Cytotoxic and Biotherapies Credentialing Programme Module 6

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1 Cytotoxic and Biotherapies Credentialing Programme Module 6 1. Safe Handling and Administration of Cytotoxic and Biotherapies 2. Waste and Spill Management At the completion of this module the RN will Demonstrate the principles of safe handling and administration of cytotoxic and biotherapies. Demonstrate how to clean up a spill including documentation REFERENCES Christchurch Hospital Department of Nursing. (2008, June). Volume 12, Fluid & Medication Manual. Retrieved from CDHB Intranet. Nixon, S., Schulmeister, L. (2008). Safe Handling of Hazardous Drugs: Are You Protected? Clinical Journal of Oncology, 13(4),

2 Safe Handling and Administration of Cytotoxic and Biotherapies Nurses routinely administer hazardous drugs which can put them at risk of occupational exposure. Sources of exposure include liquids, powders and aerosols when air is expelled from syringes. Measures that promote safe handling must be taken by the health care provider to minimise exposure. Definition of hazardous drugs Personal Protective Equipment (PPE) Nurses who administer hazardous drugs should follow work place guidelines to minimise exposure and contamination. The most recent NZ OSH guidelines (1997) state: Precautions should be taken to prevent normal skin contact during the administration of cytotoxic drugs. Normal nursing practices involving the use of a mask, gloves and gowns or aprons and strict adherence to safe work practices should provide sufficient protection. PPE should be worn during handling the drug, assembling the delivery system, administering the drug and when disposing of all the equipment. The patients should be identified as receiving cytotoxic drugs (to alert other health care professionals within the area) and any area of contamination cleaned up in accordance with the waste and spill management procedure of your area. A dedicated trolley for chemotherapy/ biotherapy administration is recommended.

3 Procedure prior to administration Ensure the patient has had appropriate education on administration and possible side effects. Ensure patient has given written consent. Check blood counts and other results and ensure they fall within acceptable range for the treatment being given. Establish patent venous access Review previous cycle of chemotherapy with the patient. Administer antiemetics as prescribed. Ensure a spill kit is available and the nurse knows how to clean up a spill. Each nurse should ensure they are familiar with the characteristics and side effects of each drug including whether they are an irritant or a vesicant. Take any refrigerated chemotherapy out of the fridge an hour prior to administration. Put on personal protective equipment (PPE). Chemotherapy should not be removed from plastic bag without first putting on nitrile gloves. Goggles are optional but should be considered if risk of splashing to the eyes. All syringes and infusion bags should be checked for any leakage or contamination. All cytotoxic drugs should be placed in a container and placed on a plastic backed sheet. Prime any IV lines with normal saline and label with a cytotoxic label. Checking process This is covered in module five. Administration Connect administration set and infuse compatible flush (free flow if peripheral; via a pump if using a CVAD) Check blood back flow from access device by either drawing back or lowering the infusion bag below the level of the heart. Place a plastic back sheet under any luer lock connections. Bolus administration Place gauze under the side port and swab with an alcohol wipe. Wait 30 seconds. Luer lock chemotherapy onto the side port of the infusion line. Administer chemotherapy into a fast running infusion using a steady, positive technique. If the bolus is large or comes in two syringes you recheck blood back flow regularly. Once the bolus has been infused, flush with normal saline. If giving another bolus infusion, flush with at 20 mls of normal saline and repeat as above. Be aware of any potential hypersensitivity reactions. Monitor any free flowing fluids for a change in rate as a slowing down could indicate extravasation. Monitor site throughout for redness, swelling, and/or leakage and encourage patient to report any signs of pain/ discomfort.

4 If extravasation is suspected STOP IMMEDIATELY and follow guidelines for extravasation. Give another flush of at least 20 mls of normal saline at the end of administration Dispose of all waste as per guidelines IV infusion bag administration On a flat surface (use trolley) that has a plastic backed sheet on it Remove priming fluid from the infusion line. Spike the bag of chemotherapy with the already primed infusion line keeping the infusion bag within the foil container. Gently lift the bag up and observe for any leaks from spiking the bag. Place bag on IV pole. Infuse as prescribed. Remove PPE. Monitor site throughout for redness, swelling, and/or leakage and encourage patient to report any signs of pain/ discomfort. If extravasation is suspected STOP IMMEDIATELY and follow guidelines for extravasation. Post infusion Don PPE. On a flat surface (use trolley) that has a plastic backed sheet on it, remove empty chemotherapy bag from the infusion set and replace with normal saline. Flush the infusion line with at least mls of normal saline. Dispose of all waste as per guidelines. Documentation Ensure chemotherapy prescription has been signed and time written in as applicable. Document the drug administration and any adverse events in the clinical notes. General Give drugs in the following order Antiemetics Vesicants (if giving 2 vesicants, give the smallest amount first) Irritants Transporting patients with cytotoxic agents infusing Patients with cytotoxic agents infusing who have to leave the designated cytotoxic administration area for further medical assessment/treatment must be escorted with a registered nurse who holds the cytotoxic/biotherapies competency. The nurse must stay with the patient until they have returned to the clinical area. A spill kit must also go with them. The ideal situation would be to defer any movement of the patient until the infusion has been completed. Now complete the work book section on safe handling and administration

5 Waste and Spill Management The goal of safe disposal of cytotoxic and biotherapy waste and spill management is to minimise the risk of exposure from these cytotoxic and biological agents to the administrator, patient, other people and surrounding environment. The first 48 hours post administration has been deemed the most hazardous period for drug excretion however many drugs are excreted in body fluids up to seven days post administration. This is covered in Module one. Now complete the work book section on waste and spill management

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