administration of cancer treatment

Question 1

what are the advantages of injection as a route of administration?

Answer 1

–Bioavailability & predictable plasma levels
–Not affected by swallowing difficulties/
vomiting

Question 2

what are the disadvantages of injection as a route of administration?

Answer 2

–Risks associated with injection
–Multiple drug administration
*Drug/fluid incompatibilities
*IV access
–Inconvenient and time consuming
–Cost

Question 3

what are the different types of injections?

Answer 3

*Subcutaneous
*Intramuscular
*Intradermal
*Intravenous

Question 4

what is a canula and how it is cared for?

Answer 4

a short tube put into a vein usually in lower arm/back of hand
*Can put clear dressing over the top to keep in place
*Short term - removed before patient discharged

Question 5

why are central lines preferred?

Answer 5

*Drips into hand/arm can be temperamental as patient can readily move area
*Speed of administration not as easy to control as with other lines (eg. central line with pump)
*Patient can have fragile veins
*High risk of extravasation

Question 6

what is a central venous catheter?

Answer 6

A tube/catheter inserted into a vein (subclavian vein,
internal jugular vein or femoral vein)
*Catheter is pushed along the vein until it reaches larger vein (superior/inferior vena cava)
*Secured into position with two stitches

Question 7

what is a PICC?

Answer 7

Peripherally inserted central catheter
*PICC
*A tube/catheter inserted into a vein in the arm
*Catheter is pushed along the vein until it reaches larger vein (superior/inferior vena cava)

Question 8

what is a portacath?

Answer 8

long term CVC with no external parts
*Catheter placed in subclavian however end
attached to titanium/plastic port which is
implanted in subcutaneous tissue in chest
*Thick rubber septum covers port reservoir, once incision sutured port is completely enclosed.
*Needle is inserted through the skin and rubber
septum

Question 9

what are the different methods of IV administration?

Answer 9

*Continuous infusion – delivery of medication
(fluid) at a constant rate over a prescribed time
period
*Intermittent infusion – smaller volume (25-
250ml) given over a shorter period of time (15
mins – 2 hours)
*Direct intermittent injection – “bolus” injection
of a drug straight into vein

Question 10

what is used to unblock a catheter if there is a thrombolytic blood clot?

Answer 10

eurokinase

Question 11

what are the issues associated with central venous catheters?

Answer 11

infection
blood clot
blockage

Question 12

what is extravasation?

Answer 12

Accidental leakage of chemotherapy from
vein into surrounding tissues

Question 13

when is extraversion especially an issue?

Answer 13

Especially an issue with vesicant drugs
*Causes tissue damage/necrosis

Question 14

what are the risk factors for extravasation?

Answer 14

*Fragile veins
*Very young or old patients
*Confused/unconscious/sedated patients who might not report initial discomfort
*Concurrent medication that might reduce blood flow, reduce pain sensation, increase risk of bleeding eg. analgesics, anticoagulants, vasodilators, diuretics
*Peripheral administration (especially if using small veins, over joints)
*Inexperienced staff
*Bolus injections

Question 15

what do you do in early recognition and prompt treatment of extravasation?

Answer 15

*Discontinue infusion and aspirate any residual drug from canula
*Treatment dependent on drug
*Vesicant versus non vesicant
*Referral to haematologist / oncologist
*Infusion of antidote may be appropriate (dexrazoxane with antracycline)
*Referral to plastic surgery

Question 16

what are the advantages of oral therapy?

Answer 16

–More convenient for the patient
–Can be less expensive
–Lower toxicity

Question 17

what are the disadvantages of oral therapy?

Answer 17

–Adherence
–Variable plasma pharmacokinetics
–Management of drug interactions
–Nausea and vomiting

Question 18

what are other less common routes of administration?

Answer 18

Intrathecal
Injected into fluid around spine and brain (CSF)
*Brain tumours, leukaemias, some lymphomas
*IntracavitaryBladder, abdomen, chest cavityIntralesional / intratumoralDirectly into the tumourTopical*Some skin cancers (5-FU cream)