Policy for the safe handling and administration of cytotoxic drugs for Children, Teenagers and Young Adults with Cancer

Transcription

1 Policy for the safe handling and administration of cytotoxic drugs for Children, Teenagers and Young Adults with Cancer Introduction Cytotoxic drugs are used to treat cancer and a number of other disorders. They act by killing dividing cells by preventing their division, acting on normal as well as malignant cells. Cytotoxic agents may have genotoxic, oncogenic, mutagenic and teratogenic properties. Their use therefore poses certain risks to those handling and receiving them. This policy is designed to ensure the safety of staff and patients who come into contact with these drugs. Intrathecal chemotherapy will not be included in this policy (see National and Local Policies). Note: The Full Chemotherapy Operational Policy (available on the ORH Intranet via Oxnet connection IOG documents folder) should be referred to in conjunction with this document for the following elements: Policy Responsibilities Prescribing Patient/Carer information Patient Consent The TVCN Cytotoxic Policy (available at should be referred to in conjunction with this document for the following elements: Cytotoxic procedures (COSHH, reconstitution, storage, labelling, transportation, safe handling including spillage, waste disposal and accidental contact) Page 1 of 7

2 Spillage kit is located on Kamrans Ward in the Medication Preparation Room. If used these kits can be replaced by Pharmacy Administration of Cytotoxic Drugs The goals of good practice for administering cytotoxic chemotherapy are to achieve safe practice, patient comfort and therapeutic goals Chemotherapy should be started where ever possible within working hours- Monday to Friday There are some exceptions: -Continuous infusions -Multiple drug regimens -Timed chemotherapy -Chemotherapy given more than once a day -Emergency Chemotherapy Checks before Admission Ensure chemotherapy is off hold and on the ward. The nurse allocated to the patient should check the status of their chemotherapy at the beginning of the shift. Chemotherapy should be taken off hold in accordance with the Off Hold Policy (see Appendix 1). If weight loss is likely to be an issue them the treatment should be left on hold until the patient has been admitted and assessed. Checks on Admission The patient should be assessed and deemed fit for chemotherapy by a member of the haematology/ oncology team and the blue admission sheet (Source Data Form) should be completed. All critical test results and recent FBC should be reviewed and documented in. Written consent for treatment and any appropriate clinical trial must be identified in the patient s notes. All patients and their families should receive appropriate written literature prior to the first course of any new treatment. On admission every patient should have temperature, pulse, respirations and blood pressure checked and recorded. All patients must be weighed. Each patient should be given a name band of which the details should be verbally checked and the patients weight written on. The name band should be worn at all times. If weight loss or gain has occurred the dose prescribed should be within 5-8% of the dose calculated from the new weight. This should however be discussed with the prescribing doctor. Verification Procedure- of patient and chemotherapy Patients ID is checked on name band, drug chart and with child and family Page 2 of 7

3 Check protocol, regime and cycle number Weight and surface area are correct on admission Drug and doses are correct in accordance with protocol and surface area Blue chemotherapy admission sheet is completed with all critical tests results complete FBC within parameters as per individual; protocol The drug has been appropriately stored No sign of leakage or precipitation of the drug. Drug sealed in yellow bag. Any pre-hydration or hydration started as prescribed. Adequate urine output established as per protocol where required. Check drug and dilatants against prescription and expiry of dilutant bag Check expiry date and time of drug ensuring the drug will not expiry prior to the end of the infusion. Establish the rate and duration of the infusion Record the job number on the drug chart Prescription chart should be dated, timed and double signed. If there are any discrepancies do not procedure to administration. Seek advice. Intravenous Access The majority of paediatric patients will be fitted with a Central Venous Access Device- a double or single lumen Hickman line or a Portacath. The CVAD will be inserted at the start or an appropriate time of treatment. Some patients may be managed with peripheral lines. When being used for chemotherapy administration they should ideally be recently inserted. They should not be placed in the antecubital fossa due to risk of extravasation. The patency of any IV access should always be clearly established by ensuring a few mls of blood can be easily aspirated back into an empty 10ml syringe. The patient and the IV access device should be monitored frequently before, during and after the infusion for: Leakage from any point Venous irritation Phlebitis Flare reaction Allergic reactions Anaphylaxis Extravasation Known side effects Regardless of the type of IV access the infusion pump should have an appropriate resistance set (20% above baseline) once the infusion is running. Page 3 of 7

4 Giving Sets and Filters All infusional chemotherapy should be administered through a buretted set with a new set being used for each new drug. Lines with chemotherapy running through should be clearly identified with yellow cytotoxic tape. Ensure any drug that requires an additional filter has the correct size filter attached to the giving set. Administration of Infusional Chemotherapy (Full SOP- Administration of Chemotherapy) 1 Ensure chemotherapy off hold and on the ward ideally take of hold prior to patient admission. See off hold policy. But if weight loss or gain is likely to be an issue then wait until admission. 2 Ensure patient is fit for chemotherapy. Ensure all investigations are complete; full blood count is recovered within protocol guidelines 3 Do baseline observations on patient, TPR + BP, weigh patient (in line with weighting policy) and compare to see if lost or gained weight, check surface area with new weight and document on drug chart and chemo chart. Ensure patient wearing ORH name band with weight written on. Patients are allowed an 8% difference in the weight on their prescription chart, lost or gained. Recheck dose with new weight against the protocol, inform doctors if more than 8% difference either way. Chemotherapy may have to be reordered on new doses. 3 Patient has adequate anti emetics prescribed on the regular side of the drug chart. Discuss with patient and family how last course was and if anti emetics were adequate then. 4 Ensure the patient has good venous access - new cannula in acceptable location, the cannula should not be in the ante cubical fossa for any vesicant or irritant drug. Or Hickman line or portacath are working well. 5 Start any pre hydration as prescribed and ensure adequate urine output if required by the protocol 6 Collect equipment burette, apron, gloves, goggles (optional if wearing glasses), x2 10ml syringes, and blue tray 7 Prime buretted set with appropriate solution ensuring once primed there is no saline/dextrose left in the burette. 8- Complete chemotherapy checks with second nurse. Page 4 of 7

