Chemotherapy Agents: General Safety for Nurses Presented by: 12400 High Bluff Drive San Diego, CA 92130 This course has been approved for two (2.0) contact hours. This course expires on April 12, 2009.
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Acknowledgements .2 Purpose & Objectives.3 Introduction to Chemotherapy .3 Preparing Chemotherapy: Exposure Precautions.6 Administering Chemotherapy: General Considerations.6 Administering IV Chemotherapy .7 Pre-administration checks .9 Infusing the Drugs .10 Managing Extravasations.13 Patient Teaching .13 Documentation Considerations.14 Oral Chemotherapy .14 Conclusion: Safety for the Patient and the Nurse .15 Cancer Chemotherapy Drugs .15 Useful Links.16 References .17 Post Test Viewing Instructions .18 ACKNOWLEDGEMENTS RN.com acknowledges the valuable contributions of…
…Lori Constantine MSN, RN, C-FNP, author of Chemotherapeutic Agents: General Safety for Nurses. Lori is a nurse of nine years with a broad range of clinical experience. She has worked as a staff nurse, charge nurse and nurse preceptor on many different medical surgical units including vascular, neurology, neurosurgery, urology, gynecology, ENT, general medicine, geriatrics, oncology, and blood and marrow transplantation. She received her Bachelors in Nursing in 1994 and a Masters in Nursing in 1998, both from West Virginia University. Additionally, in 1998, she was certified as a Family Nurse Practitioner. She has worked in staff development as a Nurse Clinician and Education Specialist since 1999 at West Virginia University Hospitals, Morgantown, WV.
PURPOSE & OBJECTIVES
The purpose of this course is to review the general safety principles surrounding chemotherapeutic agents in any healthcare setting. It will provide information for nurses who have little or no experience in managing patients who are receiving or have received a cytotoxic agent. After successful completion of this course, you will be able to:
1. Identify appropriate nursing actions to address safety issues related to chemotherapy such as:
• Monitoring patients on continuous, intravenous chemotherapy.
• Caring for patients who have recently received chemotherapy (within the past 48 hours).
• Administering oral cytotoxic agents.
2. Differentiate the level of caution to be used when handling vesicants and irritants.
3. Identify resources that will assist you when administering cytotoxic drugs or caring for patients
that have recently received these drugs.
4. Identify the essential components of nursing documentation of chemotherapy.
5. Describe teaching issues related to chemotherapy.
6. Identify the appropriate response as to when to seek an experienced chemo-certified nurse, what
to document, and your responsibility to the patient who needs chemotherapy when you are not "certified" to give it.
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INTRODUCTION TO CHEMOTHERAPY
Chemotherapy is administered to destroy or kill rapidly dividing cancer cells. Many cells in the human body also divide rapidly, such as hair, nails, and the epithelial cells of the gastrointestinal (GI) tract. Unfortunately, these human cells are at risk for injury from the chemotherapy as well. Chemotherapy works specifically by targeting cancer cells during different phases of their lifespan. Because different agents attack cancer cells at different phases of their life cycles, chemotherapeutic agents given in combinations are used to potentiate each other. Chemotherapy is also given to patients thought to be cancer-free after surgery and/or radiation therapy. When chemotherapy is administered in this way, it is known as adjuvant chemotherapy. Adjuvant chemotherapy helps to ensure that no undetectable metastasis exists. A patient may also receive chemotherapy before surgery or radiation therapy. Administration of chemotherapy prior to surgery or radiation therapy is known as neoadjuvant or synchronous chemotherapy. Chemotherapy that acts to shrink a tumor before surgical removal or radiation therapy is known as induction chemotherapy. Chemotherapy often helps improve survival rates for advanced tumors.
