Procedures

These procedures are the standards expected when handling Cytotoxic or Biotherapy for all staff within the CDHB. Any staff involved in Cytotoxic or Biotherapy management should be familiar with all procedures.

They will be reviewed  by the Canterbury Regional Cancer and Haematology Service Clinical Nurse Specialists and Nurse Educators.

If you have any queries please contact one of us, contact details are on the Our Staff page. Please note website currently under RV - July 2018

The CDHB has adopted antineoplastic drug administration procedures developed by eviQ (add link). While these procedures cover all key aspects of administration, they DO NOT always reflect clinical practice within the Canterbury Regional Blood and Cancer Service.

Therefore critical notes have been developed to highlight practice differences. If you are unsure, please discuss with the senior nurses in your area. 

Critical Notes - Must be used in conjunction with the procedures

Written consent must be obtained if the cytotoxic drug, being administered, is part of cancer treatment. This must be sighted prior to administration. All other areas, refer to CDHB & local area consent policy for requirements. (???link to our consent and CDHB consent).

Safe Handling

You must don the following Personal Protective Equipment (PPE) when  handling any cytotoxic drugs that are administered as solutions.

  • Chemotherapy gloves. These are non-sterile gloves with reinforced finger tips & a long cuff. The current brand that is being is HALYARD.
  • Long sleeve impermeable gown

In some circumstances ie risk of cytotoxic drug splash/spill, you may consider/prefer to also don face protection (ie masks, visor, safety glasses) for cytotoxic drug administration.

All cytotoxic infusion bags must be pierced in a container, on a trolley that has been lined with a plastic back sheet.

Oral cytotoxic drugs being administered to inpatients should be identified on e-meds. They also may come from pharmacy with a purple 'cytotoxic' label on them. Chemotherapy gloves should be used when handling this medication.

​ ​ ​ ​PPE Summary Table- Administration
​Gloves​Gown​Face Protection
​Oral (tablets/Liquids)​Yes​Consider​Consider
​IV​Yes​Yes​Consider
​IT/Intraventricular​Yes​Yes​Consider
​Intraperitoneal​Yes​Yes​Consider
​Intravesicular​Yes​Yes​Consider

 

Administration - Use in Conjuction with Critical Notes

IV LEUR ANTINEOPLASTIC DRUG ADMINISTRATION

https://www.eviq.org.au/clinical-resources/administration-of-antineoplastic-drugs/1087-administration-of-antineoplastic-drugs-intra#49007

 

CVAD ANTINEOPLASTIC DRUG ADMINISTRATION

As per the CDHB CVAD policy, all medications infused via a CVAD must be administered using an infusion pump. This includes cytotoxic drugs.

https://www.eviq.org.au/clinical-resources/administration-of-antineoplastic-drugs/1127-administration-of-antineoplastic-drugs-cent#49004

 

IM/SC ANTINEOPLASTIC DRUG ADMINISTRATION

https://www.eviq.org.au/clinical-resources/administration-of-antineoplastic-drugs/457-administration-of-antineoplastic-drugs-intra#48984

Cytotoxic medication can be administered using the 'air sandwhich' technique Subcutaneous Administration of Cytotoxic Medication using the Air Sandwich Technique 

 

ORAL ANTINEOPLASTIC DRUG ADMINISTRATION

https://www.eviq.org.au/clinical-resources/administration-of-antineoplastic-drugs/450-administration-of-antineoplastic-drugs-oral

 

 

Waste Management

Flare Reaction

 Flare Reaction Procedure

 

Spill Management

Cytotoxic spill kits are no longer available from Christchurch Hospital Pharmacy. Every area administering any cytotoxic medication should have a spill kit on hand. For non-cancer areas and in an emergency spill kits may be obtained from Ward 26. These kits are now fully disposable.

 Spill Management Procedure

 Spill Management Flowchart 

 Cytotoxic Spill Kit Label 2016 

 CAUTION Cytotoxic Spill Sign

 

Infusion Related Reactions

 Infusion Related Reactions Guidance

 Serious Infusion Reaction Flow Chart

 Mild-moderate Infusion Related Reaction Flow Chart

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Page last reviewed: 19 July 2018
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