6 Chemotherapy Agent Safety
Learn how to verify antineoplastic treatment, prevent hazardous-drug exposure, and respond promptly to complications during chemotherapy.
Safe administration and verification
can harm healthy tissue as well as cancer cells. Safe administration depends on accurate verification, appropriate monitoring, a prompt response to complications, and protection of staff from hazardous-drug exposure.
Before treatment, explain the regimen and the symptoms the patient should report. Patient teaching remains necessary even when the patient has no questions. Follow the current treatment plan, drug-specific instructions, and facility policy; do not improvise when an order, dose, route, or laboratory result is unclear.
What to verify before treatment
before administration includes checking:
Two patient identifiers.
The drug, dose, route, and rate.
The treatment plan, cycle, and day.
Relevant laboratory results and the patient-specific assessment, including the patient's status and allergies.
Pause and clarify discrepancies before giving the drug. Verification does not replace explaining the regimen or discussing symptoms to report.
Protecting staff from hazardous-drug exposure
Use chemotherapy-tested gloves and a nonabsorbent protective gown when administering antineoplastic drugs. Add eye or face protection when splashing is possible, and use additional PPE when required by the task and facility policy.
Use appropriate engineering controls and follow hazardous-drug procedures for tubing, equipment, disposal, and contaminated patient waste. Do not rely on ordinary exam gloves simply because medication is in a closed IV bag. Follow the applicable procedure for tubing and equipment rather than priming tubing with the antineoplastic drug at the bedside or removing PPE before disconnecting contaminated tubing.
Responding to suspected
Suspect when a patient receiving a vesicant reports burning at the IV site, swelling is visible, or blood return is absent. Stop the infusion and leave the catheter or access needle in place while promptly following the facility's protocol.
Attempt to aspirate residual drug through the access device; do not flush. Notify the appropriate team, assess and document the site, and use a drug-specific antidote or warm or cold compress only as directed by current guidance and protocol.
Responding to an
Itching, hives, wheezing, or dizziness during an infusion may indicate a hypersensitivity reaction that can progress rapidly. Stop the antineoplastic infusion, stay with the patient, assess and monitor airway, breathing, and circulation, and summon help or activate the facility response according to emergency protocol.
Follow drug-specific orders. Maintain IV access as directed by protocol, but do not flush residual chemotherapy into the patient.
A temperature of () during chemotherapy calls for urgent contact with the oncology care team. Fever may signal infection during neutropenia and needs urgent clinical assessment. Follow the patient's specific emergency instructions.
Fever-reducing medicines can mask the symptom. The patient should contact the care team before taking one unless instructed otherwise; do not wait for chills or a cough before calling.
Recognizing
can occur when tumor cells break apart and release their contents into the blood. This can cause potentially dangerous electrolyte and other metabolic changes that may injure organs, including the kidneys and heart.
New muscle weakness or cramps, palpitations, reduced urine output, or confusion warrant urgent evaluation. Promptly report concerning symptoms and follow ordered laboratory monitoring and preventive measures for patients at risk.
Managing spills and exposure
If antineoplastic drug spills, restrict access to the area and follow the facility spill procedure. Trained personnel should use the spill kit and required protective equipment; do not permit untrained staff to clean up the spill. Document and report the spill and any exposure.
For skin contact, remove contaminated clothing, wash the skin with soap and water, and obtain the specified medical evaluation. For eye exposure, immediately irrigate at an eyewash station or with water or eyewash for at least 15 minutes and obtain medical attention.