The document provides information on chemotherapy administration including:
1. Chemotherapy involves using drugs to destroy cancer cells by interfering with cellular functions and reproduction.
2. Personal protective equipment like gloves, gowns, and masks should be worn when handling chemotherapeutic agents.
3. The administration process involves preparing medications, inserting IV lines, monitoring for side effects like extravasation during infusion, and documenting the procedure. Management of extravasation or spills should also be followed.
There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is.
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
Cancer is a global issue majorly affecting developing countries. According to a survey, 63% of deaths due to cancer are reported from developing countries. There are different conventional treatment modalities that are available to treat and manage cancer. However, new cancer treatment options are being explored continuously as over 60% of all current experimental trials worldwide are focusing on tumor cure. The success of treatment depends upon the type of cancer, locality of tumor, and its stage of progression. Surgery, radiation-based surgical knives, chemotherapy, and radiotherapy are some of the traditional and most widely used treatment options. Some of the modern modalities include hormone-based therapy, anti-angiogenic modalities, stem cell therapies, and dendritic cell-based immunotherapy.
A standout among the best cancer treatment modalities is the gene therapy which is direct in situ insertion of exogenous genes into the tumors which could give a powerful remedial way for the treatment of benign tumors. Similarly, hormonal treatments are also widely used for cancer malignancies and generally considered as cytostatic. Hormonal treatment restricts tumor development by limiting hormonal growth factors. It most likely acts via the down direction of hypothalamic-pituitary-gonadal axis, blockage of hormone receptor, and restraint of adrenal steroid synthesis.
Chemotherapy is a widely used treatment for cancer. More specifically, this therapy is administered to destruct cancer cells. However, it may also include some antibiotics along with other medications for treating severe infection or illness.
Oncology Nursing:-An oncology nurse is a specialized nurse who cares for cancer patients. These nurses require advanced certifications and clinical experiences in oncology further than the typical baccalaureate nursing program provides. Oncology nursing care can be defined as meeting the various needs of oncology patients during the time of their disease including appropriate screenings and other preventive practices, symptom management, care to retain as much normal functioning as possible, and supportive measures upon the end of life.
What is oncology?
Oncology is the branch of medicine that researches, identifies, and treats cancer. A physician who works in the field of oncology is an oncologist.
Oncologists must first diagnose cancer, which is usually carried out via biopsy, endoscopy, X-ray, CT scanning, MRI, PET scanning, ultrasound, or other radiological methods. Nuclear medicine can also be used to diagnose cancer, as can blood tests or tumor markers. Oncology is often linked with hematology, which is the branch of medicine that deals with blood and blood-related disorders.
Treatment
Once a diagnosis is made, the oncologist discusses the disease stage with the patient. Staging will dictate the treatment of cancer. Chemotherapy — which is defined as the destruction of cancer cells — may be used, as well as radiation therapy. Surgery is used to remove tumors. Hormone therapy is used to treat certain types of cancers, and monoclonal antibody treatments are gaining popularity. Research into cancer vaccines and immunotherapies is ongoing. Palliative care in oncology treats pain and other symptoms of cancer.
Treatment team
Cancer is often treated in a team effort, with at least two or three types of oncologists, including medical, surgical, or radiation. The oncology treatment team may also include a pathologist, a diagnostic radiologist, or an oncology nurse. In the event of a new or a difficult-to-treat case of cancer, the oncology care team may consult a tumor board, made up of various medical experts from all relevant disciplines. The tumor board reviews the case and recommends the best course of cancer treatment for the patient.
Oncology nurse
The oncology nurse has many roles, from helping with cancer screening, detection, and prevention, to the intensive care focus of bone marrow transplantation. Work settings for oncology nurses also vary and include acute care hospitals, ambulatory care clinics, private offices, radiation therapy facilities, and home care agencies. Oncology nurses work with adult and pediatric patients with cancer.
Pediatric Oncology
Pediatric oncology is a medical specialty that focuses on cancer care for children.
The National Cancer Institute estimates that 10,270 new cases of cancer will be diagnosed in children in 2017. Of these, 1,190 children will die from the disease.
