MEDICAL CENTER

PROCEDURE FOR HANDLING CYTOTOXIC DRUGS

NURSING ACTION:

PROCEDURE STEPS:

WHEN OBTAINING CYTOTOXIC MEDICATION FROM PHARMACY

1. Pharmacy will prime tubing under a biological safety cabinet before adding cytoxic drug to IV bag.  If oral chemotherapy is ordered, liquid dose is preferred.  Avoid crushing chemotherapy tablets or opening capsules. 

2. When ready for floor pickup, all cytotoxic medications will be sealed in a leak-proof container.  Medication will be labeled appropriately.  Container will be labeled as hazardous on the outside.

3. Personnel obtaining cytotoxic drug from pharmacy will be trained in recognition of a chemotherapy spill.  Personnel will be aware of location of the nearest spill kit  (pharmacy or nursing care area).

4. Personnel will deliver the cytotoxic drug directly to the RN responsible for administration or ensure it is immediately secured in the medication room.

PROPER WEAR OF PERSONAL PROTECTIVE EQUIPMENT

1. Put on gown.

2. Put on face shield.

3. Put on gloves ensuring the glove cuffs are over the gown cuffs.

PROPER REMOVAL OF PERSONAL PROTECTIVE EQUIPMENT

1. Immediately remove any material that comes in contact with a cytotoxic agent or when no longer needed. 

2. Remove and discard gloves by removing the first and grasping it in the hand of the other, then pulling the other off so that it contains the first glove and is wrong side out. 

3. Remove and discard gown and face shield.

4. Dispose of all personal protective equipment in cytotoxic waste container.

WHEN PERFORMING DOSAGE DOUBLE-CHECKS

1. See-through container:  Dosage double-check is performed prior to opening bag.

2. Non-see-through container:  RN administering cytotoxic drug (first RN) must wear full personal protective equipment prior to opening the leak-proof container.

3. First RN opens and removes chemotherapy from leak-proof container taking care to only expose what is necessary to do the dosage check.  Second RN holds the orders and reads them to first RN while first RN looks at the drug label.

4. First RN replaces and reseals chemotherapy in leak-proof container when dosage check complete.

DURING ADMINISTRATION

1. Place a yellow or blue top cytotoxic waste container near the area administration will occur.

2. Wear personal protective equipment.

3. Work below eye level.

4. Ensure that a spill kit is available.

5. Place a disposable plastic-backed pad on the work area to absorb any droplets that may spill.

6. Place a gauze pad under the injection site to catch any droplets during administration.

7. Use only luer-lock connectors (no needles or tape)

8. After administration, remove the bag or bottle with tubing attached.  Do not remove the spike from IV containers or reuse the tubing.

9. Use detergent and water to wash surfaces that come into contact with hazardous drugs.

10. Discard all contaminated material and PPE in the yellow or blue top cytotoxic waste container.

11. Discard all needles and sharps in the sharps container.

AFTER ADMINISTRATION

1. Most cytotoxic agents are excreted in the patient’s body fluids for 48 hours to one week (7 days) after administration.  During this time, all caregivers should wear full personal protective equipment if exposure to body fluids is a possibility.  Avoid splashing body fluids to decrease release of droplets into the atmosphere.

2. Patients receiving cytotoxic agents will be identified on the unit by a blue armband with a corresponding Blue High Risk form on front of the chart and a "SAFE HANDLING PRECAUTIONS" sign on the door.

3. Patient Education will be available on Adobe Acrobat: "Chemotherapy Exposure Precautions"

4. Place disposable urinals, bedpans, urinary drainage bags and emesis basins in the cytotoxic waste container at patient’s discharge or when replacing.

5. Dispose of vomitus and excreta in toilet.  Avoid splashing or spraying which create large amounts of aerosol. 

6. Seal cytotoxic waste containers when full for pickup from Environmental Health and Safety. 

DISCHARGE TEACHING

1. If patient will be going home before the cytotxic drugs are cleared from their system, provide them with the teaching sheet in Adobe Acrobat “Safe Management of Body Waste After Chemotherapy.”