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PROCEDURE FOR ADMINISTRATION
OF INTRAVENOUS CYTOTOXIC DRUGS
PURPOSE: To
provide directions in the administration of I.V. antineoplastic agents
in a safe and appropriate manner so as to prevent any adverse effects.
SUPPORTIVE DATA:
Careful administration of agents and observation of the I.V. site
is essential to prevent complications . Peripheral infusion of a vesicant
agent is not recommended and if absolutely required will be limited
to a maximum of a two-hour infusion with frequent assessment for patency.
EQUIPMENT:
- Peripheral administration - IV Start Kit &
catheters (smaller size preferred)
- Implanted devices - Huber needle as needed - CVL
Kit
- I.V. solution and drug as ordered
- Pump and tubing
- PPE – chemo protective gloves
- Trifercator IV connection, if appropriate
NURSING ACTION:
PROCEDURE STEPS:
- Don
gloves and verify or initiate access making sure the insertion site
and surrounding area is visible.
KEY POINT:
Avoid side of mastectomy, invading neoplasm, DVT, sites of a recent
venipuncture antecubital fossa, wrist and back of hand. Forearm
is the preferred site for venipuncture.
- Luer-lock
the connections and begin the infusion at the ordered rate.
- Assess the IV site every hour.
- For I.V.P. administration, reconfirm vein patency every 3-4ml of drug
administered.
- For peripheral vesicant infusions (up to 120 minutes)
check patency every 5 minutes. Peripheral vesicant infusion is not
recommended and is limited to 2 hours only. It should be run through
the Y port of a free flowing IV.
KEY POINT :
Assessment of insertion site and immediate area for swelling,
redness, blebs, hives and pain. Extravasations can occur with
implanted ports, and these should be assessed, as well as peripheral
lines.
KEY POINT:
See Lippincott page 110 Management of an Extravasation.
- Flush
with a minimum of 5-10ml of Normal Saline or primary I.V. fluid
between each agent and when therapy is complete.
- D/C peripheral IV or Huber needle if
appropriate; apply pressure 3-4 minutes with 2 X 2 gauze.
- Use new tubing with each agent.
KEY POINT:
Pharmacy will send tubing with each bag. The risk of creating
aerosol with agents increases when bags are changed using existing
tubing.
REFERENCES:
Dorr, R.T. & Van Hoff, D.D.,
1994. Cancer Chemotherapy Handbook. 2nd Edition, Appleton &
Lang
Cancer Nursing (1993) Programmed Instruction: Cancer Chemotherapy,
Vol. 16, pp. 1-6, New York.
Cancer Chemotherapy Guidelines and Recommendations for Practice. Oncology
Nursing Press Inc. 1996, Pittsburgh,
PA.
RESOURCE PERSON(S):
Jackie Nelson, RN; Maureen Parker, RN-BMT
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