5 Check patient consent for treatment Chemotherapy dose against protocol Chemotherapy against prescription Check diluent and ensure bag used is in date Visibly check chemotherapy bag for precipitation Check name and hospital number of patient Check expiry date and time of drug Record job number on the chemo chart, double sign, date and time. 9 Spike chemotherapy bag and empty into burette where possible (i.e., volumes less than 150mls), note the bag volume if over 150mls 10 Calculate your rate Exact volume of chemotherapy in the burette (mls) or volume on bag Time to be given over 11 Take chemotherapy to the patient, checking the patient s identity against drug chart and wristband. With second checker present throughout. 12 Flush IV access and ensure the line is bleeding back easily using an empty 10ml syringe. Attach chemotherapy 13 Administer anti emetics as prescribed 14 Programme pump to infuse the first 17mls of saline/dextrose at a rate of 500mls/hour or 300mls/hour for portacaths. 15 If both checkers are happy with the pump start the infusion and stay with the patient and pump until the 17mls have infused and the pump goes into KVO. Place on hold 16 Programme the pump to infuse the chemotherapy over the exact time required. 17 If both checkers are happy with the pump programming start infusion. 18 The resistance for the pump MUST be set at 20% above the normal resistance for the line; you may have to wait for a couple of minutes for this to happen. 19 The pump will alarm once burette is empty, however there will be a remaining VTBI of 17mls. Add 17ml flush of compatible solution as normal until infusion is complete. 20 Take chemotherapy line down and dispose of appropriately Page 5 of 7

6 21 Ensure that parents and carers are aware of the necessity to wear gloves if helping their children to use the toilet or change nappies. Recalculating rates If a long slow infusion requires recalculation of rates you must add the volume of your flush to the remaining volume in the burette and divide by the remaining time. 22 If required continue hydration as per protocol and keep a strict fluid chart. Bolus Chemotherapy - Prepare and check as per 1-4 and 6 - Ensure take safety goggles to the patient/glasses - Check patient point 11 - Ensure patency of line as per 12 - Attach syringe to line and push drug in aspirate blood every 3-5mls - Note Vincristine needs to be given as fast as the line allows - Bolus cytarabine can also be given subcut if venous access a problem, decided by consultant or if protocol dictates (See Burkitts Lymphoma group C) Infusion chemotherapy in a syringe - Check patient, protocol and use PPE as above - Prime syringe driver line with saline, attach bung to the end before to create sealed line don t prime line with chemotherapy! - Syringe line holds less than 2mls no need to fast run - Work out rate with second checker - Attach chemotherapy syringe to bung on the line - Then attach as from point Administration of Oral Chemotherapy (SOP Administering Oral Chemotherapy IOG 09-7B-137) - Ensure Oral chemotherapy is on the ward and correctly prescribed within the protocol guidelines - Ensure patient fit to receive the oral chemotherapy. If febrile neutropenic check can receive therapy this particularly applies to ALL patients. - Ensure correct dose within the protocol guidelines - Wear gloves - Check dose and drug with second checker, using purple oral syringe or medicine pot to administer drug. - Ensure parent and child aware of what they are having, ask parents to wear gloves if helping their child to take the medication. Page 6 of 7

7 - Refer to page 34 safe handling of cytotoxic medications in the shared care diary to inform parents of care and procedure. - Dispose of syringe or medicine pot in cytotoxic bin - Any spillage to be managed according to Thames Valley Cancer Network guidance - If your patient is receiving 6 Mecaptopurine ensure no milk products taken one hour before or after. - If giving via NG tube or gastrostomy flush well following the drug administration. Check NG tube as per local policy. Opening oral chemotherapy capsules on the ward Chemotherapy capsules should only be opened on the ward if the patient is unable to swallow the capsule whole. - This should be done in Kamrans Ward drug room with the door closed and a sign to indicate that entry to other staff is prohibited - Shouldn t be undertaken by a nurse who is pregnant or could be pregnant - Recommended that staff wear personal protective equipment goggles, mask, full arm length gown or armlets, plastic apron and gloves - Any spillage to be managed according to Thames Valley Cancer network spillage guidance - If administering Lomustine this can be mixed with milk or yoghurt and the dose required measured and administered within one hour Review Name Revision Date Version Review date Angela Houlston, New doc June June 2012 Matron and Clare Jamieson, Ward sister Angela Houlston, Review only June June 2015 Matron and Clare Jamieson, Ward sister Clare Jamieson, Ward sister TVCN link updated Nov 2015 Nov 2017 Page 7 of 7