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Principles of Administration of Chemotherapy

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... affects doseage, administration time, pre-medication, ... Medical and surgical history. Psychosocial status and cultural issues. Patient performance status ... – PowerPoint PPT presentation

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Title: Principles of Administration of Chemotherapy


1
Principles of Administration of Chemotherapy
2
Principles of Administration
  • Correct Medication - Check drug against
    Physician order. 2 RNs check med, BSA.
  • Correct BSA - pts current height and weight
  • Correct route - affects doseage, administration
    time, pre-medication, other considerations.
  • Pre-medication - given before MOST chemo timing
    varies
  • Dose - mg or unit Clarify unclear orders
  • Patient - correctly identify and educate patient
    and significant others.

3
Pretreatment Nursing Assessment
  • Patient and family history
  • Previous cancer treatment
  • Medical and surgical history
  • Psychosocial status and cultural issues
  • Patient performance status
  • Allergy history
  • Accurate height and weight
  • Laboratory data
  • Tumor characteristics
  • Chemotherapy plan
  • Patient and family education

4
Pretreatment Plan Review
  • Review chemotherapy orders
  • Check drug dose and body surface area (BSA)
  • Identify treatment plan
  • Check current lab values
  • Confirm informed consent
  • Assess patient experience and readiness
  • Explain procedure to patient

5
Determination of Drug DoseCalculate Body Surface
Area
  • Height (cm) x Weight (kg)
  • 3600

6
Calculation of AUC (area under the curve)
  • Creatinine clearance
  • (CC) (140-age) x (weight in kilograms)
  • 72 x (serum creatinine)
  • AUC x (cc 25) doseage
  • Multiply result x 0.85 for female

7
Routes of Administration
  • Oral
  • Intramuscular
  • Intravenous
  • Central venous catheter infusion
  • Venous access via implantable access device
  • Topical
  • Intra-arterial
  • Intraperitoneal
  • Intrathecal
  • Intracavitary
  • Ventricular reservoir

8
Intravenous Route
  • Smallest needle size
  • Forearm preferable
  • Avoid joints
  • Extravasation danger
  • Given push, piggy- back, continuous infusion
  • Rapid blood level achieved
  • NO FILTERS except Taxol (paclitaxel)
  • Continuous infusion must be on a pump
  • Rate of infusion checked frequently
  • Never play catch up
  • Flush between drugs

9
Vesicant Chemotherapy
  • Vesicant - TISSUE NECROSIS if extravasated
  • Risk factors -- elderly, confused, poor venous
    access
  • Site Forearm only if peripheral
  • Fresh IV site avoid multiple sticks, mastectomy
    arm
  • NEVER LEAVE peipheral vesicant chemo -- Constant
    observation!
  • Blood return before and q 2 to 3 cc -- peripheral
  • Infusions only by Central Venous Route
  • Blood return before, after and q shift - infusion

10
Signs of Infiltration
  • Pain or burning at IV site
  • Edema or swelling at IV site
  • Loss of blood return
  • Redness (erythema) at IV site on arm
  • Decreased IV flow pump alarm sounds
  • Need to know vesicant status of drug

11
Vesicant Drugs
  • Nitrogen Mustard
  • Na Thiosulfate
  • Adriamycin
  • Daunorubicin
  • Epirubicin
  • Idarubicin
  • Topical DMSO
  • Apply ice
  • Elevate Extremity
  • Mitoxantrone
  • Ice and elevation
  • Actinomycin-D
  • Ice and elevation
  • Vinca Alkaloids
  • Heat
  • Elevation
  • Hyaluronidase no longer available

12
Vesicant Drugs (cont.)
  • Cisplatin
  • More than 20 cc extravasated
  • Concentration more than 0.5 mg/ml
  • If less than above amounts, irritant status
  • Sodium Thiosulfate
  • Heat/Cold not effective

13
(No Transcript)
14
Irritant Drugs
  • Taxanes (Taxol, Taxotere)
  • Ice pack for 15 - 20 minutes QID for 24 hrs
  • Elevation of limb
  • Ifosfamide
  • Carboplatin
  • Dacarbazine (DTIC)
  • Carmustine (BCNU)

15
Irritants (cont.)
  • Doxil (Doxorubicin liposomal)
  • Bleomycin
  • Apply ice if needed
  • Assess site daily
  • VP-16
  • Heat
  • Elevation

16
Prevention
  • Large vein in forearm 2 from wrist and 1 from
    elbow
  • Smallest gauge needle you can use (23 g)
  • Limit IV sticks ONE per vein
  • Check blood return q 2 to 3 cc for IV push
  • Check blood return q 5 min-IV piggyback
  • Check blood return q shift-IV infusion
  • Continuous infusion thru central line ONLY

17
Treatment of Extravasation
  • AT FIRST SIGN, stop chemo
  • Attempt to aspirate residual drug
  • Remove IV
  • Notify physician
  • Administer antidote (if ordered)
  • Heat/Cold as appropriate
  • Elevate extremity
  • Document extravasation and management

