administration of cancer treatment

Question 1

advantages of injeciton admin

Answer 1

bioavailability and predictable plasma levels

not affected by swallowing difficulties/vomiting

Question 2

disadvantages of injection admin

Answer 2

• risks associated with injection - extravasion
• multiple drug admin - drug/fluid incompatibilities, IV access
• inconvenient and time consumnig
• cost

Question 3

2 types of IV injection

Answer 3

cannula

central line

Question 4

What is a cannula?

Answer 4

short tube put into a vein usually in lower arm/hand

clear dressing over top to keep it in place

short term, removed when patient discharged

Question 5

Why are central lines preferred?

Answer 5

• arm/hand, patient moving these areas
• speed of admin easier to control (central line with pump)
• patient can have fragile veins
• high risk of extravasation

Question 6

What is a central venous catheter?

Answer 6

• tube/catheter inserted into vein
• pushed along until reached larger vein
• secured into position by 2 stitches
• stays in place LT

Question 7

What veins can central venous catheter be inserted into?

Answer 7

subclavian vein

femoral vein

Question 8

Larger vein that central venous catheter reaches

Answer 8

superior or inferior vena cava

Question 9

PICC - peripherally inserted central catheter

Answer 9

tube/catheter into vein in the arm

catheter pushed along until reached larger vein

Question 10

larger vein that peripherally inserted central catheter reaches

Answer 10

superior or inferior vena cava

Question 11

What is a Portacath?

Answer 11

• LT central venous catheter wth no external parts
• catheter placed in subclavian and end attached to titanium/plastic port that is implanted in subcutaneous tissue in chest
• rubber septum coveres top
• needle inserted through skin and rubber septum

Question 12

3 types of IV administration

Answer 12

continuous infusion

intermittent infusion

direct intermittent infusion

Question 13

continuous infusion

Answer 13

delivery of med at constant rate over period of time

100-1000ml

long period (hrs-days)

Question 14

intermittent infusion

Answer 14

smaller volume (25-250ml)

given over shorter period od time - 15mins-2hrs

Question 15

direct intermittent injection

Answer 15

bolous injection of drug into a vein/IV line/portacath

Question 16

issues with central venous catheter

Answer 16

infection

blood clots

blockage

extravaasation

Question 17

infection of central venous catheter

Answer 17

swelling, redness, discharge at exit site, pyrexia

treat with ABX and may have to remove line

Question 18

blood clots in central venous catheter

Answer 18

• blood clot (thrombosis) can form in vein at end of line
• presents as swelling, redness, SOB, tightness in chest, tenderness in arm/chest/up into neck (same side as line)
• give thrombolytic meds, may have to remove line

Question 19

blockage of central venous catheter

Answer 19

inside of line can become partly/completely blocked - by drugs, blood

flush line with saline to clear blockage

thrombolytic flush can be used if blocked by blood clot

Question 20

What is extravasation?

Answer 20

accidental leakage of chemotherapy form vein into surrounding tissues

Question 21

What do vesicant drugs cause?

Answer 21

tissue damage or necrosis

Question 22

RF for extravasation

Answer 22

• fragile veins
• very young/old patients
• confused/unconscious/sedated patients, might not report initial disomfort
• concurrent meds that can recude blood flow, pain sensation, inc bleeding risk -> analgesics, anticoagulants, vasodilators, diuretics
• peripheral administration (esp small veins, over moving joints)
• inexperienced staff
• bolus injection (very concentrated)

Question 23

Sx of extravasation

Answer 23

redness
swelling
pain/burning sensation
superficial skin loss
tissue necrosis

Question 24

Tx for extravasation

Answer 24

• discontinue infusion
• aspirate any residual drug from cannula
• Tx depends on drug - vesicant or non
• refer to haematologist/oncologist
• might need infusion of antidote
• referral to plastic surgery

Question 25

antidote for extravasation with anthracycline

Answer 25

dexrazoxane

Question 26

advantages of oral therapy

Answer 26

more convenient for patient
less expensive
lower toxicity
avoid complications with IV access

Question 27

disadvantages of oral therapy

Answer 27

adherance
variable plasma pharmacokinetics
management of drug interactions
N&V

Question 28

intrathecal admin

Answer 28

injected into fluid around spine and brain (CSF)

brain tumours, leukaemia, some lymphomas

Question 29

intracavitary admin

Answer 29

bladder, abdomen, chest cavity

Question 30

intralesional/intratumoral admin

Answer 30

directly into tumour

Question 31

eg of topical admin

Answer 31

5-FU cream

for some skin cancers