To see all protocols that comply with the WHO Essential Medicine List 

This resource provides guidance on how to safely undertake the procedure. Institutional practice may vary in accordance with local policy.

Only health care professionals who have attained competency (as per institutional guidelines) should perform this procedure.

Clinical safety note
The consequences of inadvertently administering antineoplastic drugs not intended for intrathecal or intraventricular use can be FATAL. See the safety alert from Australian Commission on Safety and Quality in Health Care
The COSA Guidelines for the Safe Prescribing, Dispensing and Administration of Cancer Chemotherapyr state that "methotrexate, cytarabine, hydrocortisone and dexamethasone are commonly given by the intrathecal route.  Occasionally rituximab and thiotepa may be given by this route."
All medications for intrathecal/intraventricular use must be:
  • isotonic and preservative free
  • labelled for its intended use e.g., "For intrathecal use only"
  • must be stored separately to all other chemotherapy
  • should be supplied in a designated container from the pharmacy and remain in the designated container until ready to be administered
There is some risk of meningitis in this procedure; health professionals should wear a face mask when performing this procedure

This clinical procedure outlines the care of the patient pre, during and post lumbar puncture and administration of intrathecal antineoplastic drugs and the equipment required for this procedure.

Please access your local institutions lumbar puncture procedure.

A register of staff designated as competent to prescribe, prepare, dispense, supply, receive or administer intrathecal therapy for cancer should be maintained and accessible across the institution. Only staff listed on the register should undertake the specified tasks.r

This document reflects what is currently regarded as safe practice. While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. Use is subject to eviQ’s disclaimer available at

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25 May 2020