Generally, chemotherapy is effective at high doses. However, adverse effects often limit the dosage. The goal of oncologists is to maximize the dose of chemotherapy that a patient can receive, while simultaneously minimizing the toxic effects to the patient. Thus, combination agents and frequent administration is preferred over a one-time bolus dose, which would most likely prove harmful, even deadly to patients. Care of the patient receiving chemotherapeutic drugs requires specialized knowledge in these cytotoxic agents. Cytotoxic drugs are toxic to cells. Chemotherapeutic agents are toxic to rapidly dividing cells, including both cancer cells and normal human cells such as hair, nails, and epithelial cells of the gastrointestinal tract. Cytotoxic drugs have carcinogenic, mutagenic and/or teratogenic potential. When you or your patient touches these drugs directly, they may cause irritation to the skin, eyes, and mucous membranes, ulcerations, and tissue death or necrosis. Little research has been done on the long-term risks of the various levels of exposure encountered by unprotected healthcare workers. However, cytotoxic drugs have been associated with human cancers at high (therapeutic) levels of exposure and are carcinogens and teratogens in many animal studies. Because of this risk, most healthcare facilities have developed policies, procedures, and protocols to decrease nurses’ and other healthcare providers’ exposure to these drugs. For example, most facilities have policies regarding protective clothing, spill kits, and isolation precautions. All nurses should be aware of potential sources of exposure to cytotoxic agents. Avoid accidental
contact by taking appropriate precautions What do you do when you face a situation established by your facility. If you handle or mix
in which you are the only nurse available
chemotherapeutic agents, strictly follow your facility’s
to give a chemotherapeutic agent and you
protective protocols. If you are pregnant or even
lack facility-required education regarding
think you might be, be aware that handling these
cytotoxic drugs may lead to birth defects or
miscarriage. Most institutions allow pregnant nurses
to refrain from handling chemotherapy without fear of
• Consult your immediate supervisor for
After consulting your supervisor, and following facility
policy, if you are required to give the drug due to a unique circumstance, the Infusion Nurses Society (INS) recommends that you have knowledge of:
• Dosage calculations related to height, weight and body surface area
(Kowalak, 2003) Review appropriate laboratory data prior to administration of chemotherapy. Assess the patient for the appropriateness of the prescribed therapy. With a second clinician, validate the drug order, paying special attention to medication concentration and rate of infusion.
Additionally, if you are administering IV chemotherapy, you must be knowledgeable about the patient’s particular IV access. Central access is usually preferred for most chemotherapeutic agents.
PREPARING CHEMOTHERAPY: EXPOSURE PRECAUTIONS
The preparation of chemotherapeutic agents is one area of great concern for nurses. Fortunately, in most healthcare facilities, specially trained pharmacists prepare these cytotoxic agents under special aseptic conditions in the pharmacy. However, in some facilities, the nurse may prepare some agents for administration. If you are required to mix any chemotherapeutic agent, you must do so strictly according to the directions for that particular drug. Prepare the drug under a vertical laminar flow hood or in a biological safety cabinet, wearing protective clothing at all times. Never smoke, drink, apply cosmetics, or eat where these drugs are prepared, stored, or used. Facility policies usually strictly prohibit such activities. Occupational Safety and Health Administration (OSHA) guidelines for handling chemotherapeutic drugs have two basic requirements:
1. Healthcare workers who handle chemotherapeutic drugs must be educated and trained. A key
element of such training involves learning how to reduce your exposure when handling drugs.
2. The drugs should be prepared in a class II biological safety cabinet. If a biological safety cabinet
is not available, OSHA recommends that a respirator be worn while mixing the drugs. (http://www.nih.gov/od/ors/ds/pubs/cyto/)
It is advisable that your education regarding the mixing and administration of chemotherapeutic agents occur within the facility in which you practice. However, this course will provide you with the basic knowledge you need in case you must prepare or administer these drugs, under a highly unusual circumstance. If you plan to work in an oncology unit, cancer clinic, or other area in which preparing cytotoxic drugs may be a job requirement, seek additional education to learn your facility’s specific protocols before you handle these cytotoxic drugs. The primary routes of exposure during the preparation and administration phases are through the inhalation of an aerosolized drug or by direct skin contact. Some of the steps in preparing the drug may result in generating an aerosol, spraying, and splattering. Examples of these steps include:
• Withdrawing needles from drug vials.
• Using syringes and needles or filter straws for drug transfer.
• Opening ampules. • Expelling air from the syringe when measuring the precise volume of a drug. Therefore, prime all
IV bags that contain chemotherapeutic drugs under the hood. Leave the hood blower on 24 hours a day, 7 days a week.
Use a protective gown, chemotherapeutic or other specially designated gloves, and a vertical laminar flow hood or biological safety cabinet when preparing chemotherapeutic agents. If a vertical laminar flow hood or biological safety cabinet is not available, a respirator should be worn.
