Chemo

OBJECTIVES
1-Chemotherapy.
2-Classification of chemotherapy.
3-General side effects.
4- How to manage.
1-Chemotherapy is the use of
cytotoxic drugs in the treatment
of cancer. It is one of the four
modalities- surgery, radiation
therapy, chemotherapy and
biotherapy- that provide cure or
control .. It AFFECTS THE WHOLE
BODY.
COMMONLY USED CHEMOTHERAPY
1-ALKYLATING AGENTS
2-ANTIMETABOLITES
3-ANTHRACYCLINES&CYTOTOXIC ANTIBIOTICS
4-VINCA ALKALOIDS AND ETOPOSIDES
5-PLATINUM COMPOUNDS
6-TAXENS
7-MONOCLONAL ANTIBODIES
8-HORMONAL THERAPY&ANTAGONISTS
9-CORTICOSTEROIDS
10-OTHERS
Commanly used
Chemotherapy
Anthracyclines
Alkylating agents &antibiotics
Clorambucil( leukorn ) Bleomycin Mitoxantron

Doxorubici
Cyclophosphamide(Endoxan) n Mitomycin
Dacarbazine Epirubicin
Vinica
Antimetabolites : alkaloids&etoposide
Capcitabine (xeloda) Gemcitabine (gemzar) vincristine
Cytatabine Methotrexate Vinblastine
Fludarabine (fludara) Pemetrexed (alimta) Etoposide

5-fu
Platnium comp.: others
Brotezomib
Carboplatin Bevcizumab (avastin) (velcade)
Cisplatin Cetuximab (erbitux) Erlotinib (tarceva)
Oxaliplatin Imitinib (glivec) Sorafenib (nexavar)
Sunitinb (sutent) Irinotecan (campto)
Trastuzumab Rituximab
(herceptin) (mabthera)
Hydroxyurea (hydra)
Hormonal
Taxens therapy &antagonists
Docetaxel (taxotere) Adrenocortical teroids Oestrogen
Oestrogen
Epitaxel antagonists (tamoxifen)
Side Effects of Chemotherapy
 T hrombocytopenia
 Alopecia
 Nausea and vomiting
 Diar rhoea/constipation
 C a r d i o t ox i c i t y
 N e p h r o t ox i c i t y
 N e u r o t ox i c i t y
 O t o t ox i c i t y
 Extravasation
 Hemor rhagic cystitis
 F l u - l i ke s y n d r o m e
 Tu m o r l y s i s s y n d r o m e
 Hand-foot syndrome, photo -
sensitivity
 P u l m o n a r y f i b r o s i s ; ke r at i t i s
T i s s u e d a m a g e ( v e s i c a n t ) 7
Prior to chemotherapy administration
1.PATIENT IDENTIFICATION.
2.Review- The chemotherapy drugs prescription
which should have :
-Name of anti-neoplastic agent.
-Dosage.
-Route of administration.
-Date and time that each agent to be
administered.
3-Pre-and-Post chemotherapy medications.
4.Assess the PATIENT condition
including:
-Lab Results.
-Complication.
-Physical status.
-Psychological status.
5. Prepare for potential complications:
- immediate intervention.
- having medication available for anaphylaxis.
6.Assure accurate preparation of the agent:

-Dosage calculation.
-Expiry date .
-Procedure for correct reconstitution and
Recommended procedures for administration.
7.Assess patients understanding of the chemotherapeutic

agents and administration procedures.
5.Drug administration
1. Route
i)Oral : - Administration time.
-Regarding meals.
-Storage conditions.
ii) Intramuscular and subcutaneous:

-Few in number. like L-Asperaginase,
Bleomycin,Cyclophosphamide,Methotraxate.
Cytarabine,and some hormonal agents are
given (IM)& /Or subcutaneously.
-Change the needle after withdrawing the agent
from a vial or ampoule.
-Select a site with adequate muscle and/or SC tissue.
iii) Intravenous
- It is the most common method.
-May be given through central venous catheters or
peripheral access.
- Because the (IV) provides direct access to the
circulatory system, the potential for infection and life
threatening sepsis is a serious complication of (IV)
chemotherapy.
-Aseptic technique should be followed.
-Wash hands before and after drug handling. (hand
wash tech.)
-Personal protective equipment (PPE)includes
disposable surgical gloves, long sleeves gown and elastic
or knit cuffs.
- minimize exposure.
-Limit access to drug preparation area.
-Keep labeled drug spill kit near preparation
area.
-Apply gloves before drug handling.
-Open drug vials/ ampoules away from body.
-Place absorbent pad on work surface.
-Wrap alcohol wipe around neck of ampoule
before opening.
-Label all chemotherapeutic drugs.
-Clean up any spill immediately
VI)Intrathecal:
(Follow policy-INTRATHECAL ADMINISTRATION)
a)Wear protective equipment.
b)Inform the patient that chemotherapeutic drug are

harmful to normal cells and that protective measures used
by personnel minimize their exposure to these drugs.
c)Administer drugs in a safe environment.
d)Place a plastic backed absorbent pad under the tubing

