Cancer is a disease in which some body cells start to divide rapidly, leading to a spread to other parts of the body. Tumour cells tend to grow in a much more rapid way than normal cells. Chemotherapy administration stops this cell division process by killing them.
Chemotherapy administration routes include oral, subcutaneous, intramuscular, intravenous, intrathecal (into the spinal fluid) , intravesical (into the bladder to treat bladder cancer) and topical (eg. in melanoma).
A Chemotherapy Treatment Chart includes:
- chemotherapy name
- dosage
- route
- date and time for each chemotherapy administration (be it on the same day or on different days)
- patient details
- medications to be administered along with chemotherapy eg. antiemetics to counteract nausea caused by chemotherapy
- signature, name or initials of medical officer prescription in chemotherapy administration chart
In reference to the above protocol excerpt:
- R-CHOP-21 is the name of the protocol
- The letters RCHOP refer to the chemotherapies being administered
- P is referring to Prednisolone
- 21 refers to the number of days per chemotherapy cycle
- The protocol outlines all details related to the chemotherapies being administered and how all medications should be administered to one specific patient
Prior To Chemotherapy Administration
- Medical assessment needs to be carried out and documented on file (patient has to be deemed fit for chemotherapy prior to treatment start)
- Parameters as well as height and weight need to be taken as baseline (patient shouldn’t be given when or if patient is severely unwell, as chemotherapy worsens patient condition)
- Informed consent should be acquired from the patient and placed in file
- Routine tests such as blood tests, allergies and pregnancy result should be acquired and checked by the medical officer
- Re-discuss side effects with patient
- Get chemotherapy from designated locations
First Check – Prior to Chemotherapy Administration
- Patient identity details
- Name of Chemotherapy
- Dose of Chemotherapy
- Route of administration
- Date and Time of administration
- Chemotherapy drugs sequence
- Duration of infusion
- Rate of administration
- Pharmacist signature
- Expiry date and time
- Uncompromised integrity of chemotherapy bag
- Known drug allergies
- Protect from light if required
With reference to the above, the information on the chemotherapy treatment chart and the chemotherapy plastic bag must be compared and matched. Check should be carried out independently by two different nurses at the patient’s side immediately prior to administration.
Second Check – Prior to Chemotherapy Administration
- Patient identity details
- Name of chemotherapy
- Chemotherapy dose and volume
- Route of administration
- Date and Time of administration
- Expiry date and time
- Pharmacist signature
- Check for precipitation in chemotherapy container
With reference to the above, the information on the chemotherapy plastic bag and the chemotherapy container inside must be compared and matched. Check should be carried out independently by two different nurses at the patient’s side immediately prior to administration.
Third Check – Prior to Chemotherapy Administration
- Patient identity details
- Known drug allergies
With reference to the above, the information on the chemotherapy container must be checked with patient. Check is usually carried out by the nurse administering the chemotherapy.
Once all checks are performed, the two nurses sign on the treatment chart, indicating that the chemotherapy administration can be started.
Preparation – Prior to Chemotherapy Administration
- Anaphylactic reaction/shock tray (Hydrocortisone, Chlorphenamine – antihistamine, Ventolin for bronchospasms, flushes, oxygen masks etc.)
- CPR trolley
- Emergency call bell
- Hypersensitivity tray
- Extravasation kit
- Hot and Cold pack
- Chemotherapy spillage kit
- Emergency shower
Oral Chemotherapy
- compliance with prescribed drug schedule
- check dietary requirements in relation to oral drug administration
- handle with gloves
- do NOT crush chemotherapy tablets/capsules
Drug Administration
- Administer chemotherapy preferably via a central line
- If a cannula is being used (eg. if chemotherapy needs to be administered urgently), insert cannula immediately before chemotherapy administration in large veins in the upper limbs (use either the pink or the blue cannulas for chemotherapy administration); chemotherapy should NOT be administered via cannulas in the lower limbs or over bony prominences or in small veins
- Avoid repeated punctures to the same vein during the same venepuncture session as this increases the risk of extravasation
- Use clear dressing over insertion site to see any leakages immediately (do not use bandages or occlusive dressings)
- Tell patient to report immediately any signs or symptoms such as stinging, burning sensation, tenderness, pain or any other sensation at the infusion site
- Check for venous return (back-flow) prior to chemotherapy administration
Personal Protective Equipment
- gloves (one set of gloves is enough)
- use double gloving only in the case of chemotherapy spillage or topical application of chemotherapy
- cover cuts and scratches with waterproof dressing to avoid infiltration of the skin by chemotherapy
- gloves should be worn at all times when in contact with bodily fluids from patient receiving chemotherapy
- plastic apron or if available, gown during chemotherapy administration
- gown should be used in the case of chemotherapy spillage
- goggles or full face visor should be used when dealing with spillages (if chemotherapy is splashed into eyes, rinse continuously with cold running water for 10-20 minutes and seek medical advice)
- masks should be worn in chemotherapy spillage event
- shoe covers should be worn for spillage management
- handle chemotherapy below waist level to avoid spillages on face
- pregnant nurses should avoid administering chemotherapy
- items that come into contact with chemotherapy should be discarded into the appropriate chemotherapy waste bins
Chemotherapy cannot be cleaned by alcohol handrub…use soap and water instead.
In the case of Extravasation…
- STOP infusion and DISCONNECT tubing
- WITHDRAW as much drug from cannula or central line as possible
- DO NOT FLUSH!
- Inform medical officer
- Open extravasation kit
In the case of Hypersensitivity Reaction…
Hypersensitivity reaction manifests as uticaria, bronchospasm, rash, abdomen cramping and hypotension, usually with treatments such as Rituximab. If the patient has a high risk of hypersensitivity reaction, premedication is given as steroids and antihistamines.
Further information about different chemotherapy drugs can be found at https://www.macmillan.org.uk/
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