ADMINISTERING CHEMOTHERAPY: GENERAL CONSIDERATIONS
Chemotherapeutic drugs may be administered through various routes, although the intravenous (IV) route is used most commonly. Chemotherapeutic drugs can also be given orally, subcutaneously, intramuscularly, intra-arterially, into a body cavity (i.e. intraperitoneal, intrapleural), or through an Ommaya Reservoir into the spinal canal.
The administration route depends on the drug’s pharmacodynamics and the tumor’s characteristics. For example, if a malignant tumor is confined to one area, the drug may be administered through a localized or regional method. Regional administration allows delivery of a high drug dose directly to the tumor. This is particularly advantageous because many solid tumors fail to respond to drug levels that are safe for systemic administration. Examples of drug delivery routes to a localized tumor include intraperitoneal, intrapleural, and intrathecal. The Ommaya Reservoir is used to administer drugs intrathecally and target tumors of the central nervous system. However, most chemotherapy is given via the IV or oral route. The information in this course will assist you to administer IV or oral chemotherapy safely. This course does not substitute for specialized training at your particular facility. This course should not be utilized as a “competency or education” that will permit you to routinely administer chemotherapeutic agents. However, the course gives you the basic knowledge you need to handle an unusual circumstance in which you must administer the chemotherapeutic agent. Additionally, it should prepare you to care for patients who have received either IV or oral chemotherapy within the past 48 hours and will assist you in knowing when you need to seek assistance from one of the unit’s regular oncology nurses. Definitions
Intraperitoneal - Into the peritoneal cavity. Intrapleural - Into the pleural space, outside the lungs. Intrathecal – Into the cerebral spinal fluid. ADMINISTERING IV CHEMOTHERAPY
• Aluminum foil or a brown paper bag (if the drug is photosensitive)
• Normal saline solution • Syringes and needleless adapters
Central lines are the preferred route of administration for most chemotherapeutic agents.
• Peripherally Inserted Central Catheters (PICC lines). A PICC line can be inserted for
chemotherapy and used for weeks to months before it is discontinued. PICC placement involves the positioning of a long, plastic catheter into one of the larger veins of the arm. This procedure is a non-surgical outpatient procedure. Fluoroscopy will confirm that the catheter is in the correct location. PICCs work well for multiple short infusions or continuous infusions given in a hospital or at home with a portable pump.
• Tunneled Catheters. Tunneled catheters are placed through the skin in the middle of the chest.
They are tunneled through the subcutaneous tissue and inserted into the superior vena cava at entrance of the right atrium of the heart. There is a Dacron cuff approximately two inches from the exit-site within the chest. Scar tissue forms around the cuff to hold the catheter in place. These catheters are usually inserted during visualization with fluoroscopy. These catheters can be left in place for chemotherapy for months or years. Tunneled catheters are usually called by their brand names: Broviac, Groshong, or Hickman.
• Implanted Ports. A more permanent option involves the
placement of an implanted port. The implanted port is placed
under the skin on the chest. The catheter is then inserted into
the superior vena cava vessel at the entrance of the right
atrium of the heart. This catheter can be placed in radiology by
an interventional radiologist or by a surgeon. It is approximately a one-hour procedure. Implanted ports can remain within the patient for as long as five years. The implanted port can be felt under the skin so that you can insert a Huber needle through the middle diaphragm of the port to obtain access to the underlying vessel. Implanted ports are usually called by their brand names: Infusaport and Port-a-cath.
Common Vesicants and Irritants
A vesicant is a drug or other agent that produces blisters. Vesicants are highly active corrosive materials even at extremely low concentrations. If the drug to be administered is a vesicant, remember two key factors:
1. A low-pressure infusion device is the instrument of choice (i.e. low rate via infusion pump or
2. If the patient does not have central access and the drug is to be given peripherally, initiate a new
access site prior to administering the vesicant.
