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presentation1-201119091427(chemotherapy).pdf
- 1. Chemotherapy Administration SUBMITTED TO- Mrs. Manisha Negi Lecturer, NINE PGIMER Chandigarh SUBMITTED BY- Nisha Yadav MSc. Nursing 1st Year NINE, PGIMER Chandigarh
- 2. Outline • Chemotherapy. • Classification of Chemotherapeutic Agents. • Purposes of Chemotherapy. • Principles of Chemotherapy • Articles for Chemotherapy Administration. • Steps of Procedure of Administration of Chemotherapy. • Extravasation. • Management of Extravasation. • Management of Chemotherapeutic Spill.
- 3. Learning Objectives At the end of the class students will be able to- • Define Chemotherapy. • Classify Chemotherapeutic Agents. • Enlist Purposes of Chemotherapy. • Enlist Articles Needed for Chemotherapeutic Agents. • Explain Steps of Procedure of Administration of Chemotherapy. • Define Extravasation. • Describe Management of Extravasation. • Describe Management of Chemotherapeutic Spill.
- 4. Introduction Chemotherapy is the use of antineoplastic agents in an attempt to destroy tumor cells by interfering with cellular functions and reproduction. Chemotherapy is the use of drugs or medications to treat disease, a method of cancer treatment. The medication enters the body and circulates, in order to destroy cancer cells. Chemotherapy can be used alone or as part of a treatment plan that could include surgery, radiation therapy or biotherapy. There are several goals of using chemotherapy, i.e. cure, control and palliation. Some types of cancer respond best to chemotherapy medications, others react best with several treatment options combined.
- 5. Cont.….. As per the cell cycle specificity the chemotherapy drugs can be divided into two types, i.e. the cell cycle-specific drugs and cell cycle non-specific. The cell cycle-specific drugs destroy cells actively reproducing by means of cell cycle. Many of these agents are specific to certain phases of the cell cycle. Most affect cells in the S-phase by interfering with DNA and RNA synthesis. Others such as Vinca or plant alkaloids are specific to the M-phase where they halt mitotic spindle formation. The cell cycle agents usually have a prolonged effect on cells leading to cellular damage or death.
- 6. Classification of Chemotherapeutic Agents Chemotherapeutic agents Examples Alkylating agents Busulfan, carboplatin, Chlorambucil, Cisplatin, Cyclophosphamide, Dacarbazine, Hexamethyl melamine, Ifosfamide, Melphalan, Nitrogen mustard and Thiotepa. Nitrosoureas Carmustin, Lomustine, Semustine, Streptozocin. Topoisomerase-I inhibitors Irinotecan and topotecan Antimetabolites Cytarabine, edatrexate fludarabine, 5-fluorouracil, gemcitabine, hydroxyurea, leustatin, 6- mercaptopurine, methotrexate, pentostatin, 6-thioguanine. Antitumor antibiotics Bleomycin, dactinomycin, daunorubicin, doxorubicin. Mitotic spindle poison Paclitaxel and docetaxel Plant alkaloids Etoposide, teniposide, vinblastine, vincristine, vindesine, vinorelbine.
- 7. Purposes of Chemotherapy • To treat the systemic diseases • To reduce tumor size preoperatively • To destroy any remaining tumor cells postoperatively • To treat some forms of leukaemia • To kill cancer cells
- 8. Principles of Chemotherapy 1. The intent of chemotherapy is to destroy as many tumor cells as possible with minimal effect on healthy cells. 2. Cancer descend on the same mechanism for cell division as normal cells. Damage to those mechanism leads to cell death. 3. Chemotherapy is utilised in different clinical setting Adjuvant chemotherapy is the use of systemic treatment following surgery and for radiation therapy. Adjuvant therapy is given to patients who have no evidence of residual disease but who are at high risk for relapse. Neoadjuvant chemotherapy is the use of systemic treatment prior to primary surgery or radiation. The goal is to shrink or downstage the primary tumor to improve the effectiveness of surgery as well as control/ irradicate microscopic cancer cells. The goal of therapy is to decrease the amount of tissue that needs to be removed as well as to attempt to maximize cure potential.
