Download C- 7.1 Administration of Intravenous Chemotherapy KENNEDY

C- 7.1 Administration of Intravenous Chemotherapy
KENNEDY UNIVERSITY HOSPITALS
(KUH)
POLICY: Administration of Intravenous
MANUAL: Generic Nursing Standards
Chemotherapy
FUNCTION: Care of Patients
POLICY NUMBER: C-7.1
IMPLEMENTATION DATE: December 1994
LAST REVISION: September 2011
September 2012
AUTHOR: Patient Care Committee
PAGE(s): 6
DISTRIBUTION: System Wide
POLICY:
It is the policy of Kennedy University Hospitals to safely administer intravenous chemotherapy
per physician’s orders to patients.
PURPOSE:
To promote patient and staff safety through current handling, administration and disposal of
chemotherapeutic agents.
SCOPE:
POPULATION SERVED:
Adult patients receiving chemotherapeutic agents. Patients receiving chemotherapy will
be assigned to designated nursing units (GI Infusion Suite & MS1). If a patient is unable
to be admitted to a designated unit, then a chemotherapy competent registered nurse will
be assigned to that patient/unit for the duration of the therapy including administration
and monitoring.
PHYSICIAN ORDER REQUIREMENT: Yes
CONSENT REQUIREMENT: Yes for administration of chemotherapy medications.
RESPONSIBILITIES: Chemotherapy Competent RN. Pregnant associates will not
administer chemotherapy.
DEFINITION OF TERMS:
1. Chemotherapeutic agents are categorized into two different classes:
Antineoplastic/Cytotoxic and Biologic/Molecularly target agents.
 Antineoplastic/Cytotoxic: an agent that prevents the development, growth
or proliferation of malignant cells.
 Biologic/Molecularly: an agent that prevents the development, growth or
proliferation of malignant cells by targeting a specific pathway. These
include antibodies, interleukins, vaccines and other oral agents.
2. High Risk Medications: medications that bear a higher risk of causing significant
harm when they are used in error.
3. Chemotherapy Competent Nurse: a RN who has successfully completed the
KUH’s Basic Chemotherapy Course to include competency every two years and
Note: Any printed copy of this policy is only as current as of the date it was printed; it may not
reflect subsequent revisions. Refer to the online version of the manual for the most current
policy.
C- 7.1 Administration of Intravenous Chemotherapy
an annual Chemotherapy update regarding safety, spills, PPE, and review of
policies.
EQUIPMENT: Personal Protective Equipment (PPE)
 Infusion Pump
 Rigid biohazard container
 Chemotherapy cart, where available, or these items separately:
- Ziploc biohazard bag
- Chemotherapy stickers
- Biohazard sign: “Caution Chemotherapy” (5510.197)
- Chemo gloves (2 pair-non-sterile)
- Chemo gown (non-sterile)
- Chemo spill kit (available)
- Disposable plastic backed liners
- Sterile gauze pads (approximately 2-3)
 Medications and IV fluids/equipment as ordered
PROCEDURE:
STEPS
KEY POINTS
PRIOR TO ADMINISTRATION OF A CHEMOTHERAPEUTIC AGENT,
THE CHEMO-COMPETENT RN
1. Will obtain and review baseline data from
1. Safe administration of chemotherapy
physician, which includes the following:
may depend on adequate laboratory
values, especially RBC’s, WBC’s and
 Problem focused H&P/Note to include:
platelets.
 allergies
 current medications
NOTE: If a patient is unable to be admitted
 problem focused
to a designated unit, then a chemo proficient
physical examination
nurse will be assigned to that patient/unit
 pertinent co-morbid
for the duration of the therapy including
complications
administration and monitoring
 therapeutic plan
 duration of care
 Results of diagnostic studies (CBC &
blood chemistry, etc.) if applicable
 Patient’s actual weight/height/BSA
 Signed consent
2. Notify the ordering physician of any missing 2. The ordering physician is responsible to
data or abnormality in above data.
determine if chemotherapy is continued
or held based on patient information.
3. RN completes initial RN assessment form.
4. Initiate &/or update the interdisciplinary
Patient Care Plan with patient-specific goals
and interventions.
