Administration of Chemo drugs & safe drug handling Flashcards
What are essential pieces of the patient assessment prior to treatment?
- PCNAR (assess all systems for signs of toxicity and to ensure proper follow-up and that treatment is appropriate)
- The rights of drug administration, including that dose calculation is appropriate (eg. consider weight)
- Pre-treatments (are there orders for any? what are the usual or pt specific responses to the drug and are pre-treatments necessary?)
- Specific double-checking standards prior to dose admin (eg. double check with another RN, allergies, orders)
What are chemo doses based on?
- Body surface area (BSA), with dosage prescribed as mg, g or units per square meter of BSA
- Most common formula to determine is the Mosteller formula (m2) = square root of (height in cm x weight in kg) divided by 3600
what are the advantages of the mosteller formula in determining BSA compared to other methods?
- Validated against other formulas
- reduces change of error that can arise when sliding scales used
- easy to remember
- applied to children and adults
What is the mosteller formula for BSA?
- Multiple the height (cm) by weight (kg) / divide that number by 3600 - then take the square root of that number = the final product is the m2
- The average BSA for women is 1.6 m2 and 1.9 m2 for men (most often between 1 and 2)
- If you calculate a number that is less than 1 or more than 2, consider a few things - is the math right? Is the height and weight right? Is the pt particularly small, tall, overweight or underweight?
What are the common routes for administering chemo?
1) Oral
2) IV ** (most common, multiple types)
3) Intramuscular and SC (rarer)
4) Intra-arterial (rarer, for Liver Ca)
5) Intra-peritoneal (Ovarian Ca)
6) Intra-pleural (in attempt to eliminate the pleural space if frequent effusions a concern)
7) Intra-vesicular (Bladder Ca)
8) Intra-thecal or Intra-Ventricular (CNS/Hematologic/Lymphoma)
9) Topical (Skin Ca)
What are the three methods for administering IV chemo?
1) Winged infusion devices (“butterflies”) - short section of tubing attached to steel needle, used for boluses into peripherals
2) Peripheral IV’s - short term use for boluses or short infusions
3) Central lines - allows for less pokes, higher osmolality drugs (toxic to veins) - PICC’s, skin-tunnelled catheter, and implantable ports
What drugs are known vesicants?
Doxorubicin * Daunorubicin Epirubicin Mitomycin, other -mycin drugs Vinblastine Vincristine *, other -stine drugs Vindesine Vinorelbine Mechlorethamine Paclitaxel Streptozocin
What pre-cautions should be taken to prevent extravasation?
- Intact vein: insertion site should not be distal to a recent venipuncture or arm with altered circulation
- Choose a large vein not adjacent to a joint or important structures (eg wrist)
- Use new PIV instead of a pre-existing one
- Ensure needle entry site visible during infusion
- Have IV flowing freely at all times with NS
- For injections check for blood return q2-3 cc’s
- Elevate limb and maintain gentle pressure over sure for 5 minutes after needle withdrawn
- For CVC’s ensure adequate flushing with 25cc NS and flush after with same
- Prevention is the best measure in caring for extravasations *
Define: Extravasation
Escape of a drug from a vessel into SC tissue
Define flare
- Painless local reaction along the vein or near intact injection site
- Immediate, red blotches or streaks (histamine release), sometimes with edema, pruritus or irritation
What is spasm of the vein?
- Aching/red streaking along vein or resistance with injection can be inflammation or spasm of vein
- Stop injection and flush with saline until pain/redness subsided, may take 30 min to subside after stopping med
- Sometimes you can give hydrocortisone IV to hasten clearing of the reaction
What is the procedure if extravasation of a vesicant occurs?
- Stop injection immediately but DO NOT remove catheter or needle!
- Disconnect IV tubing from PIV or CVC, and attempt to aspirate as much drug as possible (minimum 10cc) in a new syringe
- Notify attending
- Following actions are drug dependent (some require topical solutions, ice/warmth, gentle pressure, elevating limb); most will receive ice aside from the vinka alkaloids class
- for large extravasations there are some antidotes for particular drugs
- Trace affected area on a transparent dressing paper and attach to chart for monitoring
- PSLS reporting
- Arrange for Rx use at home (eg. analgesia) and handout sheet for caring for extravasation
- For suspected extravasation, have phone nurse f/u within 1-3 days - may be requested to return to clinic
- For known extravasation, arrange for f/u in clinic within 48 hours and for multiple days the next two weeks
What is the difference between extravasation, spasm of vein or flare reaction in terms of pain?
EXTRA: Severe pain or burning at needle site or anywhere along vein; lasts minutes or hours, usually while the drug is being given (but can occur up to 48 hours later)
SPASM: Aching/tightness, not really painful
FLARE: No pain
What is the difference between extravasation, spasm of vein or flare reaction in terms of redness?
EXTRA: Blotchy redness around needle site, not always present at time of extra (can occur hours-months late)
SPASM: Full length of vein may be reddened or darkened
FLARE: Immediate blotches or streaks along vein, usually subside within 30 min of stopping treatment
What is the difference between extravasation, spasm of vein or flare reaction in terms of swelling?
EXTRA: Severe swelling or ‘bleb’ formation at needle site or anywhere along vein, usually immediately
SPASM: Not likely
FLARE: Not likely, sometimes skin wheal (very small raised patch) along vein
