How to Administer Cancer Chemo Drugs

? According to the American Cancer Society, chemotherapy is a cancer treatment option that involves the application of hazardous chemicals into the body in order to destroy cancer cells. Chemotherapy medications primarily affect cancer cells, as cancer cells have a faster rate of metabolism than normal tissue, therefore absorbing proportionately more of the drugs. However, chemotherapy drugs also affect some healthy cells leading to side effects like fatigue, nausea and hair loss.

There are many methods that chemotherapy can be administered. Ways to give chemotherapy regimens include:

Orally- To be taken by mouth and normally a pill form, although liquids are available Intravenous (IV)- Injected into a vein Topical To be applied to the skin, and is in the form of a cream or lotion Intramuscular (IM)- The drug is injected into a muscle Intra-arterial The drug in injected into an artery Intrapleural Infusion into the chest cavity Intrathecal Infusion into the central nervous system through cerebrospinal fluid Subcutaneous The drug is injected under the skin Intraperitoneal Infusion into the abdominal cavity IntratumoralInjection into the tumor Intralesional- Injection into the tumor

Intravesical- Infusion into the bladder

Repeated exposures are especially dangerous

The chemotherapy drugs nurses are most likely to administer are paclitaxel (Taxol); doxorubicin HCl (Adriamycin, Doxil); cyclophosphamide (Cytoxan); cisplatin (Platinol); docetaxel (Taxotere); etoposide, which is commonly known as VP-16 (VePesid); methotrexate; fluorouracil, which is commonly known as 5-FU (Adrucil); and carboplatin (Paraplatin). Accidental exposure to such agents can occur in several ways: by direct absorption of a drug through the skin; by ingestion while eating or drinking after hand contact with a drug; and by inhalation of airborne droplets. You may have an exposure without realizing it. In a study of 83 nurses and pharmacists who handled or administered chemotherapy drugs, a specialized scanning device revealed that 13% of the group had one or more spots of drug contamination on their gloved or ungloved hands, gowns, or shoes.1 Acute exposure generally causes transient symptoms such as headache, nausea, dizziness, rash, skin and mucous membrane irritation, and eye or throat irritation. However, repeated exposure to chemotherapeutic agents is especially dangerous. Chemotherapy drugs are carcinogenic, mutagenic (induces or increases genetic mutations), and/or teratogenic (causes malformations in developing embryos). They can cause organ toxicity, including damage to a woman's reproductive system. The adverse reproductive effects associated with occupational exposure to these drugs such as temporary and permanent infertility, birth defects, menstrual dysfunction, ectopic pregnancies, and spontaneous abortionshave been documented in a number of studies.2,3 One study compared the reproductive outcomes of 663 women. 4 About one-third were oncology nurses, one-third were non-oncology nurses, and the other third weren't nurses at all. The percentage of birth defects was 3.1% for oncology nurses, 1.5% for the nononcology nurses, and 0.3% for the non-nurses. It's more difficult to connect long-term exposure in healthcare workers to an increased risk of developing malignancies because of the time interval between exposure and the onset of malignancy. It's also difficult to differentiate the influence of individual risk factors for cancer from occupational ones. Some studies have found increased chromosomal aberrations and evidence of mutagenicity in the urine of nurses who handle cytotoxic drugs, while other studies have failed to find a relationship between exposure and these measures.1,2 These disparate results may be due to differences in levels of exposure between studies, differences in the use of personal protective equipment (PPE) and work techniques, and differences in urine collection timing. 2

While the long-term effects on nurses who are occupationally exposed to these drugs require further study, much research has already been done on the long-term effects on patients receiving chemotherapy. The development of secondary malignancies such as leukemia, bladder cancer, and lymphoma is well documented.2