It is IMPERATIVE that you check your facility’s policy before administering a vesicant. Because vein integrity decreases with time, some facilities require that vesicants be administered before other drugs. Conversely, because vesicants increase vein fragility, other facilities require that vesicants be given after other drugs. When giving vesicants, avoid sites where damage to underlying tendons or nerves may occur (for example, veins in the antecubital fossa, near the wrist, or in the dorsal surface of the hand). Irritants cause a short-lived and limited irritation to the vein. Symptoms include tenderness, warmth, and/or redness along the vein or at the infusion site. A deviation to this is a hypersensitivity or "flare reaction" at the infusion site. Symptoms of this reaction are redness and itching at the infusion site. Infiltration of a vesicant is known as an extravasation. Extravasation initially looks like an irritation but may worsen, depending on the amount of vesicant that has leaked into the subcutaneous tissue. Vesicant extravasation may cause redness and blistering. Larger extravasations may cause severe skin damage within days. However, you may not notice symptoms for up to six to twelve hours after the chemotherapy infusion. Complaints of itching are common in the absence of pain. Severity of the reaction depends on the vesicant potential of the drug, the amount and concentration of the drug exposure, and the immediate measures taken once the extravasation occurs.
Common Irritants Common Vesicants Pre-administration checks
Before administering chemotherapeutic agents, there are many steps you must take to ensure accurate and safe administration of the drug, regardless of route of administration. Additionally, know your facility’s policy, procedures, and protocols governing who can administer chemotherapy and any other precautions to take prior, during, and post-chemotherapy administration. Some steps to take before administration of chemotherapy include:
• Verify the drug in the patient’s chart for the complete chemotherapy protocol order, including the
patient’s name, drug’s name and dosage, and the route, rate, and frequency of administration. Ascertain if the drug’s dosage depends on certain laboratory values.
• With another RN, read the dosage order and check the drug and the amount to be administered is
• Verify that the dose to be administered is within the correct dose range recommended in a
chemotherapy reference manual. Knowledge of how to calculate body surface area may be required since most chemotherapy doses are based on this factor.
Body Surface Area (BSA) (m2) =
Example: A patient whose height = 5ft 5in (165.1 cm) and whose weight = 160 lb (72.7kg)
(BSA) (m2) =
Formula: Centimeters to inches: cm X 0.39 Inches to centimeters: in X 2.54 How tall is a woman in centimeters who is 5' 5" (65 in)? 65 in X 2.54 = 165.1 cm
• Know your patient’s physical condition and relevant medical history.
• Assess the knowledge of your patient and the patient’s family regarding the chemotherapy
regimen, side effects, and potential complications.
• Verify that there is a signed consent form on the chart.
• Ask about your patient’s reactions to previous chemotherapy administrations.
• Check to see if pre-medications that may limit side effects of the particular agent are to be given.
• Assess your patient’s fluid status, as certain chemotherapeutic agents require pre-hydration.
• Verify the correct route of administration.
• Confirm patent and appropriate IV access.
• Review the results of recent laboratory studies, specifically the complete blood count, blood urea
nitrogen levels, platelet count, urine creatinine level, and liver function studies.
• Assess your patient’s absolute neutrophil count. The absolute neutrophil count, or ANC, is the
real number of white blood cells (WBCs) that are neutrophils in the blood. The ANC is not measured directly. It is derived by multiplying the WBCs by the percent of neutrophils in the differential WBC count. The percent of neutrophils consists of the segmented (fully mature) neutrophils + the bands (almost mature neutrophils).
ANC = WBC X (segs + bands)
The normal range for the ANC = 1.5 to 8.0 (1,500 to 8,000/mm3).
Example: WBC = 6,000/mm3 Segs: 30% Bands: 3% ANC = 6,000 X (30% + 3%) = 1,980/mm3 ANC = 2.0 (by convention) Normal range: 1.5 to 8.0 (1,500 to 8,000/mm3) Interpretation: Normal
• Check the patient’s drug history for medications that might interact with chemotherapy. As a rule,
do not mix chemotherapeutic drugs with other medications.
• If you have questions or concerns about giving the chemotherapeutic drug, talk with the physician
Infusing the Drugs
• Put on required personal protective equipment.
• Again, confirm vessel or IV access patency by instilling 10-20 mL normal saline and attempting to
visualize blood return. Never test vein patency with a chemotherapeutic drug.
• Next, administer the drug as appropriate:
. Non-vesicants by IV push or pre-mixed in a bag of IV fluid . Irritants and vesicants by IV push through a piggyback set connected to a rapidly infusing IV
• During IV administration, closely monitor the patient for signs of a hypersensitivity reaction or
extravasation. If you cannot stay with the patient during the entire infusion, use an infusion pump or controller to ensure drug delivery within the prescribed time and rate.
