Wk 10: Administration of cancer treatment

Question 1

What are the advantages of injection?

Answer 1

• Bioavailability + predictable plasma levels
• Not affected by swallowing difficulties/vomiting

Question 2

What are the disadvantages of injection?

Answer 2

• Risks associated w/ IV
• Drug/fluid incompatibilities
• IV access
• Inconvenient + time consuming
• Cost

Question 3

What are the types of injections?

Answer 3

• Subcutaneous
• Intramuscular
• Intradermal
• Intravenous

Question 4

What is a cannula?

Answer 4

• Short tube put into vein in lower arm/back of hand
• Clear dressing on top
• Short term

Question 5

Why are central lines preferred over cannulas?

Answer 5

• Temperamental + patient can readily move arm
• Speed of admin = harder to control
• Fragile veins
• High risk of extravasation

Question 6

What is a central venous catheter?

Answer 6

• Tube inserted into vein (subclavian, femoral or jugular)
• Catheter pushed along vein til reaches larger vein (vena cava)
• Secured w/ 2 stitches
• Long term

Question 7

What is a peripherally inserted central catheter (PICC)?

Answer 7

• Tube inserted into vein in arm
• Catheter pushed along vein til reaches larger vein (vena cava)

Question 8

What is a portacath?

Answer 8

• Long term CVC w/ no external parts
• Catheter in subclavian, end attached to titanium/plastic port planted in subcutaneous tissue in chest
• Thick rubber septum covers port, once sutured, port is enclosed
• Needle inserted through skin + rubber septum

Question 9

What are the different types of intravenous administration methods?

Answer 9

• Continuous infusion
• Intermittent infusion
• Direct intermittent injection

Question 10

What is continuous infusion?

Answer 10

Med delivered at constant rate over prescribed time period

Question 11

What is intermittent infusion?

Answer 11

Small vol (25-250ml) given over shorter period of time (15mins-2hr)

Question 12

What is direct intermittent injection?

Answer 12

Bolus injection of drug straight to vein

Question 13

Outline the issues of central venous catheters

Answer 13

• Infection
• Blood clots
• Blockage

Question 14

How does an infection present in CVC + how is it treated?

Answer 14

• Swelling, redness, discharge at exit site
• Treat: antibiotics or remove line

Question 15

How do blood clots present in CVC + how is it treated?

Answer 15

• Swelling, redness, tenderness in arm, chest + neck.
• SOB + tightness
• Treat: thrombolytic med or line removed

Question 16

How is a blockage treated in a CVC?

Answer 16

• Flushed w/ saline
• If blocked w/ blood: thrombolytic flush out

Question 17

What is extravasation?

Answer 17

• Accidental leakage of chemotherapy from vein into surrounding tissue
• Esp. vesicant drugs

Question 18

What are the symptoms of extravasation?

Answer 18

• Redness
• Swelling
• Burning
• Superficial skin loss
• Tissue necorisis

Question 19

What are the risk factors of extravasation?

Answer 19

• Fragile vein
• V young/old
• Confused/sedated patient not reporting discomfort
• Concurrent med: analgesic, anticoag, vasodilators + diuretics
• Peripheral admin
• Inexperienced staff
• Bolus injections

Question 20

How do you treat/manage extravasation?

Answer 20

• Discontinue infusion + aspirate residual drug from cannula
• Refer to hematologist/oncologist/plastics
• Infusion of antidote (dexrazoxane w/ anthracycline)

Question 21

What are the advantages of oral therapy?

Answer 21

• More convenient
• Less expensive
• Lower toxicity
• Avoid complications associated w/ IV access

Question 22

What are the disadvantages of oral therapy?

Answer 22

• Adherence
• Variable plasma pharmacokinetics
• Manage drug interactions
• Nausea + vom

Question 23

Give examples of less common routes of admin

Answer 23

• Intrathecal: fluid into spine + brain (brain tumours, leukaemia + lymphoma)
• Intracavitary (bladder, abdomen + chest cavity)
• Intralesional/tumoral (into tumour)
• Topical (skin cancer - 5 FU cream)