Pediatric oncology is an important medical field that treats all pediatric cancer types, including acute lymphocytic leukemia,
Chemotherapy is a drug treatment that uses powerful chemicals to kill fast-growing cells in your body. Chemotherapy is most often used to treat cancer, since cancer cells grow and multiply much more quickly than most cells in the body.
cancer of breast , this slide cointains detailed information about the breast cancer that is definition, causes and risk factor, sign and symptoms, management of patient with cancer , giving psychological support .treatment
There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is.
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
Cancer is a global issue majorly affecting developing countries. According to a survey, 63% of deaths due to cancer are reported from developing countries. There are different conventional treatment modalities that are available to treat and manage cancer. However, new cancer treatment options are being explored continuously as over 60% of all current experimental trials worldwide are focusing on tumor cure. The success of treatment depends upon the type of cancer, locality of tumor, and its stage of progression. Surgery, radiation-based surgical knives, chemotherapy, and radiotherapy are some of the traditional and most widely used treatment options. Some of the modern modalities include hormone-based therapy, anti-angiogenic modalities, stem cell therapies, and dendritic cell-based immunotherapy.
A standout among the best cancer treatment modalities is the gene therapy which is direct in situ insertion of exogenous genes into the tumors which could give a powerful remedial way for the treatment of benign tumors. Similarly, hormonal treatments are also widely used for cancer malignancies and generally considered as cytostatic. Hormonal treatment restricts tumor development by limiting hormonal growth factors. It most likely acts via the down direction of hypothalamic-pituitary-gonadal axis, blockage of hormone receptor, and restraint of adrenal steroid synthesis.
Chemotherapy is a widely used treatment for cancer. More specifically, this therapy is administered to destruct cancer cells. However, it may also include some antibiotics along with other medications for treating severe infection or illness.
Oncology Nursing:-An oncology nurse is a specialized nurse who cares for cancer patients. These nurses require advanced certifications and clinical experiences in oncology further than the typical baccalaureate nursing program provides. Oncology nursing care can be defined as meeting the various needs of oncology patients during the time of their disease including appropriate screenings and other preventive practices, symptom management, care to retain as much normal functioning as possible, and supportive measures upon the end of life.
What is oncology?
Oncology is the branch of medicine that researches, identifies, and treats cancer. A physician who works in the field of oncology is an oncologist.
Oncologists must first diagnose cancer, which is usually carried out via biopsy, endoscopy, X-ray, CT scanning, MRI, PET scanning, ultrasound, or other radiological methods. Nuclear medicine can also be used to diagnose cancer, as can blood tests or tumor markers. Oncology is often linked with hematology, which is the branch of medicine that deals with blood and blood-related disorders.
Treatment
Once a diagnosis is made, the oncologist discusses the disease stage with the patient. Staging will dictate the treatment of cancer. Chemotherapy — which is defined as the destruction of cancer cells — may be used, as well as radiation therapy. Surgery is used to remove tumors. Hormone therapy is used to treat certain types of cancers, and monoclonal antibody treatments are gaining popularity. Research into cancer vaccines and immunotherapies is ongoing. Palliative care in oncology treats pain and other symptoms of cancer.
Treatment team
Cancer is often treated in a team effort, with at least two or three types of oncologists, including medical, surgical, or radiation. The oncology treatment team may also include a pathologist, a diagnostic radiologist, or an oncology nurse. In the event of a new or a difficult-to-treat case of cancer, the oncology care team may consult a tumor board, made up of various medical experts from all relevant disciplines. The tumor board reviews the case and recommends the best course of cancer treatment for the patient.
Oncology nurse
The oncology nurse has many roles, from helping with cancer screening, detection, and prevention, to the intensive care focus of bone marrow transplantation. Work settings for oncology nurses also vary and include acute care hospitals, ambulatory care clinics, private offices, radiation therapy facilities, and home care agencies. Oncology nurses work with adult and pediatric patients with cancer.
Pediatric Oncology
Pediatric oncology is a medical specialty that focuses on cancer care for children.
The National Cancer Institute estimates that 10,270 new cases of cancer will be diagnosed in children in 2017. Of these, 1,190 children will die from the disease.