• Observe the patient at regular intervals and after treatment for adverse reactions. Monitor vital
signs throughout the infusion to assess any changes during chemotherapy administration.
• Check for adequate blood return after 5mL of the drug had been infused or according to your
• After infusion of the medication, infuse 20 mL of normal saline solution. Do this between
administrations of different chemotherapeutic drugs and before discontinuing the IV line.
• Dispose of used needles and syringes carefully. To prevent aerosol dispersion of
chemotherapeutic drugs, do not clip needles. Place them intact in an impervious container for incineration.
• Dispose of the IV bags, bottles, gloves, and tubing in a properly labeled and covered trash
• Wash your hands thoroughly with soap and warm water after giving any chemotherapeutic drug,
• Maintain a list of the types and amounts of drugs the patient has received. This is especially
important if he has received drugs that have a cumulative effect and that can be toxic to such organs as the heart or kidneys.
Exposure precautions during administration
During administration of chemotherapeutic agents, you must take certain precautions to minimize exposure to these agents. These precautions include:
• Wash your hands before and after drug preparation and administration.
• Make sure the prepared drug is appropriately labeled with the patient’s name, dosage strength,
• Excess air from tubing and syringes should already be cleared from the line, by the preparer of the
drug. If the line has not been cleared, clear the line, taking into consideration exposure risks outlined above in the preparation section.
• When you remove bubbles from syringes or IV tubing, place an alcohol pad carefully over the tip
of such items in order to collect any of the cytotoxic drugs, which may be inadvertently discharged.
• Prevent leakage of agents at tubing, syringe, or stopcock connections.
• Keep a waterproof, absorbent pad under connections where there is the potential for leakage.
• Dispose of syringes and unclipped needles into a leak-proof and puncture-resistant container.
• Dispose of cytotoxic drugs and trace-contaminated materials (i.e. gloves, gowns, needles,
syringes, and vials) in accordance with your facility’s policy and procedure and in a clearly labeled and puncture-resistant container.
• When actually administering the drug, wear a protective outer garment such as a closed-front
• Wear appropriate chemotherapeutic or other specially designated gloves during administration.
• You may also wear a surgical mask to limit your risk of inhaling aerosolized agents.
• Dispose of gloves and masks appropriately after each use and wash hands.
• NEVER recap needles! (http://www.nih.gov/od/ors/ds/pubs/cyto/)
Exposure precautions after administration
• Consider body fluids from patients receiving cytotoxic drug therapy contaminated for 48 hours,
and in some cases up to seven days. Body fluids may contain high concentrations of the agent. (Consult your drug book or pharmacist for these specifics).
• Wear disposable surgical gloves when there is a likelihood for exposure to blood or body fluids.
• Use standard isolation protocols to handle linen that is obviously contaminated with any cytotoxic
agent, blood or body fluids from a patient within 48 hours following drug administration. Standard isolation protocols are considered safe for laundering and disposal of such contaminated items. For example, place the contaminated articles in a yellow cloth bag lined with a water-soluble plastic bag and then place in the soiled linen area for removal. Again, refer to your facility’s policy and procedure for specifics.
• Use normal laundering mechanisms for handling linen free of obvious contamination. (http://www.nih.gov/od/ors/ds/pubs/cyto/)
Managing leaks and spills
Spills represent a very real hazard of chemotherapy administration. Learn the appropriate spill procedures to protect yourself and others. Assure that a Spill Kit is readily available on any unit where chemotherapy is administered. The kit should include:
• Water-resistant, non-permeable, long-sleeved gown with cuffs and back closure • Shoe covers
• Two pairs of gloves (for double gloving)
• Plastic scraper (for collecting broken glass)
• Vial or container of powder or granules (to absorb wet contents)
• Puncture proof, leak proof container labeled biohazard waste
• Container of 70% alcohol for cleaning the spill area (Kowalak, 2003) If a chemotherapy leak or spill should occur. Implement these procedures immediately:
• Put on a pair of appropriate gloves (per facility policy).
• If the chemotherapeutic agent has spilled on clothing, remove immediately and take a shower,
scrubbing the exposed skin with soap and water. Watch for redness, blistering, or a burning sensation. Notify your immediate supervisor for further instructions.
• Remove any and all sharp objects, placing them into your sharps container.
• Soak up the spill with an absorbent disposable material, such as paper towels.
