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Home Epley manoeuvre to treat BPPV (left ear) - patient information

Description
This factsheet explains what benign paroxysmal positional vertigo (BPPV) is, what the Epley manoeuvre treatment method is and how to perform
Url
/Media/UHS-website-2019/Patientinformation/Audiology/Home-Epley-manoeuvre-to-treat-BPPV-left-ear-2782-PIL.pdf

Renal cryoablation aftercare advice - patient information

Description
This factsheet explains the symptoms you need to be aware of and when to seek medical advice after having percutaneous renal
Url
/Media/UHS-website-2019/Patientinformation/Digestionandurinaryhealth/Renal-cryoablation-aftercare-advice-1531-PIL.pdf

Stereotactic vacuum assisted biopsy (VAB) of breast - patient information

Description
This leaflet explains more about having a stereotactic VAB of the breast, including the benefits, risks and what you can expect
Url
/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Stereotactic-vacuum-assisted-biopsy-VAB-of-breast-2024-PIL.pdf

Vestibular disorders in children - patient information

Description
This factsheet contains information about vestibular disorders in children.
Url
/Media/UHS-website-2019/Patientinformation/Audiology/Vestibular-disorders-in-children-2874-PIL.pdf

Welcome to radiotherapy - patient information

Description
This factsheet contains information about your visit to the radiotherapy department at Southampton General Hospital and aims to answer some of
Url
/Media/UHS-website-2019/Patientinformation/Cancercare/Welcome-to-radiotherapy-1330-PIL.pdf

Stereotactic vacuum assisted excision (VAE) of breast - patient information

Description
This leaflet explains more about having a stereotactic VAE of the breast, including the benefits, risks and any alternatives, and what
Url
/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Stereotactic-vacuum-assisted-excision-VAE-of-breast-2025-PIL.pdf