Pediatric oncology is an important medical field that treats all pediatric cancer types, including acute lymphocytic leukemia,
Chemotherapy is a drug treatment that uses powerful chemicals to kill fast-growing cells in your body. Chemotherapy is most often used to treat cancer, since cancer cells grow and multiply much more quickly than most cells in the body.
cancer of breast , this slide cointains detailed information about the breast cancer that is definition, causes and risk factor, sign and symptoms, management of patient with cancer , giving psychological support .treatment
chemotherapy or cancer chemotherapy is the treatment modality used for the treatment of a tumor or cancerous disease this ppt give a detailed use of drugs used for the cancer and what all the pracuation can be taken while handling it and can be used as study material for bsc and gnm for their examination purpose as well as apply their knowledge in their clinical practice
Oncology treatment of cancer: Chemotherapy.pptxRinkupatel55
it help to gain the knwoledge about the cancer treatment about the chemotherapy. in also provide the knowledge regarding criteria for the selection of chemo drug, route, dose, team, preparation of drug, and protection from the side effect of the chemotherapy during the drug prepartion & person itself.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
2. Outline
• Chemotherapy.
• Classification of Chemotherapeutic Agents.
• Purposes of Chemotherapy.
• Principles of Chemotherapy
• Articles for Chemotherapy Administration.
• Steps of Procedure of Administration of Chemotherapy.
• Extravasation.
• Management of Extravasation.
• Management of Chemotherapeutic Spill.
3. Learning Objectives
At the end of the class students will be able to-
• Define Chemotherapy.
• Classify Chemotherapeutic Agents.
• Enlist Purposes of Chemotherapy.
• Enlist Articles Needed for Chemotherapeutic Agents.
• Explain Steps of Procedure of Administration of Chemotherapy.
• Define Extravasation.
• Describe Management of Extravasation.
• Describe Management of Chemotherapeutic Spill.
4. Introduction
Chemotherapy is the use of antineoplastic agents in an
attempt to destroy tumor cells by interfering with cellular
functions and reproduction.
Chemotherapy is the use of drugs or medications to treat
disease, a method of cancer treatment.
The medication enters the body and circulates, in order to
destroy cancer cells. Chemotherapy can be used alone or as
part of a treatment plan that could include surgery, radiation
therapy or biotherapy.
There are several goals of using chemotherapy, i.e. cure,
control and palliation. Some types of cancer respond best to
chemotherapy medications, others react best with several
treatment options combined.
5. Cont.…..
As per the cell cycle specificity the chemotherapy drugs can be divided into two
types, i.e. the cell cycle-specific drugs and cell cycle non-specific.
The cell cycle-specific drugs destroy cells actively reproducing by means of cell
cycle.
Many of these agents are specific to certain phases of the cell cycle. Most affect
cells in the S-phase by interfering with DNA and RNA synthesis.
Others such as Vinca or plant alkaloids are specific to the M-phase where they
halt mitotic spindle formation.
The cell cycle agents usually have a prolonged effect on cells leading to cellular
damage or death.
7. Purposes of Chemotherapy
• To treat the systemic diseases
• To reduce tumor size preoperatively
• To destroy any remaining tumor cells postoperatively
• To treat some forms of leukaemia
• To kill cancer cells
8. Principles of Chemotherapy
1. The intent of chemotherapy is to destroy as many tumor cells as possible with minimal effect on
healthy cells.
2. Cancer descend on the same mechanism for cell division as normal cells. Damage to those
mechanism leads to cell death.
3. Chemotherapy is utilised in different clinical setting
Adjuvant chemotherapy is the use of systemic treatment following surgery and for
radiation therapy. Adjuvant therapy is given to patients who have no evidence of residual
disease but who are at high risk for relapse.
Neoadjuvant chemotherapy is the use of systemic treatment prior to primary surgery or
radiation. The goal is to shrink or downstage the primary tumor to improve the
effectiveness of surgery as well as control/ irradicate microscopic cancer cells. The goal of
therapy is to decrease the amount of tissue that needs to be removed as well as to
attempt to maximize cure potential.
9. CONT…
High-dose/ intensive therapy is the administration of high doses of
chemotherapy usually in association with growth factor support before
bone marrow transplant/ stem cell rescue.
Palliative chemotherapy is when a cure is not possible to control the
cancer and minimize side effects from the disease.
4. Chemotherapeutic agents can be effective on any stage of the cell cycle in which
cells are dividing the cell cycle is divided into five stages-
G0 (gap 0) - Resting phase cells are not dividing in this stage and for the most
part is refractory to chemotherapy.
