IV ADMINISTRATION OF CANCER CHEMOTHERAPY/CYTOTOXIC DRUGS VIA

INTERMITTENT PIGGYBACK INFUSION IN A PERIPHERAL VEIN

MATERIALS:
 Personal Protective Equipment (PPE)
- Chemo gloves (2 pair-non-sterile)
- Chemo gown (non-sterile)
 Infusion Pump
 Rigid biohazard container
 Chemotherapy cart, where available, or these items separately:
- Ziploc biohazard bag
- Chemotherapy stickers
- Biohazard sign: “Caution Chemotherapy”
- Chemo spill kit (available)
- Disposable plastic backed liners
- Sterile gauze pads (approximately 2-3)
 Medications and IV fluids/equipment as ordered
PROCEDURE RATIONALE
PRIOR TO ADMINISTRATION
1. Will obtain and review baseline data from physician, which includes Safe administration of
the following: chemotherapy may depend
a. Problem /Notes to include: on adequate laboratory
 Allergies values, especially RBC’s,
 current medications WBC’s and platelets.
 problem focused physical examination NOTE: If a patient is
 pertinent co-morbid complications unable to be admitted to a
 therapeutic plan designated unit, then a
 duration of care chemo proficient nurse will
b. Results of diagnostic studies (CBC & blood chemistry, etc.) if be assigned to that
applicable patient/unit for the duration
c. Patient’s actual weight/height/BSA of the therapy including
d. Signed consent administration and
monitoring
2. Notify the ordering physician of any missing data or abnormality in The ordering physician is
above data. responsible to determine if
chemotherapy is continued
or held based on patient
information.
3. Completes an initial RN assessment form.
 Vital signs
4. Place a Caution Chemotherapy sign in the immediate patient care Identification of patients
area. receiving chemotherapy is
essential to ensure safe
contact by all associates
with the patient’s excreta
and IV fluids, which may
contain chemotherapeutic
agents up to 48 hours.
5. Verify accuracy and completeness of chemotherapy orders with a This verification process
second RN and pharmacist preparing medication. Hydration, premeds, will also include chemo-
name of drug, drug dose, route, rate, frequency of administration. specific verification of
 drug sequence, dosage and
route of administration.
Determine if medication is
a vesicant or irritant.
6. Provide patient education to include: Right of the patient to be
 Drug purpose informed of the procedure
 The potential for immediate and delayed adverse drug reactions
 Symptoms to report
7. Obtain IV access. If a peripheral vein is to be used, select forearm Proper administration site
venipuncture site (the forearm is the site of choice). is essential to avoid
extravasation of toxic drug
into tissue.
 Small catheter size
ensures good blood flow
and maintains vein
patency.
 Avoid IV sites subject to
a lot of movement of
flexion, such as the wrist or
antecubital space.
The pharmacist will
prepare all
chemotherapeutic agents to
include priming tubing
with neutral IV fluid,
which will then be
transported to the nursing
unit in a chemotherapy zip-
lock, safety bag, labeled
with the patient’s name and
attached to a chemotherapy
tracking sheet
8. Start normal saline or ordered IV fluids.
9.Observe and assess the patient at least every 60 minutes and/or This step will assure no
between every drug given for signs and symptoms of untoward effects. untoward effects go
unnoticed.
ADMINISTRATION OF CHEMOTHERAPEUTIC AGENTS
1.Perform 15 second hand-washing.
2. Don 2 pairs of chemo gloves and disposable, non-absorbent, lint- Gloves and gown prevent
free gown before administering chemotherapeutic drugs direct skin contact with
chemotherapeutic agents.
3. Assess IV administration site for patency by checking for blood
return and absence of redness or swelling. Infuse 10 to 20 ml IV fluid
4. Place a plastic-backed liner underneath the IV connection site/port. Protects the patient from
exposure to chemotherapy
drugs
5. Cleanse medication port or lower y-port of mainline IV with an
antimicrobial swab and allow to dry.
6. Connect chemotherapy line as a secondary line to appropriate port of
mainline IV.
7. Hang secondary bag on IV pole
8. Lower primary bag.
9. Open clamp on secondary bag tubing to allow solution to flow. Vesicant drugs: Sit with
and consistently monitor
site for signs and
symptoms of extravasation
during infusion. Ensure IV
continues to low freely.
Irritant drugs: Monitor IV
site and patient sensation
every 30 minutes.
DURING CHEMOTHERAPY ADMINISTRATION
1.Check IV for positive blood return after at least every 60 minutes by
IV drip.
2. Assess IV site & patient response to treatment every 20 minutes It is necessary to notify the
when administering vesicants for signs of hypersensitivity reaction or physician of any change
extravasation (swelling, redness, pain, urticaria) and document in the that might alter the
flow record/medical record. administration of drug.
3. The nurse will contact the physician immediately to reassess the It may be necessary to
patient for any of the following conditions: aspirate chemo medication
 Significant change in the patient’s medical status from the patient’s tissue
 a significant response (undesired) to a procedure or intervention (via the IV catheter) or to
 Extravasation suspected ~ If extravasation is suspected: administer an antidote, per
 Stop the infusion immediately the physician’s order.
 Leave the IV catheter in place
 Do not attempt to flush IV line
4. Infuse 20 ml of normal saline in between all chemo medications, at
the conclusion of the infusion and before discontinuing the IV line.
5. Dispose of IV bags, tubing, syringes and needles in the
chemotherapy zip lock safety bag and place in rigid biohazard waste
container. Return the chemotherapy tracking sheet to pharmacy.
6. Dispose of gloves, gown and plastic-backed liners in the rigid
chemotherapy container and close lid tightly.
7. Perform a 15 second hand washing.
8. Assess IV site.

9. Document. Patient’s tolerance of

treatment and any adverse
reactions and interventions
in the patient’s flow
record/medical record.
Time started and time
finished.