• Disinfect the spill area with soap and water or a household cleaner such as window cleaner, 409,
alcohol, bleach, or liquid carpet cleaner.
• Put the absorbent material and the gloves into a chemotherapy waste container.
• If a spill occurs on a patient's or caregiver's clothing or sheets, wash these articles in hot water
• If a spill occurs on unprotected furniture, don protective chemo safety gloves and scrub the area
with soap and water. Then rinse with clean water.
• In case of skin contact with any cytotoxic drug, thoroughly wash the affected area with soap and
water. However, do not abrade the skin by using a scrub brush. For spatters into the eye, hold back the eyelid(s) and flush the affected eye(s) with copious amounts of water for at least 15 minutes. After initial cleansing of exposure site as outlined above, medical evaluation by a physician is recommended.
• Always wash hands after removing gloves. (http://www.nih.gov/od/ors/ds/pubs/cyto/)
IV administration of chemotherapeutic drugs creates risk for complications of chemotherapy. Safe IV administration requires the nurse to use knowledge and act quickly. As discussed earlier, extravasation is the infiltration of a vesicant drug into the surrounding tissue. It is a rare occurrence resulting from leakage of a vesicant around the venipuncture site or through a damaged vessel. Prevention of extravasation is the key. Observe the IV site frequently for signs of extravasation and allergic reaction, such as swelling, redness, and urticaria. Vesicant extravasation can result in significant pain, prolonged healing, infection, cosmetic disfigurement, and loss of function. It may necessitate multiple debridements, amputation, and/or plastic surgery if extensive enough. When extravasation is suspected, act quickly to minimize damage to surrounding tissues. Extravasation of a vesicant drug is considered an emergency. Take steps to stop damage after an extravasation:
• Stop the IV flow, aspirate the remaining drug in the catheter, and remove the IV line, unless you
need the needle to infiltrate a prescribed antidote.
• Estimate the amount of extravasated solution and notify the physician.
• Instill the appropriate antidote according to your facility’s protocol.
• Record the extravasation site, patient’s symptoms, estimated amount of infiltrated solution, and
treatment. Include the time you notified the physician and the physician’s name. Continue documenting the appearance of the site and associated symptoms.
• For extravasation of most drugs, ice is typically applied to all extravasated areas for 15 to 20
minutes every 4 to 6 hours for about 3 days. For etoposide and vinca alkaloids, heat is applied.
• If skin breakdown occurs, apply dressings as ordered.
Teach the patient throughout the chemotherapy process: before, during, and after chemotherapy administration. Key teaching points include:
• Side effects of the particular agent.
• Complications or things to report to the nurse including symptoms of neutropenia and
thrombocytopenia. Some patients with thrombocytopenia may not have symptoms. When symptoms occur, some of the most common symptoms are bruising, epistaxsis, and bleeding around the gums. Instruct your patient to report any of these symptoms immediately.
• How to manage and when to report other drug specific symptoms such as:
• Measures to reduce the infection risk such as avoiding people recently vaccinated with live
organisms or viruses (e.g., polio), avoiding pet urine and/or stool, including fish and birds, and avoiding exposure to fresh fruits, vegetables, flowers, and live plants.
• Any idiosyncrasies of the drug such as discoloration of urine or stool and idiosyncratic symptoms.
• Pre-medications your patient will be receiving prior to chemotherapy administration to minimize
If your patient will be going home and receiving chemotherapy from a family member or friend, you will need to teach the patient and the caregiver the procedures for administering the drug and any other drugs given in conjunction or for prevention of complications. They will also need to know how to handle these drugs. In your teaching, include measures to safely dispose of contaminated equipment and other articles:
• Wear gloves whenever handling chemotherapy equipment, contaminated lines or gowns and
• Place soiled linens in a separate washable pillowcase and launder the pillowcase twice, with the
soiled linens inside. Wash these linens separately from the other linens.
• Empty waste products into the toilet close to the water to minimize splashing. Close the lid and
flush two to three times after emptying the chemotherapy into the toilet.
• Place all materials used for treatment in a leak proof container and take it to a designated disposal
• Arrange with either a hospital or a private company for pickup and proper disposal of
To document chemotherapy administration correctly, it is essential that you record:
• The location and description of the IV site before treatment, including the presence of blood return
before, during, and after administration.
• The sequence of drug administration.