G1 (gap 1) phase: Ribonucleic acid RNA and Protein synthesis in rhymes for
DNA synthesis are manufactured.
10. CONT….
S Phase during a long period the DNA component doubles for the
chromosomes in preparation for cell division
G2 Phase- this protein and RNA synthesis occurs and the mitotic
spindle apparatus is formed
Mitosis phase in an extremely short period the cell divides into two
identical daughter cells.
5. Routes of administration- Oral- capsule, tablet or liquid, Intravenous- Push
(bolus) or infusion over a specified period, Intra muscular, Intrathecal, Intra-
arterial, Intracavitary, Intravesical & Topical.
6. Dosage is based on surface area in both adults and children.
7. Most chemotherapeutic agents have dose limiting toxicities that require
nursing interventions. Chemotherapy predictably affects normal rapidly
growing cells. It is imperative that these toxicities be recognised early by the
nurse.
11.
12. Personal Protective Equipment
• Gloves- Wear gloves that are powder free such as nitric,
polyurethane and have been tested for use with
hazardous drugs avoid latex drugs due to potential latex
sensitivity. Double gloves are recommended for all
handling.
• Gown- Wear disposable lint-free ground made of low
permeability fabric. the gown should have a solid front
long sleeves, tight cuffs and back closure. The intact
gloves should be worn under the gown cuff and the
outer gloves should extend over the gown to protect the
skin gown and gloves are meant for single use only.
13. Cont.…
• Respirators- Wear a National Institute for
Occupational Health and Safety approval
respirator mask when there is a risk of aerosol
exposure such as when administering
chemotherapy for cleansing oil spill. Surgical
mask do not provide adequate protection.
• Eye and face protection- Wear eye shield and
mask that provides splash protection whenever
there is a possibility of splashing.
14. Points to Remember
User biologics safety cabinet for the preparation of all chemotherapy agents.
Wear surgical gloves when handling antineoplastic agents and the excretion of
patients who received chemotherapy.
Wear disposable long-sleeved gowns when preparing and administering
chemotherapy agents.
Use luer-lock fitting on all intravenous tubing used to deliver chemotherapy.
Dispose off all equipment used in chemotherapy preparation and
administration in appropriate leak proof puncture proof container according to
biomedical waste category 5 cytotoxic drugs.
Dispose of all chemotherapy waste as hazardous material.
15. Articles
Kidney tray
Paper bag
Personal Protective Kit (cap, mask, gown, shoe cover, goggle)
Spirit swabs in a container
Gloves
Intravenous set
Micropore for sticking
Chemotherapy drug as prescribed
Intravenous cannula
16G, 18G needles
10, 20 ml disposable syringes
16. Steps of Procedure
Preprocedural steps
Explain the procedure to the patient and take consent. Educate the patient
regarding adverse effect of chemotherapy and the strategies to manage these
effects. Instruct the patient to report any side effect of chemotherapy
Check for the following
o Physicians order including any supportive care medications including pre
medications antiemetics, hydration, growth factor or emergency
medications.
o Review patients medication history including over the counter medications
for possible interactions
Check current laboratory values complete blood count, differential platelets,
liver function test and creatinine. Drugs may be withheld in severe neutropenia,
thrombocytopenia or impaired liver or kidney function.
17. Cont.…
Check the 10 rights like right drug, route, dose, time, patient, evaluation, etc.
during drug administration
Calculate the dosage according to milligrams per kilogram mg/kg or milligrams
per metre squared and by body surface area
Be aware of agents that cause anaphylactic reaction such as asparaginase,
paclitaxel detection and docetaxel so keep the emergency resuscitation
equipment and drugs available
18. Intraprocedural steps
Insert IV check for patency of IV line
Select vein puncture site free from sclerosis thrombosis for sac formation if
possible if the patient has an established IV assess the site for erythema, pain or
tenderness
Check for a blood return by aspirating at a Y- site close to the IV catheter. Do not
pinch the catheter tubing
If doubt exist about vein patency and safety of chemotherapy administration;
discontinue the administration and treat as an extravasation if a recipient
chemotherapeutic agent has been used
Monitor for pain the patient may describe it as localised to severe burning and
radiating along with vein. Examine the site for swelling.