- 9. CONT… High-dose/ intensive therapy is the administration of high doses of chemotherapy usually in association with growth factor support before bone marrow transplant/ stem cell rescue. Palliative chemotherapy is when a cure is not possible to control the cancer and minimize side effects from the disease. 4. Chemotherapeutic agents can be effective on any stage of the cell cycle in which cells are dividing the cell cycle is divided into five stages- G0 (gap 0) - Resting phase cells are not dividing in this stage and for the most part is refractory to chemotherapy. G1 (gap 1) phase: Ribonucleic acid RNA and Protein synthesis in rhymes for DNA synthesis are manufactured.
- 10. CONT…. S Phase during a long period the DNA component doubles for the chromosomes in preparation for cell division G2 Phase- this protein and RNA synthesis occurs and the mitotic spindle apparatus is formed Mitosis phase in an extremely short period the cell divides into two identical daughter cells. 5. Routes of administration- Oral- capsule, tablet or liquid, Intravenous- Push (bolus) or infusion over a specified period, Intra muscular, Intrathecal, Intra- arterial, Intracavitary, Intravesical & Topical. 6. Dosage is based on surface area in both adults and children. 7. Most chemotherapeutic agents have dose limiting toxicities that require nursing interventions. Chemotherapy predictably affects normal rapidly growing cells. It is imperative that these toxicities be recognised early by the nurse.
- 12. Personal Protective Equipment • Gloves- Wear gloves that are powder free such as nitric, polyurethane and have been tested for use with hazardous drugs avoid latex drugs due to potential latex sensitivity. Double gloves are recommended for all handling. • Gown- Wear disposable lint-free ground made of low permeability fabric. the gown should have a solid front long sleeves, tight cuffs and back closure. The intact gloves should be worn under the gown cuff and the outer gloves should extend over the gown to protect the skin gown and gloves are meant for single use only.
- 13. Cont.… • Respirators- Wear a National Institute for Occupational Health and Safety approval respirator mask when there is a risk of aerosol exposure such as when administering chemotherapy for cleansing oil spill. Surgical mask do not provide adequate protection. • Eye and face protection- Wear eye shield and mask that provides splash protection whenever there is a possibility of splashing.
- 14. Points to Remember User biologics safety cabinet for the preparation of all chemotherapy agents. Wear surgical gloves when handling antineoplastic agents and the excretion of patients who received chemotherapy. Wear disposable long-sleeved gowns when preparing and administering chemotherapy agents. Use luer-lock fitting on all intravenous tubing used to deliver chemotherapy. Dispose off all equipment used in chemotherapy preparation and administration in appropriate leak proof puncture proof container according to biomedical waste category 5 cytotoxic drugs. Dispose of all chemotherapy waste as hazardous material.
- 15. Articles Kidney tray Paper bag Personal Protective Kit (cap, mask, gown, shoe cover, goggle) Spirit swabs in a container Gloves Intravenous set Micropore for sticking Chemotherapy drug as prescribed Intravenous cannula 16G, 18G needles 10, 20 ml disposable syringes
- 16. Steps of Procedure Preprocedural steps Explain the procedure to the patient and take consent. Educate the patient regarding adverse effect of chemotherapy and the strategies to manage these effects. Instruct the patient to report any side effect of chemotherapy Check for the following o Physicians order including any supportive care medications including pre medications antiemetics, hydration, growth factor or emergency medications. o Review patients medication history including over the counter medications for possible interactions Check current laboratory values complete blood count, differential platelets, liver function test and creatinine. Drugs may be withheld in severe neutropenia, thrombocytopenia or impaired liver or kidney function.
- 17. Cont.… Check the 10 rights like right drug, route, dose, time, patient, evaluation, etc. during drug administration Calculate the dosage according to milligrams per kilogram mg/kg or milligrams per metre squared and by body surface area Be aware of agents that cause anaphylactic reaction such as asparaginase, paclitaxel detection and docetaxel so keep the emergency resuscitation equipment and drugs available
- 18. Intraprocedural steps Insert IV check for patency of IV line Select vein puncture site free from sclerosis thrombosis for sac formation if possible if the patient has an established IV assess the site for erythema, pain or tenderness Check for a blood return by aspirating at a Y- site close to the IV catheter. Do not pinch the catheter tubing If doubt exist about vein patency and safety of chemotherapy administration; discontinue the administration and treat as an extravasation if a recipient chemotherapeutic agent has been used Monitor for pain the patient may describe it as localised to severe burning and radiating along with vein. Examine the site for swelling.
