METHOD

RATIONALE

1.

A new cannula should be inserted prior to the administration of IV chemotherapy 

To ensure the cannula is patent and correctly located.

2.

The cannula should be tested by the flushing with normal saline or a rapid infusion rate and the flash back of blood.  Observe for any swelling, infiltration into the tissue, pain or discomfort.  If venous integrity cannot be proven a new cannula must be inserted. 

To ensure the cannula is correctly placed and the vein patent.

3.

Administer antiemetic therapy 20 mins prior to the chemotherapy. 

To achieve effective symptom control.

4.

Administer the chemotherapy in turn giving the most vesicant drugs first.  During administration the following should be noted: 

a)

Vesicant drugs should be given by infusion or by bolus injection into the side arm of a fast running infusion. 

To demonstrate vein patency.  To dilute irritant drubs and minimise vein damage.

b)

The line should be flushed with 10-20mls of normal saline between each drug. 

To check cannula patency and placement.  To prevent drug interaction.

c)

Throughout administration the venepuncture site and vein should be observed for swelling/redness and the patient asked to report any discomfort/pain. 

To observe for extravasation.

d)

If any signs of extravasation are detected then administration should cease immediately and the procedure for extravasation followed. 

To minimise tissue damage if extravasation occurs.

5.

After administration of all the drugs, the cannula should be flushed with 10-20mls of normal saline.

To ensure the cannula was patent at the end of the procedure.  To flush all the drug from the cannula.  To minimise thrombophlebitis and subsequent venous damage.

6.

Record the administration on the prescription chart. 

Hospital policy states all drugs administered must be signed.

7.

The administration of chemotherapy and any adverse incident must be recorded in the patient’s medical notes. 

To maintain accurate records.

8.

Remove the cannula and apply pressure and a dressing. 

9.

Ensure the patient is aware to report any reaction at the IV site. 

10.

Dispose of all cytotoxic contaminates, syringes, needles, IV lines and solution bags in a leakproof puncture proof container.

Label:  CONTAINS CYTOTOXIC WASTE.

To protect other workers and in accordance with regulations for hazardous waste.