19. Cont.….
If extravasation is suspected, stop the infusion immediately and
follow the procedure for extravasation.
During drug administration-
Use a disposable, absorbent, plastic- backed pad under the work
area
Put on protective gown, gloves and eyewear.
Monitor the patient particularly during the first 15 minutes for signs
of hypersensitivity or anaphylaxis
Monitoring the IV site throughout the infusion
20. Postprocedural steps
• Document drug dosage and any occurrence of extravasation including estimated
amount of drug
• Observe regularly after administration for pain in duration and necrosis
• Monitor for other adverse effects of infusion
• Patient may describe sensations of pain and pressure within the vessel originating
near the vein puncture site of extending 3 to 5 inches long the vein
• Discoloration- Red streak following the line of vein called a flare reaction or
darkening of vein
• Itching, urticaria, muscle cramps or pressure in the arm caused by irritation of
surrounding subcutaneous tissue.
21. Extravasation
• Extravasation is the process by which any liquid fluid or drug accidentally leaks into
the surrounding tissues in terms of Cancer therapy. Extravasation refers to the
inadvertent infiltration of chemotherapy into the subcutaneous or subdermal
tissues surrounding the intravenous or intra-arterial administration site.
22. Management of Extravasation
• If an extravasation is suspected, stop the transfusion of the chemotherapy.
• Disconnect IV tubing and attempt to aspirate all residual chemotherapy in the IV
catheter using a syringe to prevent further infusion of chemotherapeutic agent.
• Apply warm or cold packs to area for 15 to 20 minutes 4 times a day for 24 hours.
• Cold packs for injection Dactinomycin, Idarubicin, Daunorubicin,
Mechlorethamine, Doxorubicin, Mitomycin, Epirubicin, Streptozotocin.
• Warm packs for injection Vincristine, Vinorelbine, Vinblastine.
23. Cont.…
Notify the health care provider
If an antidote is available, administer as prescribed. Gently clean the area
around the extravasation with an alcohol pad. Inject the antidote
subcutaneously in a circular pattern around the site of extravasation using
a 25-gauge needle. 1-5 injections will be needed, depending on the
volume of extravasation. Change the needle with each new injection.
Elevate affected limb if applicable for 48 hours.
Reapply warm or cold compress as indicated, depending on the
chemotherapeutic agent that has been extravasated.
24. Management of Chemotherapeutic Spill
Chemotherapy spills should be cleaned up immediately by the trained personnel. A spill
should be identified with a warning sign so that other person will not be contaminated.
A spill kit contains
Heavy duty rubber gloves
Respiratory mask for airborne powder, spills
goggles
disposable gown
Disposable scoop
26. Procedure for spill management
Alert other staff in the area of the potential hazard. Limit access to the area
while a spill kit is obtained and then place the warning sign in a prominent
position.
Don personal protective equipment in this order: mask, face shield, the safety
glasses, gloves, gown.
For a liquid spell, carefully place an absorbent pad over the spilled liquid. Absorb
as much liquid as possible into the pad.
If there is broken glass in the spill, carefully pick up the glass pieces using the
disposable scoop and place all glass in the puncture proof container.
Use the cleaning solution to wash the area of the spill thoroughly, discarding all
waste generated into the waste container.
Rinse the area well with clean water.
Document the event.
27. Special considerations
Always follow the 10 rights of drug administration.
Correct use of personal protective clothing and equipment should be instituted
to minimise exposure and health risks.
Disposable gloves should be used for dispensing hands must be washed before
and after glove application.
On disposable protective clothing as well as any disposable materials used while
handling chemotherapeutic agents should be disposed of as cytotoxic waste
according to the local waste disposal regulatory guidelines.
Information ready for necessary action in the event of accidental exposure.
Minimise the number of individuals coming in contact with the cytotoxic
medications.
28. References
1. Kaur AK, Kaur S, Kaur S, Sharma S, Singh VN, Saini KS. Clinical Nursing Procedures. 1st ed. CBS
publishers & Distributors Pvt. Ltd.; 350-354.
2. Sharma S. Lippincott Manual of Medical Surgical Nursing. Wolters Kluwers. 2016; 869- 871.
3. Nettina MS. Lippincott Manual of Nursing Practice. Wolters Kluwers. 2020; 115-120.