Tips for minimizing your risk of exposure

To learn how to handle chemotherapy drugs in a safe and conscientious manner, you should ideally have formal classroom training as well as hands-on competency training. Most facilities offer such training and prohibit nurses from administering chemotherapy without it.3 At minimum, you should be instructed on safe handling procedures. The Oncology Nursing Society (ONS) provides comprehensive guidelines on administration (Chemotherapy and Biotherapy Guidelines and Recommendations for Practice)5 and a separate set of guidelines on safe handling (Safe Handling of Cytotoxic Drugs: An Independent Study Module).6 Much of the following information is based on ONS guidelines, which include the recommendations of the Occupational Safety and Health Administration (OSHA).2 Preparation. Be sure to follow your facility's policies and procedures when preparing to administer chemotherapy. When a patient who needs chemotherapy arrives at your unit, the first thing you should do is double-check the chemotherapy orders with a nurse from the oncology unit and send the orders to the pharmacy. Making sure that your patient is well informed of the process and has received adequate teaching about the potential side effects of the drug(s) is a standard of care for chemotherapy patients. Check to ensure that a chemotherapy spill kitwhich typically contains chemical splash goggles, gloves, a gown, sheets of absorbent material, spill control pillows, a "sharps" container, a scoop to collect glass fragments, and waste disposal bagsand emergency skin and eye decontamination kits are nearby.2 In addition, material safety data sheets (MSDS) that include information on health hazards, acute exposure treatment, PPE, and spill procedures should be accessible. Put on PPE that includes a disposable, fluid-resistant, closed-front gown; disposable, powder-free gloves with a thickness of at least 0.007 inch that cover the gown cuff; and goggles or other eye protection.6 It's important to wash your hands both before you put on and after you take off gloves. Next, using either your patient's existing vascular access device or an IV that you initiate, infuse an appropriate IV solution that's compatible with the specific drug to be administered. If you're administering chemotherapy in a hospital, it's likely that the drugs used will be prepared in the pharmacy. IV bags with chemotherapy drugs must be spiked in a biological safety cabinet or hood. To prevent having to spike bags at the bedside, new tubing should be connected to each bag of chemotherapy before it's sent to the nursing unit. IV tubing should also be primed with a non-drug solution before the chemotherapy drug is added, or a back-flow closed system should be used.2

If at any point you need to transport chemotherapy, make sure you do so properly. The chemotherapy bags should be placed in another bag and appropriately labeled as chemotherapeutic agents. Many facilities use a hard-plastic carrying case for these drugs. A pneumatic tube system should never be used to transport them. Administration. When the chemotherapy arrives, double-check the dose for accuracy with another RN. When administering chemotherapy, it's important to use a main IV line to provide direct access to the patient in the event of an adverse reaction to the chemotherapy drug. Before administering the drug, verify the patency of the IV site. Extravasation can cause severe damage to tissue, especially in the case of vesicant drugs, which should be infused via a central IV line. Instruct your patient to immediately report any pain, irritation, redness, or swelling at the IV site. Place a disposable drape under the patient's arm where the tubing from the chemotherapy bag will be connected. Hang the chemotherapy bag on the pole of your infusion pump, remove the cap from the tubing, and then use a Luer-Lok to connect the tubing to the main line on the IV port closest to the patient. Set the pump to infuse at the rate ordered. Waste disposal and spills. After infusion is complete, promptly dispose of any equipment that contains or contained the drug. Wrap the equipment in the disposable drape from under the patient's arm and place it in a leak-proof, puncture-proof container that's clearly marked as "biohazard waste," "infectious material waste," or "chemotherapy/cytotoxic drug waste." Your facility should have these containers available and accessible wherever chemotherapy will be administered. If a spill occurs at some stage during infusion, ideally, specially trained personnel should clean it. However, if that's not possible and you have to clean it, be sure you're still wearing PPE, including eye protection, before you begin. The materials you use to clean a spill should be disposed of in an appropriate biohazard container. Because chemotherapy agents may be excreted in body fluids, the patient's urine and stool (and, to a lesser degree, his saliva, emesis, perspiration, mucus, and tears) may be contaminated for 48 hours after the last drug dose. Wear PPE when handling such excreta, and wash your hands after removing your gloves. Glassware or other contaminated reusable items should be washed twice with detergent by a trained employee wearing double latex gloves and a gown.2 Check your facility's policies about handling linen that's been contaminated with chemotherapy. Generally, any linen contaminated with the body fluids of a patient who receives chemotherapy should be placed in specially marked laundry bags and then placed in a second impervious bag that's also labeled.2 Accidental exposures. If a chemotherapy drug comes into contact with your skin or a patient's skin, thoroughly wash the affected area with soap and water, but don't abrade the skin with a scrub brush.7 If the drug gets in your eye(s), flush with copious amounts of water for at least 15 minutes while holding back your eyelids. Then get evaluated by employee

