Chemotherapeutic Drug Administration



Chemotherapeutic Drug Administration





Administration of chemotherapeutic drugs requires skills in addition to those used when giving other drugs.1 For example, some drugs require specialized equipment or must be given through an unusual route. Others become unstable after a while, and still others must be protected from light. Finally, the drug dosage must be exact to avoid possibly fatal complications. For these reasons, only specially trained nurses and doctors should give chemotherapeutic drugs.

Chemotherapeutic drugs may be administered through a number of routes. Although the IV route (using peripheral or central veins) is used most commonly, these drugs may also be given orally, subcutaneously, IM, intra-arterially, into a body cavity, through a central venous catheter, through an Ommaya reservoir into the spinal canal, or through a device implanted in a vein or subcutaneously, such as through a patient-controlled analgesia device. They may also be administered into an artery, the peritoneal cavity, or the pleural space. (See Intraperitoneal chemotherapy: An alternative approach.)

The administration route depends on the drug’s pharmacodynamics and the tumor’s characteristics. For example, if a malignant tumor is confined to one area, the drug may be administered through a localized, or regional, method. Regional administration allows delivery of a high drug dose directly to the tumor. This is particularly advantageous because many solid tumors don’t respond to drug levels that are safe for systemic administration.

Chemotherapy may be administered to a patient whose cancer is believed to have been eradicated through surgery or radiation therapy. This treatment, called adjuvant chemotherapy, helps to ensure that no undetectable metastasis exists. A patient may also receive chemotherapy before surgery or radiation therapy, called induction chemotherapy (or neoadjuvant or synchronous chemotherapy.) Induction chemotherapy helps improve survival rates by shrinking a tumor before surgical excision or radiation therapy.

In general, chemotherapeutic drugs prove more effective when given in higher doses, but their adverse effects often limit the dosage. An exception to this rule is methotrexate. This drug is particularly effective against rapidly growing tumors, but it’s also toxic to normal tissues that are growing and dividing rapidly. However, doctors have discovered that they can give a large dose of methotrexate to destroy cancer cells and then, before the drug has had a chance to permanently damage vital organs, give a dose of folinic acid antidote. This antidote stops the effects of methotrexate, thus preserving normal tissue.




Intraperitoneal Chemotherapy: An Alternative Approach

Intraperitoneal chemotherapy is beneficial in treating ovarian cancer that has spread within the peritoneal cavity because much higher concentrations of the drug can be delivered directly to the peritoneal cavity when compared with the IV route of administration.3

Typically, intraperitoneal chemotherapy is administered through a single-lumen implanted port that’s connected to a silicone peritoneal catheter, or through a fully implanted port that’s attached to a single-lumen venous silicone catheter. Peritoneal catheters designed for dialysis have been associated with an increased risk for bowel complications when used to administer chemotherapy in patients with ovarian cancer.3

Before administrations, the patient is typically premedicated for chemotherapy-induced nausea with an antiemetic such as ondansetron and a corticosteroid such as dexamethasone. Opioids may also be prescribed to relieve abdominal cramping. Next, the patient is positioned supine or in semi-Fowler’s position with the head of the bed elevated no more than 30 degrees.3

The peritoneal port is accessed using a 19G or 20G 1″ to 2″ right-angled noncoring needle: patency is verified.2,3 Chemotherapy is infused as rapidly as possible by gravitational flow;3 an in-line fluid warmer is used to warm the solution to body temperature to prevent abdominal cramping. After the chemotherapy is infused, 1 L of warmed normal saline solution may be infused to help distribute the medication.

Stop the infusion if the patient becomes too uncomfortable. After the chemotherapy is infused, have the patient change position every 10 to 15 minutes for 1 to 2 hours to help disperse the medication around the peritoneal cavity.2,3 Ninety percent of the administered chemotherapy drugs are absorbed within 4 hours of administration.4

After administering the chemotherapy drug, flush the port and catheter according to your facility’s policy, remove the needle, and apply an occlusive dressing; the dressing can be safely removed after 12 hours.3

If the patient is pregnant, the doctor and other members of the health care team should collaborate with the patient’s obstetric team before starting chemotherapy. Chemotherapy is contraindicated during the first trimester and isn’t recommended after 35 weeks’ gestation to avoid delivery during a period of bone marrow suppression.2




