administration of cancer treatment Flashcards
advantages of injeciton admin
bioavailability and predictable plasma levels
not affected by swallowing difficulties/vomiting
disadvantages of injection admin
- risks associated with injection - extravasion
- multiple drug admin - drug/fluid incompatibilities, IV access
- inconvenient and time consumnig
- cost
2 types of IV injection
cannula
central line
What is a cannula?
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
Why are central lines preferred?
- 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
What is a central venous catheter?
- tube/catheter inserted into vein
- pushed along until reached larger vein
- secured into position by 2 stitches
- stays in place LT
What veins can central venous catheter be inserted into?
subclavian vein
femoral vein
Larger vein that central venous catheter reaches
superior or inferior vena cava
PICC - peripherally inserted central catheter
tube/catheter into vein in the arm
catheter pushed along until reached larger vein
larger vein that peripherally inserted central catheter reaches
superior or inferior vena cava
What is a Portacath?
- 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
3 types of IV administration
continuous infusion
intermittent infusion
direct intermittent infusion
continuous infusion
delivery of med at constant rate over period of time
100-1000ml
long period (hrs-days)
intermittent infusion
smaller volume (25-250ml)
given over shorter period od time - 15mins-2hrs
direct intermittent injection
bolous injection of drug into a vein/IV line/portacath
issues with central venous catheter
infection
blood clots
blockage
extravaasation
infection of central venous catheter
swelling, redness, discharge at exit site, pyrexia
treat with ABX and may have to remove line
blood clots in central venous catheter
- 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
blockage of central venous catheter
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
What is extravasation?
accidental leakage of chemotherapy form vein into surrounding tissues
What do vesicant drugs cause?
tissue damage or necrosis
RF for extravasation
- 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)
Sx of extravasation
redness
swelling
pain/burning sensation
superficial skin loss
tissue necrosis
Tx for extravasation
- 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