health or the ED. Be sure to follow your facility's policies and procedures for reporting such incidents. The bottom line is that all nursesnot just those who work in oncologyshould know their hospital's policies and procedures on safe handling and administration of chemotherapy agents. Believing that you'll never have to handle these agents, and thus being unprepared if asked to do so, could be harmful to your health.

The treatment of cancer using specific chemical agents or drugs that are selectively destructive to malignant cells and tissues. The treatment of disease using chemical agents or drugs that are selectively toxic to the causative agent of the disease, such as a virus, bacterium, or other microorganism. Read more: http://www.answers.com/topic/chemotherapy#ixzz1PK2lwzwA

Chemotherapy Side Effects

Scientists have completed a huge deal of development in developing therapies to assist and supervise the side effects of chemotherapy. Newer helpful care treatments have led to enormous improvements in the administration of symptoms connected with cancer behavior. Some people don't practice side effects at all, and you are unlikely to practice all the side effects you read about below. Although chemotherapy is planned to delight cancer cells; unfortunately, it often affects parts of your body not unswervingly exaggerated by the cancer itself. This undesired result is referred to as a complication of treatment, or a side effect. Side effects may be acute, chronic, or everlasting. Side effects may cause trouble, anxiety, and even fatality. Side effects from chemotherapy can include soreness, diarrhea, hair loss, nausea and vomiting, constipation, mouth sores, as well as blood-related side effects. In this section, you can be taught more about the significance of diagnosing and checking blood-related side effects.

CBC and associated Side Effects The CBC, or total blood count, helps your doctor look for side effects of chemotherapy, which include changes in the 3 types of cells in your blood. Since chemotherapy destroys fast-growing blood cells as well as cancer cells, side effects concerning your blood are a predictable result of chemotherapy. Your initial step in thoughtful blood-related side effects knows CBC, or your absolute blood count. Side effects concerning blood comprise of the following: Neutropenia Neutropenia is the methodical name for a squat infection-fighting white blood cell count up. A low white blood cell tally might leave your body susceptible to illness and too feeble to obtain chemotherapy at the full dosage on schedule.11, 36, and 37 this could lead your doctor to wait your current treatment or diminish your doses until your count achieve adequate levels. Infection can escort to hospitalization. To assist lessen the risk of treatment delays due to blood-related side effects, locate further about the risks connected with low white cell blood count. Anemia Anemia is the methodical name for a squat red blood cell count. Red blood cells enclose hemoglobin, a protein that holds oxygen from the lungs to the bodys strength and organs. Oxygen is grave to the health of your tissues and organs. Thrombocytopenia Thrombocytopenia is the logical name for a stumpy platelet count up. A low platelet count might cause you to practice staining or unnecessary bleeding. Study new about the hazard of low platelet count. All of these side effects might be connected to your chemotherapy. All are analyzed throughout your CBC test. You can supervise them to assist the opportunity that they will concession your treatment. A journal offers a place for you to maintain path of your blood counts during your chemotherapy, and is one of the gear for systematizing Your Cancer Information. In calculation to blood-related side effects, chemotherapy can outcome other side effects that can obstruct with treatment if not supervised correctly. Study more about other types of chemotherapy side effects.

Occasionally side effects gesture a somber problem. Discover when to call your doctor about chemotherapy side effects.