Routes of

Administration
PRESENTED BY :
MAJOR MOHAMMAD SARAIREH
CAPTAIN LUBNA A ALKILANY
Chemotherapy
Routes of Administration
PREPARED BY:
ZAIN MANASEER& MOHAMMAD
SARAIREH
COLLAGE OF NURSING
HASHEMITE UNIVERSITY/JO 2022
ADVANCED ONCOLOGY NURSING
CARE II
Supervised by:
Dr.Anas Alsharawneh.,
Ph.D., RN
Collage of nursing
Hashemite
University/Jo 2022
Introduction
 Chemotherapy is a systemic treatment for cancer that has the ability to
travel throughout the body via the bloodstream and damage or kill dividing
cells.
 It is now possible to direct drugs systemically as well as to almost every
anatomic region in the body. Intravenous chemotherapy remains the most
common route of drug delivery, but other systemic routes include oral,
intramuscular, and subcutaneous. Regional drug-delivery routes include
topical, intraarterial, intraperitoneal, intrapleural, intravesical, intrathecal,
and intraventricular..
 Oral
 Intravenous
 Intramuscular and subcutaneous
 Intra-arterial
 Intraperitoneal
 Intrapleural
 Intravesicular
 Intrathecal or intraventricular
 Topical
 Oral chemotherapy drugs
 Administered orally to treat numerous types of cancer
 The collaborative ASCO-ONS standards for safe chemotherapy
administration has provided guidelines to ensure minimum standards to
ensure patient safety.
 After ensuring that the patient understands the drug purpose, potential side
effects, and self-care measures, nursing responsibilities for oral drug
administration include safe handling and monitoring for drug adherence
and side effects.
 When administering oral chemotherapy, the nurse should wear gloves and
pour the pill into a labeled medication cup.
Oral chemotherapy drugs
 If family members are administering the pill, they should wash their hands
before and after, wear gloves, try not to touch the drug, and use a cup to
give the pill to the patient.
 If the patient is self-administering the pill, he or she should try not to
touch the pill or, if it is a capsule, not to open the capsule.
 Currently, dry gloves and medication cups are discarded in the regular
trash.
 Oral chemotherapy should not be split or crushed because this increases
the risk of drug exposure.
 Nurse should assess the patient’s ability to adhere to the treatment regimen.
 If the patient has difficulty remembering to take the pill, discuss strategies
to remember (e.g., alarm clock or alarm watch).
 Minimize noncompliance due to nausea by ensuring that an appropriate
antiemetic is available.
 If the patient experiences emesis immediately after drug ingestion and the
pills or capsules cannot be visualized, the drug is usually not repeated.
 Several oral chemotherapy drugs are also available in parenteral forms,
providing an option for patients who are intolerant of or are not adherent
with oral regimens.
Intravenous
 The IV route is the most common method of chemotherapy drug delivery.

 Selection of a central venous access device (CVAD) or IV catheter will be

determined by the type of therapy the patient is to receive and the
condition of the patient’s veins.
Intravenous

 Factors that Complicate cannulation in oncology patients:

 Skin-graft-versus-host- disease, a post-bone marrow transplant
complication causing rash and increased skin sensitivity.
 Radiotherapy: change the characteristics of skin tissues and
veins
 History of phlebitis; common among patients receiving
chemotherapy
 Multiple courses of peripheral chemotherapy usually degrade
venous integrity
VASCULAR ACCESS DEVICES
Peripherally inserted central catheters
PICCs
Peripherally inserted central catheters
PICCs
 PICCs are inserted into a site that is distant to the central veins, for
example the basilic, cephalic, axillary or femoral veins, and then
advanced to the SVC.
 Indicated most often for the infusion of vesicant drugs.
 Can be used for long-term basis, from several weeks to a year.
 Anesthesia and surgical treatment are not required for insertion or
removal of the catheter.
 There is less potential for pneumothorax or arterial perforation.
 Insertion-related complications include bleeding, tendon damage,
nerve damage, catheter tip malposition and cardiac arrhythmias
Tunneled central venous catheters
Hickman
 Tunneled central venous catheters
Hickman
 Such catheters had an exit point that was distal from the point
at which the vein had been cannulated. A subcutaneous tunnel
existed between the two points.
 The tunnel minimizes the risk of ascending bacteria has been
shown in central catheters.
 Tunneled central venous catheters offer reliable and sustained
access to the venous System.
 Provide long term reliable Venus access that may extends for
years.
Non-tunneled central venous catheters
Non-tunneled central venous catheters

 the non-tunneled central venous catheter is

inserted for short-term therapy or monitoring.
 Itcan remain in place for 10 to 14 days after
which it can be recited or replaced over a
guide wire.
 These catheters carry a high risk of infection.
 Can be inserted in Jugular, subclavian, and
femoral veins.
Implantable ports
Implantable ports
Implantable ports
 Implantable ports
 Totally implanted CVAD made up of a reservoir attached to a catheter.
 Available in different sizes and placed in a subcutaneous pocket on the
chest wall.
 They are accessed through a compressed silicon septum by the use of a
non-coring (Huber) point needle which is inserted through the skin into
the reservoir.
 The needle can be left in place for up to seven days for continuous
infusion.
 Special training is required to access implantable ports as needle
dislodgement may cause serious complications such as Extravasation.
 Children are excellent candidates for port placement.
 After the original post-operative healing the VAD does not require
dressing and when not in use requires flushing just once a month to
maintain patency.
 Implantable ports

 The cost of insertion of an implantable port is the

device’s major disadvantage in comparison to other
central venous catheters.
 Not suitable for obese or cachectic patients, and
contraindicated on a patient with a post-irradiated
chest or at mastectomy sites.
 Using Chemotherapy infusion pump with this port
allows patient to take long infusion chemotherapy
regimen at home.
Chemotherapy infusion pump
 Intramuscular and Subcutaneous
 The development of the colony-stimulating factors has increased the
number of drugs given subcutaneously.

 chemotherapy drugs fulvestrant (Faslodex) are given intramuscularly.

