BASILDON + THURROCK GENERAL HOSPITALS NHS TRUST

POLICY FOR THE ADMINISTRATION OF INTRATHECAL CHEMOTHERAPY

The administration of Intrathecal (IT) drugs has potentially fatal side effects.  This policy must be strictly followed to minimize risk of serious errors.

These drugs only may be given intrathecally:

1                     Methotrexate

2                     Cytosine Arabinoside

3                     Triotepa

4                     Hydrocortisone

The administration of vinca alkaloids via the IT route is fatal.

The administration of cytotoxic drugs via intrathecal route must only be undertaken by a doctor who had received or is undergoing training in discussion with relevant consultant.

Prescription

The prescription must clearly state route of administration written in full.  Intrathecal doses must be prescribed separately from other cytotoxic drugs.

Distribution

Drugs intended for IT administration must be delivered to the treatment area separately from the drugs intended for intravenous (IV) administration.

Administration of IT doses

IT drugs must be administered at separate times to all other drugs.

IT drugs must be administered in a designated area separate from any area where parenteral cytotoxic drugs are administered.

If the patient is requiring intravenous cytotoxic drugs on the same day – IT drug must be given first

No other cytotoxic drugs should be delivered to or stored in the designated area.

IT doses should not be administered outside of normal working hours.

The administration of cytotoxic drugs via intrathecal route must only be undertaken by a doctor who has received or is undergoing training in discussion with the relevant consultant.

Large doses are rarely given via the IT route, the syringe should be no bigger than 5ml.

Doses of Vinca Alkaloids

The administration of Vinca Alkaloids is fatal if given intrathecally.

Vinca Alkaloid drugs:

1.                   Vincristine

2.                   Vinblastine

3.                   Vindesine

4.                   Vinorelbine

Vinca alkaloids must be diluted in 10ml syringe – never smaller than 10ml.

Labelling

Vinca alkaloids must be labelled with a warning ‘To be given intravenously only – potentially fatal if given by any other route’ labelled clearly on syringe.

Outer wrapping must be labelled ‘Do not remove this outer covering until the moment of injection – for intravenous use only – potentially fatal if given by any other route’.

Source

The safe administration of vincristine and other vinca alkaloids.

NHS Executive : North Thames Regional Office, March 2000

Approved by Dr P Cervi

Consultant Haematologist

Lead Clinician for Chemotherapy Services