18
Chemotherapy Spills
  • Do not touch spill with unprotected hands
  • Open spill kit put on both sets of gloves
  • Put on gown, goggles, and mask (if needed)
  • Use spill pillows to contain spill
  • Use absorbent sheets to blot up as much drug as
    possible
  • Use scoop and brush to pick up any glass

19
Chemotherapy Spills (cont.)
  • Wash area with soap or disinfectant
  • Use disposable towels discard in plastic bag
  • Rinse with water dispose of towels in bag
  • Remove gear into plastic bag
  • Put bag and all waste into second bag label
  • Wash hands

20
Hematologic Parameters
  • WBC - 3.0 (3,000) or higher
  • ANC - Higher than 1000
  • ANC WBC x (Segs Bands) x 0.01
  • Platelets - Higher than 100 (100,000)
  • If in doubt, check with physician

21
Oral Route
  • Convenient non-invasive
  • Compliance problematic
  • GI Absorption problematic with hypermotility
    and/or prior surgery
  • Nausea and vomiting may cause patient to miss all
    or part of dose
  • Insurance may not cover cost of oral meds

22
IM or Subcutaneous Route
  • For optimal absorption, may split into multiple
    injections
  • Never used with vesicants/irritants
  • Platelet count must be adequate
  • Z-track to prevent chemo leakage
  • Patient self-administration preferable teaching
    materials are available

23
Topical
  • For skin lesions only
  • Chemo agents 5-FU, Mustargen
  • Applied until cancer is gone (redness may remain)
  • Nursing Considerations Chemo gloves, apply with
    cotton swabs, cover to avoid spread, apply ONLY
    to lesion
  • Patient education very important

24
Intravesicular
  • Superficial cancer in hollow organs (bladder
    cancer)
  • Agents used Thiotepa, Mitomycin, Doxorubicin,
    BCG (not chemo)
  • Instilled into bladder via catheter foley
    clamped for period of time before infusate
    drained
  • Side effects excoriation, pain in bladder,
    external genitalia hematuria

25
Intra-arterial Route
  • Used for liver cancer treatment
  • Cannulate hepatic artery continuous infusion of
    chemo may use implanted pump
  • High concentration directly to tumor bed
  • High rate of complication with arterial catheters
  • Chemotherapy agents 5-FU, FUDR

26
Intraperitoneal Route
  • Indication Colon and Ovarian
  • Peritoneal space has much surface area may not
    be reached by IV chemo
  • Catheters used Tenckhoff, implanted port
  • Chemotherapy agents used Cisplatin, Taxol
  • Advantages less systemic side effects
  • Disadvantages infection, BP changes, pain,

27
Intrapleural
  • Seeding of pleura
  • Used as sclerosing agent to stop pleural
    effusions
  • Injected by physician into chest tube and clamped
    Patient changes position q15 min for 1 hour
  • Chemotherapy agents used Bleomycin, Adriamycin,
    Talc slurry
  • Side effects SEVERE pain

28
Intrathecal Route
  • Meningeal spread of cancer
  • Prophylaxis in Acute Lymphocytic Leukemia
  • Lumbar Puncture or Ommaya Reservoir
  • Chemotherapy drugs used Ara-C, MTX Never Vinca
    Alkaloids (causes immediate death)
  • Side effects minimal mild headache or nausea
  • Notify physician for neck rigidity or change in
    level of consciousness

29
Ommaya Reservoir
30
Access Devices
  • Peripheral lines
  • Non-tunneled central venous catheters
  • Tunneled central venous catheters
  • Implanted port
  • Implanted pump (Infusaid, Synchromed)
  • Ommaya reservoir

31
Tunneled Catheter
32
Implanted Port
33
Peripherally Inserted Central Catheter (PICC)
34
Infusaid Pump
Synchro-Med Pump
35
Troubleshooting Vascular Access
  • Peripheral IV inserted within 24 hours of use
  • Blood return before and after each drug
  • NO BLOOD -- NO DRUG!!!
  • Flush with NS before and after each drug
  • Reposition patient, Valsalva
  • Use clot lysing agent
  • Dye study for catheter patency
  • For ports use correct size Huber needle

36
Treatment Phase
  • Identify plan for administration
  • Designate workplace
  • Secure spill kit and personal protective
    equipment
  • Prepare equipment
  • Emergency equipment available

37
Local Reactions from Chemotherapy Administration
  • Extravasation leakage or infiltration of a
    vesicant chemotherapy agent into local tissue
  • Vesicant any agent that has the potential to
    cause blistering or tissue necrosis
  • Irritant any agent that causes a local
    inflammatory reaction but does not cause tissue
    necrosis
  • Flare reaction venous inflammatory response with
    subsequent histamine release that may result in
    flare reaction incidence is usually about 3 and
    duration usually less than 45 minutes

38
Local Reactions
39
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