Equipment

Patient’s medical record ▪ prescribed chemotherapy drug ▪ administration set ▪ material safety data sheet for the prescribed chemotherapy drug ▪ prescribed IV solution ▪ other prescribed medications ▪ syringes with luer-lock connector ▪ antiseptic pads ▪ infusion pump with preprogrammed dosing limits ▪ low-pressure, flow-control infusion device (for vesicant administration) ▪ powder-free chemotherapy gloves ▪ nonlinting, nonabsorbent disposable gown ▪ face shield ▪ National Institute for Occupational Safety and Health (NIOSH)-approved respirator mask (if aerolization is likely) ▪ chemotherapy sharps container ▪ hazardous waste container approved for cytotoxic waste ▪ labels ▪ chemotherapy spill kit ▪ extravasation equipment ▪ emergency equipment ▪ Optional: aluminum foil or a brown paper bag (if the drug is photosensitive), noncoring needle, IV insertion equipment.


Preparation of Equipment

Make sure that a chemotherapy spill kit, extravasation equipment, and emergency equipment are readily available. Make sure that the emergency equipment is functioning properly.




Implementation



  • Verify the doctor’s written order for the chemotherapy drug in the patient’s medical record; verbal orders aren’t permitted. Make sure the order contains the patient’s complete name and a second identifier; the date; the patient’s diagnosis; the patient’s allergies; the regimen’s name and number (if applicable), including the individual drug’s generic names; treatment criteria; dosage calculation method; the patient’s height and weight; and any other variables used to calculate the dosage. Also verify the route and rate of administration as well as the schedule, duration of therapy, cumulative lifetime dose (if applicable), sequence of drug administration (if applicable), and supportive care treatments that are appropriate for the regimen, such as hydration (if necessary) and premedications for hypersensitivity and nausea. Have another practitioner qualified to prepare or administer chemotherapy do the same.2,4,5


  • Make sure the doctor has obtained a written informed consent and that the consent form is in the patient’s medical record.2,4,6


  • Become familiar with the information contained within the material safety data sheet specific to the drug.7


  • In collaboration with the patient’s multidisciplinary team, review the patient’s laboratory test results, specifically the complete blood count, blood urea nitrogen level, platelet count, urine creatinine level, and liver function studies.1


  • Check the patient’s drug history for medications that might interact with chemotherapy.8


  • Determine whether the patient has received chemotherapy before, and note the severity of any adverse effects.


  • Check to see whether the doctor has ordered an antiemetic, fluids, a diuretic, or electrolyte supplements to be given before, during, or after chemotherapy administration. Administer them as prescribed following safe administration practices.


  • Perform hand hygiene.9,10,11


  • Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.12




Classifying Chemotherapeutic Drugs

To administer chemotherapy safely, you need to know each drug’s potential for damaging tissue. In this regard, chemotherapeutic drugs are classified as vesicants, nonvesicants, or irritants.


Vesicants



  • dactinomycin (Cosmegen)


  • daunorubicin (Cerubidine)


  • docetaxel (Taxotere)


  • doxorubicin (Adriamycin)


  • epirubicin (Ellence)


  • idarubicin (Idamycin)


  • mechlorethamine (Mustargen)


  • mitomycin (Mutamycin)


  • mitoxantrone (Novantrone)


  • paclitaxel (Taxol)


  • vinblastine (Velban)


  • vincristine (Oncovin)


  • vinorelbine (Navelbine)


Nonvesicants



  • asparaginase (Elspar)


  • cyclophosphamide (Cytoxan)


  • cytarabine (Cytosar-U)


  • floxuridine (FUDR)


  • fluorouracil (Efudex)


Irritants



  • bleomycin (Blenoxane)


  • carboplatin (Paraplatin)


  • carmustine (BiCNU)


  • dacarbazine (DTIC-Dome)


  • etoposide (VePesid)


  • gemcitabine (Gemzar)


  • ifosfamide (Ifex)


  • irinotecan (Camptosar)


  • melphalan (Alkeran)


  • streptozocin (Zanosar)


  • topotecan (Hycamtin)

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Jul 21, 2016 | Posted by in NURSING | Comments Off on Chemotherapeutic Drug Administration

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