- 19. Cont.…. If extravasation is suspected, stop the infusion immediately and follow the procedure for extravasation. During drug administration- Use a disposable, absorbent, plastic- backed pad under the work area Put on protective gown, gloves and eyewear. Monitor the patient particularly during the first 15 minutes for signs of hypersensitivity or anaphylaxis Monitoring the IV site throughout the infusion
- 20. Postprocedural steps • Document drug dosage and any occurrence of extravasation including estimated amount of drug • Observe regularly after administration for pain in duration and necrosis • Monitor for other adverse effects of infusion • Patient may describe sensations of pain and pressure within the vessel originating near the vein puncture site of extending 3 to 5 inches long the vein • Discoloration- Red streak following the line of vein called a flare reaction or darkening of vein • Itching, urticaria, muscle cramps or pressure in the arm caused by irritation of surrounding subcutaneous tissue.
- 21. Extravasation • Extravasation is the process by which any liquid fluid or drug accidentally leaks into the surrounding tissues in terms of Cancer therapy. Extravasation refers to the inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the intravenous or intra-arterial administration site.
- 22. Management of Extravasation • If an extravasation is suspected, stop the transfusion of the chemotherapy. • Disconnect IV tubing and attempt to aspirate all residual chemotherapy in the IV catheter using a syringe to prevent further infusion of chemotherapeutic agent. • Apply warm or cold packs to area for 15 to 20 minutes 4 times a day for 24 hours. • Cold packs for injection Dactinomycin, Idarubicin, Daunorubicin, Mechlorethamine, Doxorubicin, Mitomycin, Epirubicin, Streptozotocin. • Warm packs for injection Vincristine, Vinorelbine, Vinblastine.
- 23. Cont.… Notify the health care provider If an antidote is available, administer as prescribed. Gently clean the area around the extravasation with an alcohol pad. Inject the antidote subcutaneously in a circular pattern around the site of extravasation using a 25-gauge needle. 1-5 injections will be needed, depending on the volume of extravasation. Change the needle with each new injection. Elevate affected limb if applicable for 48 hours. Reapply warm or cold compress as indicated, depending on the chemotherapeutic agent that has been extravasated.
- 24. Management of Chemotherapeutic Spill Chemotherapy spills should be cleaned up immediately by the trained personnel. A spill should be identified with a warning sign so that other person will not be contaminated. A spill kit contains Heavy duty rubber gloves Respiratory mask for airborne powder, spills goggles disposable gown Disposable scoop
- 25. Cont.… Absorbent pads Absorbent towel Waste disposable bags Container of detergent solution Puncture proof and leak proof container
- 26. Procedure for spill management Alert other staff in the area of the potential hazard. Limit access to the area while a spill kit is obtained and then place the warning sign in a prominent position. Don personal protective equipment in this order: mask, face shield, the safety glasses, gloves, gown. For a liquid spell, carefully place an absorbent pad over the spilled liquid. Absorb as much liquid as possible into the pad. If there is broken glass in the spill, carefully pick up the glass pieces using the disposable scoop and place all glass in the puncture proof container. Use the cleaning solution to wash the area of the spill thoroughly, discarding all waste generated into the waste container. Rinse the area well with clean water. Document the event.
- 27. Special considerations Always follow the 10 rights of drug administration. Correct use of personal protective clothing and equipment should be instituted to minimise exposure and health risks. Disposable gloves should be used for dispensing hands must be washed before and after glove application. On disposable protective clothing as well as any disposable materials used while handling chemotherapeutic agents should be disposed of as cytotoxic waste according to the local waste disposal regulatory guidelines. Information ready for necessary action in the event of accidental exposure. Minimise the number of individuals coming in contact with the cytotoxic medications.
- 28. References 1. Kaur AK, Kaur S, Kaur S, Sharma S, Singh VN, Saini KS. Clinical Nursing Procedures. 1st ed. CBS publishers & Distributors Pvt. Ltd.; 350-354. 2. Sharma S. Lippincott Manual of Medical Surgical Nursing. Wolters Kluwers. 2016; 869- 871. 3. Nettina MS. Lippincott Manual of Nursing Practice. Wolters Kluwers. 2020; 115-120.