during administration to catch any leakage.
Do not dispose of any supplies or unused drugs in patient
care areas.
V-Documentation: ( Record )
-Chemotherapeutic drugs, dose, route ,and time .
-Premedication, post medications, prehydration and
other infusions and supplies used for chemotherapy
regimen.
-Any complaints by the patient .
VI. Disposal of supplies and unused drugs
a)Do not clip or recap needles or break syringes.
b)Place all supplies used and unused drug in a labeled sharp
box.
.
(chemowaste+date+location)
C)Dispose of containers filled with chemotherapeutic supplies and unused
drugs in accordance with regulations of hazardous wastes.
Spill kit
s
VII. Management of
chemotherapeutic spills:
Chemotherapy spills should be
cleaned up immediately by properly
protected personnel trained in the
appropriate procedure. A spill should
be identified with a warning sign so
that other person will not be
contaminated.
Supplies Required:
Chemotherapy spill kit contains;
1-Respirator mask .
2-Plastic safety glasses or goggles.
3-Heavy duty rubber gloves.
4-Absorbent pads to contain liquid spills.
5-Absorbent towels for clean up after spills.
6-Small scoop to collect glass fragments.
7-Two large waste disposal bags.
Chemotherapy spill kit contains;
8-Protective disposable gown.
9-Containers of detergent solution and clear tap water
for post spill clean up.
Spill on hard surface
1-Restrict area of spill
2-Obtain drug spill kit
3-Put on protective gown, gloves, goggles.
4-Open waste disposal bags
5-Place absorbent pads gently on the spill; be careful not to
touch spill.
6-Place absorbent pad in waste bag.
7-Clean surface with absorbent towels using detergent solution
and wipe clean with clean tap water.
8-Place all contaminated materials in the chemo waste bag.
9-Wash hands thoroughly with soap and water.
Spill on personnel or patient
1-Restrict area of spill.
2-Obtain drug spill kit.
3-Immediately remove contaminated protective
equipments.
4-Wash affected skin area with soap and water
5-If eye exposure-immediately flood the affected eye with
water for at least 5 mts;
6-Obtain medical attention .
7-Notify the physician if drug spills on patient.
8-Documentation- Document the spill.
Extra-vasation
Taxotere Doxorubicin Taxol
extravasation extravasation extravasation
24
IX.Extravasation management:
-IS ACCIDENTAL INFILTRATION OF DRUG FROM VEIN
INTO THE SURROUNDING TISSUES
-LEADS TO BLISTER,TISSUE
DESTRUCTION,IRRITATION,INFLAMMATION,
INFECTION,PAIN & LOSS OF MOBILITY.
1.Prevention of extravasation :
1-Drug Knowledge .
2-Skill in drug administration.
3-Identification of risk factors.
4-Management protocol
5-New venipuncture site daily if
peripheral access is used.
6-Central venous access for 24 hrs
vesicants infusion.
7-Quiet, unhurried environment.
8-Testing vein patency .
9- Adequate drug dilution.
10-Careful observation.
11-Ensuring blood return from I.V. site .
12-Educating patients regarding
symptoms of drug infiltration.
2.Extravasation management at
peripheral site:
1-Emergency medications should be
readily available.
2-Stop the drug.
3-Leave the needle or catheter in place.
4-Aspirate any residual drug and blood in
the I.V. tubing.
5-Instill the I.V. emergency medication.
6-Remove the needle.
7-Avoid applying pressure.
8-Apply topical ointment if ordered.
9-Cover lightly with a sterile dressing.
10-Apply cold or warm compresses as
indicated.
11-Observtion.
12-Documentation.
13-All nursing personnel should be alert
and prepared for the possible
complications of anaphylaxis.
PATIENT ADDRESSOGRAPH:
Name: File No. Date :

Age: Sex: Allergies:
Weight: kg BSA: Diagnosis:
Height: m m2 Chemotherapy Protocol: Cycle
I.V Access □ Peripheral □ Central
PRE-CHEMOTHERAPY MEDICATION:
Diluent
Medication Dose Route Duration Comments
Vol./ Type
I.V. Hydration:
CHEMOTHERAPY:
Diluent
Medication/Dose Dose Route Duration Comments
Vol./ Type
PATIENT NAME:
FILE NUMBER: WARD:
MEDICINE:
DOSE: ROUTE:
RATE OF INFUSION:
PREP. DATE&TIME:
EXP. DATE &TIME:
PREPARED. BY:
CHECKED BY:
Conclusion
Chemotherapy offers patients
with cancer a great deal of hope
for a cure or a means of control
cancer for a long period of time.
Hope and optimism are vital
ingredients in care plan.

Chemo

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OBJECTIVES

Clorambucil( leukorn ) Bleomycin Mitoxantron

Capcitabine (xeloda) Gemcitabine (gemzar) vincristine

Cytatabine Methotrexate Vinblastine

Fludarabine (fludara) Pemetrexed (alimta) Etoposide

6.Assure accurate preparation of the agent:

7.Assess patients understanding of the chemotherapeutic

ii) Intramuscular and subcutaneous:

b)Inform the patient that chemotherapeutic drug are

c)Administer drugs in a safe environment.

d)Place a plastic backed absorbent pad under the tubing

Name: File No. Date :

I.V Access □ Peripheral □ Central

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