. Some need a bit of Lasix to help them offload, but not often. We usually end up with a final diuresis of 4 or 5 litres which is the goal. Given that alot of the patients are fit young men with testicular tumours, they can usualy take it.

So no, your level of hydration doesn't shock me. In fact it's rather tame!

Thank you for responding.

In my neck of the woods, 99% of our patients are elderly. I'm often giving Cisplatin to patients 65+ for bladder, head/neck cancer, or esophageal cancer. Many have hypertension as a comorbidity. We have been additionally hydrating the patients twice weekly with 1L of fluid at least, with some patients getting up to an additional liter or two if needed. We do give Lasix to about half those patients, typically 20 mg. I've recently had several incidents with patients being unable to make it to the restroom on time and having accidents who typically are not incontinent, which brought about this post.

[DavidFR, BSN, MSN, RN]

10 minutes ago, DowntheRiver said:

I've recently had several incidents with patients being unable to make it to the restroom on time and having accidents who typically are not incontinent, which brought about this post.

I have actually had that happen with young people, not often, but it does occur.