HSCT Amb Melphalan-Bortezomib SC

Description
Chemotherapy Protocol HAEMATOLOGY – HSCT AUTOGRAFT AMBULATORY MELPHALAN and BORTEZOMIB SC Multiple Myeloma This regimen will only be available to prescribe at units which carry out autograft transplantation. Regimen HSCT – AmB Melphalan-Bortezomib SC Indication • Conditioning for haematopoietic stem cell transplant in patients with multiple myeloma Toxicity Drug Melphalan Bortezomib Adverse Effect Nausea, vomiting, diarrhoea, stomatitis, alopecia and myelosuppression GI disturbance, peripheral neuropathy, hypotension, dizziness, blurred vision, headache, musculoskeletal pain, pyrexia The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs • FBC, LFTs, U&Es, bone profile, CRP, LDH, serum immunoglobulins and electrophoresis and serum free light chains prior to initiating treatment • GFR measurement done by Nuclear Medicine or creatinine clearance calculation prior to first day of treatment. Dose Modifications The dose modifications listed are for liver and renal function. Dose adjustments may be necessary for other co-morbidities as well which will involve discussions with the Transplant Director, Senior Transplant Clinician or patient’s consultant. Haematological Confirm with transplant consultant before proceeding if there are signs of disease relapse. Version 1.0 (September 2023) Page 1 of 8 AmB Melphalan-Bortezomib SC Autograft Conditioning Hepatic Impairment Drug Bortezomib Bilirubin μmol/L 1.5xULN or below greater than 1.5xULN AST/ALT units/L N/A N/A Dose (% of original dose) 100% Consider initiating treatment at 0.7mg/m2 No information is available on melphalan in hepatic impairment. No dose changes recommended. Renal Impairment Drug Melphalan Bortezomib Creatinine Clearance (ml/min) greater than 50ml/min 30 – 50ml/min less than 30 ml/min greater than 20 20 and below Dose (% of original dose) 200mg/m2 140 mg/m2 Clinical decision, high dose melphalan is not recommended 100% Clinical decision Other Bortezomib For patients experiencing NCI-CTC grade 1 neuropathy without loss of function or pain continue with full dose bortezomib. For NCI-CTC grade 1 with pain or grade 2 neuropathy reduce the dose of bortezomib to 1mg/m2. Regimen Drug Melphalan Bortezomib Dose 200mg/m2 1.3mg/m2 Days -1 -1 and +5 Administration Intravenous infusion in 500ml sodium chloride 0.9% over 30 minutes subcutaneous injection over 5 seconds Day -1 to be given 8 hours after melphalan infusion Dose Information • The melphalan dose is rounded down to the nearest 10mg. The National Dose Banding Team have advised not to use dose banding tables for this product in view of the 90 minute expiry (must be made locally for individual patient), the 50mg vial size and frequent stock shortages. Version 1.0 (September 2023) Page 2 of 8 AmB Melphalan-Bortezomib SC Autograft Conditioning • Bortezomib will be dose banded in accordance with the national dose banding table (2.5). Administration Information • Bortezomib SC on day -1 to be given 8 hours after melphalan infusion. Extravasation • Melphalan – neutral • Additional Therapy • Antiemetics - Aprepitant 125mg once a day prior to melphalan followed by 80mg once a day for two days afterwards, oral. -dexamethasone 4mg each morning, on the same days as aprepitant, oral -metoclopramide 10mg three times a day oral or intravenous until nausea subsides - ondansetron 8mg twice a day oral or intravenous for ten days then review • Antimicrobials Antimicrobials should be prescribed according to the institution guideline and may include: - ciprofloxacin 250mg twice daily from day +5 to continue whilst neutropenic. - fluconazole 100mg once daily from admission until recovery from neutropenia - aciclovir 400mg twice or three times a day from admission to continue after discharge • Growth factors According to local formulary choice. For example: - filgrastim or bioequivalent 30million units subcutaneous once a day starting from day +7 to continue until neutrophils are more than 0.5. - lenograstim or bioequivalent 33.6million units subcutaneous once a day starting from day +5 to continue until neutrophils are more than 0.5. • Gastric protection with a proton pump inhibitor should be prescribed throughout admission. • Mouthwashes including: - nystatin 1ml four times a day to continue until count recovery - sodium chloride 0.9% 10ml four times a day to continue until count recovery. • Thromboprophylaxis -in accordance with individual transplant schedule Version 1.0 (September 2023) Page 3 of 8 AmB Melphalan-Bortezomib SC Autograft Conditioning • Premedication for stem cell transfusion -chlorphenamine 10mg intravenous -paracetamol 1000mg oral • Intravenous hydration before and after melphalan infusion prescribed on inpatient prescribing system or using paper proforma (appendix 1) The evening before melphalan infusion (to be completed by 0930 on the morning of the infusion) Sodium chloride 0.9% with potassium chloride 27mmol 1000ml The day of melphalan infusion 0830hrs Contact Pharmacy on ext 5037 to inform them that the patient is present. Confirm that they have melphalan prescription (on ARIA) □ Request melphalan to be on the ward by 11:30 □ Start fluid balance sheet and start daily weight measurement. 0915hrs Administer anti-emetics and supportive medication as per ARIA prescription. 0930hrs 20mg furosemide intravenous bolus Warning – Check hydration and fluid balance 1000hrs 1000ml sodium chloride 0.9% intravenous infusion over 90 minutes 1030hrs 20mg furosemide intravenous bolus Measure urine output since 0900hrs ▪ If more than 500ml continue with melphalan infusion ▪ If less than 500ml give second furosemide 20mg intravenous bolus dose and check urine output since 0900hrs again at 1100hrs: • if more than 500ml go ahead with melphalan • if less than 500ml contact the prescriber. 