• The specifics of the IV access used, including the gauge and type of access.
• The amount and type of flushing solution used.
• The condition of the site after treatment.
• The patient’s tolerance of the treatment.
• Any topics discussed with the patient and family and their reponses within the discussion.
When handling oral chemotherapeutic agents, use all the safety principles discussed in the IV administration guidelines. However, oral chemotherapy requires only gloves for personal protective equipment. Apply the guidelines for patient teaching and documentation that are relevant to oral administration of chemotherapy. It is imperative that you know your facility’s policy regarding who can administer oral chemotherapeutic agents.
If you have not completed a chemotherapy certification recognized by your facility, it is recommended that you seek assistance from a nurse who is certified. Chemotherapy via the oral route presents many safety hazards. Oral medications identified as cytotoxic chemicals should be clearly labeled as such with warning stickers regarding safe handling on the package. If you must mix oral agents, use a biological safety cabinet. Wear a gown and gloves. Goggles and mask are also recommended. To wash contaminated equipment including the prepackaging machine, use water, then detergent, and rinse thoroughly. Discard all contaminated disposable materials in a zip-lock chemotherapy bag. Wear personal protective equipment (including a fitted respirator mask) when cleaning contaminated equipment. Fit Testing should be done at your particular facility. Disposal of unused oral cytotoxic medications is the same as for IV chemotherapy, in an approved clearly-labeled, puncture-resistant container (Solimando et al., 2000).
CONCLUSION: SAFETY FOR THE PATIENT AND THE
This course presents guidelines to protect your patients and yourself during the process of preparing, administering and monitoring chemotherapy. Your facility’s policies, procedures and protocols govern chemotherapy treatment, including who may administer chemotherapy. Know and abide by facility policy. Seek direction from your immediate supervisor in any situation in which you believe compromises patient safety or your own safety.
CANCER CHEMOTHERAPY DRUGS
GENERIC NAME(S) TRADE NAME(S) OTHER NAMES Useful Links
Occupational Safety and Health Administration (OSHA)
National Study Commission on Cytotoxic Agents
American Society of Hospital Pharmacists
Kowalak, J. (2003). Best practices: A guide to excellence in nursing care. Philadelphia, PA: Lippincott, Williams, and Wilkins. pp. 119-127 National Institutes of Health. Recommendations for the safe handling of cytotoxic drugs. Available at: (http://www.nih.gov/od/ors/ds/pubs/cyto/) Accessed 12/21/05. Solimando et al. (2000). Drug information handbook for oncology. Hudson, OH: Lexcomp Copyright 2006, AMN Healthcare, Inc. Please Read: This publication is intended solely for the use of healthcare professionals taking this course, for credit, from RN.com It is designed to assist healthcare professionals, including nurses, in addressing many issues associated with healthcare. The guidance provided in this publication is general in nature, and is not designed to address any specific situation. This publication in no way absolves facilities of their responsibility for the appropriate orientation of healthcare professionals. Hospitals or other organizations using this publication as a part of their own orientation processes should review the contents of this publication to ensure accuracy and compliance before using this publication. Hospitals and facilities that use this publication agree to defend and indemnify, and shall hold RN.com, including its parent(s), subsidiaries, affiliates, officers/directors, and employees from liability resulting from the use of this publication. The contents of this publication may not be reproduced without written permission from RN.com.
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Microscopic colitisChris J. J. Mulder1, Ivar M. Harkema2, Jos W. R. Meijer31 Department of Gastroenterology, Vrije Universiteit Medisch Centrum / Free University Medical Centre, Amsterdam, the Netherlands2 Department of Gastroenterology, Ziekenhuis Rijnstate / Rijnstate Hospital, Arnhem, the Netherlands3 Department of Pathology, Ziekenhuis Rijnstate / Rijnstate Hospital, Arnhem, the Netherlands
Sicherheitsdatenblatt gemäß 1907/2006/EG, Artikel 31 ABSCHNITT 1: Bezeichnung des Stoffs bzw. des Gemischs und des Unternehmens 1.1 Produktidentifikator Handelsname: Anti-Insekt Artikelnummer: 2059, 2060 1.2 Relevante identifizierte Verwendungen des Stoffs oder Gemischs und Verwendungen, von denen abgeraten wird Keine weiteren relevanten Informationen verfügbar. Verwendung d