 Other chemotherapy drugs that may be given intramuscularly are

methotrexate and asparaginase.

 Subcutaneous injections of small volumes are given in the usual sites and
should be rotated if given daily.
 Intramuscular and Subcutaneous

 One drug that is administered subcutaneously in a rather unique way is

goserelin acetate (Zoladex).
 This dry drug pellet is implanted in the soft tissue of the abdomen, where it
is absorbed gradually over 1 to 3 months.
 A local anesthetic such as an anesthetic cream or ice is usually used to
minimize discomfort because the needle is large (16-gauge).
 Syringes with needles should be dropped intact into a chemotherapy,
puncture-proof bucket, and they should not be clipped because this will
aerosolize the drug and increase the risk of contamination.
 Intra-arterial
 Began in the early 1960s and is experiencing a resurgence in
practice today, involves cannulation of the artery that provides
a tumor’s blood supply and subsequent administration of the
drug directly through the arterial catheter to the tumor bed.
 Increases the concentration of the drug to known areas of
tumor and decreases the systemic drug concentration and thus
the side effects.
Intra-arterial

 The primary use of this route is via the hepatic artery

for the management of potential or actual metastasis
of colon cancer to the liver.
 Hepatocellular carcinoma, cancers of the brain, head
and neck, and pelvis.
 Possible complications of arterial cannulation are
catheter tip migration, infection, and thrombosis.
Intra-peritoneal

 Regional delivery of chemotherapy into the peritoneal space

found to be a safe and well tolerated treatment for stage III
ovarian cancer and is being studied in other solid tumors.
 There is a resurgence of interest in the treatment of patients
with surgically debulked stage III ovarian cancer using the
intra-peritoneal approach.
Intra-pleural
 patient with a pleural effusion traditionally involves insertion
of chest tubes, drainage of the fluid, and sclerosis of the
pleural space to prevent recurrence of the effusion.
 The pleural membranes are the visceral pleura (lines the outer
surface of each lung) and the parietal pleura (lines the thoracic
cavity), and pleural effusions develop between these pleural
membranes.
 Sclerosis, or chemical pleurodesis, involves the instillation of
a drug or substance that is irritating to the pleura, causing
pleuritis of the pleural membranes.
Intrathecal or intraventricular
 Cancer cells can cross the blood brain barrier and appear in the
cerebrospinal fluid (CSF), resulting in central nervous system involvement.
 Most commonly in leukemia (meningeal leukemia)
 A lesser extent breast cancer, lymphoma, and rhabdomyosarcoma
(meningealcarcinomatosis).
Intrathecal or intraventricular
 drugs cross the blood–brain barrier, temozolomide, irinotecan,
topotecan, and at high doses, cyclophosphamide and
methotrexate.
 For tumors insensitive to these drugs, chemotherapy must be
injected directly into the CSF as prophylaxis or to manage
existing disease so that the drug bypasses the blood–brain barrier.
Intrathecal or intraventricular

 The antineoplastic drugs used currently include methotrexate,

and cytarabine.
 preservative-free drug is always admixed under strict sterile
conditions with a preservative-free diluent such as sodium
chloride USP (unpreserved) or Ringer’s injection USP
(unpreserved).
 Methotrexate is available in an unpreserved lyophilized form for
intrathecal use.
 Cytarabine is supplied with a diluent that contains benzyl
alcohol and should be replaced with an appropriate unpreserved
diluent (sodium chloride or Ringer’s solution).
Intrathecal or intraventricular
 The two primary methods of instillation are intrathecal and
intraventricular.
 The intrathecal route is achieved by performing a standard
lumbar puncture using established techniques to ascertain
placement and injecting 10 to 12 mL of drug, followed by
withdrawal of the needle.
 This procedure usually is performed by a physician or an
advanced practice nurse on a daily to weekly basis depending on
the protocol.
 This method is quick and easy.
 disadvantage that the drug may reach only epidural or subdural
spaces.
Intrathecal or intraventricular
 Even when it reaches the subarachnoid space,
therapeutic levels of the drug usually are not achieved
in the ventricles.
 For this reason, it may be preferable to use the
intraventricular route.
 Central instillation of the drug into the ventricle can
be achieved via an Ommaya reservoir.
 surgically implanted through the cranium.
 A skin flap is created, and the Ommaya reservoir is
placed underneath the ventricle.
Intrathecal or intraventricular
 Once the surgical site has healed, the only visible evidence of the
device is a small bump on the head.
 Placement of this reservoir obviously involves greater risk than
performance of a lumbar puncture.
 but it provides permanent intraventricular access for patients in
whom repeated translumbar puncture is impractical.
 Ommaya reservoirs usually are accessed by physicians or
specially trained nurses.
 Topical
 Topical Cutaneous malignant lesions can be treated in a variety of ways,
including the topical application of antineoplastic drugs.
 Topical drugs are used most commonly for cutaneous T-cell lymphoma,
basal cell carcinoma, Kaposi’s sarcoma, and squamous cell carcinoma.
 The drugs used include nitrogen mustard for cutaneous T-cell lymphoma
and fl uorouracil for basal and squamous cell carcinomas.
Topical
 The topical agent usually is applied once or twice daily until the lesions
progress to the necrosis phase.
 may take 1 to 3 weeks.
 The affected area is not washed vigorously during the treatment period.
 The expected result of topical antineoplastic administration is local
sloughing of the affected area and eventual regranulation of normal tissue.
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