1130hrs – give melphalan intravenous infusion over thirty minutes (this product has a short expiry so adhering to set timing is essential) 1200hrs - 1000ml sodium chloride 0.9% intravenous infusion over 120 minutes Instruct patient to take all supportive medications with reference to antiemetics. Advise patient to drink 1000 ml of oral fluids over the evening. Emergency contact details for AOS given to patient. Patient and carer to return to C7 at 08:30 on day 0 References Version 1.0 (September 2023) Page 4 of 8 AmB Melphalan-Bortezomib SC Autograft Conditioning 1. P-P-54 Wessex Blood and Marrow Transplant – Dose adjustments for stem cell transplant conditioning agents policy. Version 1.0 2. P-P-43 Wessex Blood and Marrow Transplant – WESSEX BLOOD AND MARROW TRANSPLANT – Conditioning schedule for High Dose Melphalan Policy. Version 1.4 3. Dosage Adjustments for Cytotoxics in Hepatic Impairment January 2009 University College London Hospitals 6. Summary of Product Characteristics for Melphalan (Aspen) – last updated 09 Dec 2014 7. Handbook of Systemic Treatments for Cancer 7th Edition 2012 Lilly Oncology 8. National Dose Banding Tables Version 1.0 (September 2023) Page 5 of 8 AmB Melphalan-Bortezomib SC Autograft Conditioning REGIMEN SUMMARY Melphalan-Bortezomib SC Ambulatory Care Other than those listed below, supportive medication for this regimen will not appear in Aria as prescribed agents. The administration instructions for each warning describes the agents which must be prescribed on the in-patient chart or general electronic prescribing system. Day -1 1. Aprepitant 125mg oral 2. Dexamethasone 4mg oral or intravenous 3. Ondansetron 8mg oral or intravenous 4. Metoclopramide 10mg oral or intravenous 5. Furosemide 20mg injection bolus Administration instructions – to be given if required for fluid overload. 6. Warning – Check hydration and fluid balance The evening before melphalan infusion (to be completed by 0930 on the morning of the infusion) Sodium chloride 0.9% with potassium chloride 27mmol 1000ml The day of melphalan infusion 0830hrs Contact Pharmacy on ext 5037 to inform them that the patient is present. Confirm that they have melphalan prescription (on ARIA) □ Request melphalan to be on the ward by 11:30 □ Start fluid balance sheet and start daily weight measurement 0915hrs Administer anti-emetics and supportive medication as per ARIA prescription 0930hrs 20mg furosemide intravenous bolus 1000hrs 1000ml sodium chloride 0.9% intravenous infusion over 90 minutes 1030hrs 20mg furosemide intravenous bolus Measure urine output since 0900hrs If more than 500ml continue with melphalan infusion If less than 500ml give second furosemide 20mg intravenous bolus dose and check urine output since 0900hrs again at 1100hrs: if more than 500ml go ahead with melphalan if less than 500ml contact the prescriber. 1130hrs – give melphalan intravenous infusion over thirty minutes (this product has a short expiry so adhering to set timing is essential) 1200hrs - 1000ml sodium chloride 0.9% intravenous infusion over 120 minutes 7. Time– Administer melphalan at 1130hrs 8. Melphalan 200mg mg/m2 intravenous infusion in 500ml sodium chloride 0.9% over 30 minutes Administration Instructions - see separate hydration prescription chart for the post hydration. 9. Bortezomib 1.3mg/m2 subcutaneous injection over 5 seconds Administration instructions - To be given at 8 hours after melphalan infusion. Day 0 Version 1.0 (September 2023) Page 6 of 8 AmB Melphalan-Bortezomib SC Autograft Conditioning 10. Chlorphenamine 10mg Intravenous bolus Administration instructions – to be given pre stem cell infusion 11. Paracetamol 1000mg Tablet Oral Administration instructions – to be given pre stem cell infusion 12. Stem Cell Return – see separate chart Day +5 13. Bortezomib 1.3mg/m2 subcutaneous injection over 5 seconds Take home medicines. 14. Aprepitant 80mg once a day oral for 2 days starting the day after melphalan 15. Dexamethasone 4mg once a day oral for 2 days starting the day after melphalan 16. Ondansetron 8mg twice a day for 5 days starting the evening of melphalan administration 17. Metoclopramide 10mg three times a day oral Administration instructions – take regularly for 5 days then when required. Please supply 28 tablets or an original pack as appropriate 18. Levomepromazine 6.25mg four times a day oral Administration instructions – to be taken on advice from medical team for nausea or vomiting. Please supply 3 days. 19. Aciclovir 400mg three times a day oral Administration Instructions Please supply 28 days or an original pack if appropriate. 20. Ciprofloxacin 250mg twice a day starting on day 5 (6 days after melphalan administration) Administration Instructions Please supply 14 days with no stop date 21. Fluconazole 100mg oral once a day Administration instructions – please supply 14 days with no stop date 22. Nystatin 1ml four times a day oral Administration instructions – please supply 1 x OP 23. Gastric Protection Administration Instructions The choice of gastric protection is dependent on local formulary choice and may include; - esomeprazole 20mg once a day oral - omeprazole 20mg once a day oral - lansoprazole 15mg once a day oral - pantoprazole 20mg once a day oral - rabeprazole 20mg once a day oral - cimetidine 400mg twice a day oral - famotidine 20mg once a day oral - nizatidine 150mg twice a day oral - ranitidine 150mg twice a day oral Please supply 28 days or the nearest original pack size. 24. Sodium Chloride 0.9% oral rinse 10mL four times a day Administration instructions – pharmacy please supply 50 x 10mL pods DOCUMENT CONTROL Version 1.0 (September 2023) Page 7 of 8 AmB Melphalan-Bortezomib SC Autograft Conditioning Version Date Amendment Written By Approved By 1.0 September 2023 None Eleanor Taylor Cancer Services Pharmacist Matthew Jenner Consultant Haematologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; University Hospital Southampton NHS Foundation Trust – Wessex Blood and Marrow Transplant All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors that occur as a result of following these guidelines. HIGH DOSE MELPHALAN VELCADE HYDRATION PRESCRIPTION_2023-11-1.docx Version 1.0 (September 2023) Page 8 of 8 AmB Melphalan-Bortezomib SC Autograft Conditioning
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Transplant/HSCT-Amb-Melphalan-Bortezomib-SC-Ver1.pdf

MRI-guided vacuum assisted biopsy (VAB) of the breast - patient information

Description
This factsheet explains what a MRI guided vacuum assisted biopsy (VAB) of the breast is and what you can expect at
Url
/Media/UHS-website-2019/Patientinformation/Scansandx-rays/MRI-scans/MRI-guided-vacuum-assisted-biopsy-VAB-of-the-breast-2281-PIL.pdf

HSCT AmB Melphalan

Description
Chemotherapy Protocol HAEMATOLOGY – HSCT AUTOGRAFT AMBULATORY MELPHALAN (200mg/m2) Multiple Myeloma This regimen will only be available to prescribe at units
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Transplant/HSCT-AmB-Melphalan.pdf

Having an ultrasound-guided tunnelled drain insertion - patient information

Description
This factsheet explains what an ultrasound-guided tunnelled drain insertion is, what the procedure involves and how to prepare for it
Url
/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Having-an-ultrasound-guided-tunnelled-drain-insertion-3302-PIL.pdf
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