5. Place a Caution Chemotherapy sign in the
5. Identification of patients receiving
Note: Any printed copy of this policy is only as current as of the date it was printed; it may not
reflect subsequent revisions. Refer to the online version of the manual for the most current
policy.
C- 7.1 Administration of Intravenous Chemotherapy
STEPS
immediate patient care area.
6. Verify accuracy and completeness of
chemotherapy orders with a second RN and
pharmacist preparing medication.
Hydration, premeds, name of drug, drug
dose, route, rate,, frequency of
administration.
7. Provide patient education to include:
 Drug purpose
 The potential for immediate and delayed
adverse drug reactions
 Symptoms to report
8. Obtain IV access. If a peripheral vein is to
be used, select forearm venipuncture site (the
forearm is the site of choice).
KEY POINTS
chemotherapy is essential to ensure safe
contact by all associates with the patient’s
excreta and IV fluids, which may contain
chemotherapeutic agents up to 48 hours.
6. This verification process will also
include chemo-specific verification of drug
sequence, dosage and route of
administration.
Determine if medication is a vesicant or
irritant.
Reference High Alert IV Medication
Administration Policy (PPINCH), H-1.
7. Patient education is documented on the
Patient Education Assessment portion of the
Patient Care Plan.
8. Proper administration site is essential to
avoid extravasation of toxic drug into
tissue.
NOTE: If a vesicant drug is to be
administered, and it will run longer than 60
minutes, a central venous access site is
recommended.
 Small catheter size ensures good
blood flow and maintains vein
patency.
 Avoid IV sites subject to a lot of
movement of flexion, such as the
wrist or anticubital space.
(Use of a central venous access does not
preclude extravasation injuries.
Extravasation in the upper torso or neck
may result in serious injuries, requiring
extensive reconstruction. It is imperative
that administration of vesicant therapy
into a central line be very carefully
monitored.)
The pharmacist will prepare all
chemotherapeutic agents to include priming
tubing with neutral IV fluid, which will then
be transported to the nursing unit in a
Note: Any printed copy of this policy is only as current as of the date it was printed; it may not
reflect subsequent revisions. Refer to the online version of the manual for the most current
policy.
C- 7.1 Administration of Intravenous Chemotherapy
STEPS
KEY POINTS
chemotherapy zip-lock, safety bag, labeled
with the patient’s name and attached to a
chemotherapy tracking sheet.
9. Start normal saline or ordered IV fluids.
10. Observe and assess the patient at least
10. This step will assure no untoward
every 60 minutes and/or between every drug
effects go unnoticed.
given for signs and symptoms of untoward
effects.
ADMINISTRATION OF CHEMOTHERAPEUTIC AGENTS
1. Perform 15 second hand-washing.
2. Don 2 pairs of chemo gloves and disposable, 2. Gloves and gown prevent direct skin
non-absorbent, lint-free gown before
contact with chemotherapeutic agents.
administering chemotherapeutic drugs.
3. Assess IV administration site for patency by 3. Never use a chemo drug to check for
checking for blood return and absence of
vein patency; use normal saline.
redness or swelling. Infuse 10 to 20 ml IV
fluid to assure patency.
4. Place a plastic-backed liner underneath the
4. Protects the patient from exposure to
IV connection site/port.
chemotherapy drugs.
5. Use a sterile gauze pad(s) to connect and
5. Protects from splashing of
disconnect the IV tubing or syringe
chemotherapy drugs when attaching or
containing chemotherapeutic agents.
removing syringe or tubing..
DURING CHEMOTHERAPY ADMINISTRATION
1. Check IV for positive blood return after:
1. An infusion pump is to be used for
intermittent or continuous IV drip.
 Each 2- 5 ml of medication is injected by
IV push or;
NOTE: If vesicant drug, the proficient RN
 At least every 60 minutes by IV drip
must remain with the patient throughout the
infusion. Do not place on pump but use
gravity drip for those infusions lasting 60
minutes or less.
2. Assess IV site & patient response to
2. It is necessary to notify the physician of
treatment every 20 minutes when
any change that might alter the
administering vesicants for signs of
administration of drug.
hypersensitivity reaction or extravasation
(swelling, redness, pain, urticaria) and
document in the flow record/medical record.
3. The nurse will contact the physician
3. It may be necessary to aspirate chemo
immediately to reassess the patient for any of
medication from the patient’s tissue (via
the following conditions:
the IV catheter) or to administer an
antidote, per the physician’s order
 Significant change in the patient’s
(reference C-7.3, Extravasation of a
Note: Any printed copy of this policy is only as current as of the date it was printed; it may not
reflect subsequent revisions. Refer to the online version of the manual for the most current
policy.
C- 7.1 Administration of Intravenous Chemotherapy
4.
5.
6.
7.
8.
9.
STEPS
KEY POINTS
medical status
Chemotherapeutic Vesicant).
 a significant response (desired or
undesired) to a procedure or
intervention
 Extravasation suspected ~ If
extravasation is suspected:
 Stop the infusion immediately
 Leave the IV catheter in place
 Do not attempt to flush IV line.
Infuse 20 ml of normal saline in between all
chemo medications, at the conclusion of the
infusion and before discontinuing the IV line.
Dispose of IV bags, tubing, syringes and
needles in the chemotherapy zip lock safety
bag and place in rigid biohazard waste
container. Return the chemotherapy tracking
sheet to pharmacy.
Dispose of gloves, gown and plastic-backed
liners in the rigid chemotherapy container
and close lid tightly.
Perform a 15 second hand washing.
Assess IV site.
Document patient’s tolerance of treatment
9. Reference documentation section below.
and any adverse reactions and interventions
in the patient’s flow record/medical record.
AGE SPECIFIC TECHNICAL CONSIDERATIONS:
Reference Micromedex, age specific drug reference manuals and pharmacist for age specific
dosing information/considerations.
DOCUMENTATION:
See chart below for documenting patient/family response to therapy and site assessment.
Initial RN physical
assessment
Site assessment and reassessments
Drug administration
Patient education
Response to therapy
RN initial assessment form
Patient’s flow record/medical
record
MAK, I&O section of flow
record/medical record
Patient Education Assessment
portion of Patient Care Plan
Progress note section of flow
record/medical record
Note: Any printed copy of this policy is only as current as of the date it was printed; it may not
reflect subsequent revisions. Refer to the online version of the manual for the most current
policy.
C- 7.1 Administration of Intravenous Chemotherapy
REFERENCES:
Chemotherapy and Biotherapy Guidelines, Oncology Nursing Society, third edition,
Oncology Nursing Society,(2009) Fundamentals of Administration, ( p.84 – 103),
Safe handling of Hazardous Drugs, second edition, Oncology Nurses Society, 2011. (p.
34 – 47).
Safe Handling of Hazardous Medications; (November 2010) In Mosby’s Nursing Skills.
Maryland Heights, MO: Elsevier, Inc. Retrieved on August 2, 2011,
from http://www.mosbysnursingskills.com
KHS Policies or procedures: C7.2 Chemotherapeutic Spills; C 7.3 Extravasation: I 6 IV
Push/Infusion Drug Administration
ORIGINAL APPROVAL:
Date: December 1994
Department/Committee: Patient Care Committee
LIST OF REVIEW DATES:
Date: October 1995
Date: November 2002
Date: March 2006
Date: March 2007
Departments/Committees:
Departments/Committees:
Departments/Committees:
Departments/Committees: Pharmacy
Date: March 2007
Departments/Committees: Oncology;
Dr. Tom Summers
LIST OF REVISION DATES AND APPROVAL:
Date: March 2007
Departments/Committee: Patient Care Practice Committee
Date: April 18, 2007
Departments/Committee: NEC Policy Subgroup
Date: April 27, 2007
Departments/Committee: NEC
Date: January 30, 2008
Departments/Committee: NEC
Date: February 7, 2008
Departments/Committee: Patient Care Practice Committee
Date: November 5, 2008
Department/Committee/Administration: Dr. Herriman,
Cheryl Rosselli, Frank Hendrick, Linda Carrick, Ken Bevenour,
Jackie Maddison, David Gibbons
Date: September 8, 2011
Department/Committee: Patient Care Practice Committee
Date: October 2011
Department/Committee: Nurse Executive Committee
Note: Any printed copy of this policy is only as current as of the date it was printed; it may not
reflect subsequent revisions. Refer to the online version of the manual for the most current
policy.