A nurse on an oncology unit prepares to administer an IV vesicant antineoplastic medication to an adult client. Which actions are appropriate? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Hazardous antineoplastic medications require trained personnel, a policy-defined independent verification, suitable vascular access, and exposure controls (Choices 1, 2, and 3). For a peripheral vesicant, avoid joints and small distal hand or wrist veins, use a recently placed catheter in a large intact vein when permitted, and check patency and blood return according to the medication and policy. Suspected extravasation requires stopping the drug while leaving the catheter available to aspirate residual medication and deliver an antidote when indicated; then follow the medication-specific compress and escalation protocol (Choice 4). Do not wait for severe injury before responding (Choice 5). Drug-contaminated supplies require designated hazardous-drug waste handling rather than ordinary medical waste (Choice 6).
Hazardous Drug Handling (USP <800>/NIOSH) 1. PPE: chemotherapy-tested gown, double chemotherapy gloves, eye protection, respiratory protection (NIOSH-approved) per agent and route 2. Closed-system transfer device (CSTD) for compounding and administration 3. Chemotherapy spill kit immediately available; staff trained on cleanup 4. Yellow chemotherapy waste containers for ALL waste, PPE, tubing 5. Pregnant or breastfeeding staff: alternative assignment per policy
Vesicant Access - Central line preferred for continuous/repeated vesicants - Peripheral: large vein, proximal forearm, fresh IV site - AVOID hand, wrist, antecubital fossa (limited tissue, tendons, joints) - Confirm blood return before and during; monitor q30-60 min
Two-RN Verification (bedside) - Order, drug name, dose (with calculation), route, rate, BSA - Client identity (two identifiers) - Informed consent for chemotherapy - Recent labs (CBC, BMP, kidney/liver function per protocol) - Anti-emetic premedication given
Extravasation Response 1. STOP infusion 2. LEAVE the catheter in place 3. Aspirate residual drug through the catheter 4. Notify provider; follow facility extravasation protocol 5. Antidote per agent (e.g., dexrazoxane for anthracyclines; hyaluronidase for vinca alkaloids; sodium thiosulfate for nitrogen mustards) 6. Cold compress for most vesicants; WARM for vinca alkaloids and oxaliplatin 7. Photograph site; mark border; reassess regularly 8. Document; report; refer to plastics if severe
ScenarioOncology unit; IV vesicant chemotherapy for an adult client; nurse preparing safe administration.
Safety Bundle1. Chemotherapy PPE + spill kit available2. Two chemotherapy-trained RN bedside verification3. Vesicant-appropriate access (central preferred; peripheral large proximal forearm)4. Confirm blood return before and during5. Extravasation response: STOP-LEAVE-ASPIRATE-NOTIFY-ANTIDOTE-COLD/WARM6. Yellow chemotherapy waste container for all waste
Avoid- Hand or wrist IV for vesicants- Single-RN verification- Discarding chemotherapy waste in regular bins- Removing the catheter on extravasation (used to aspirate)
Hazardous Drug Handling (USP <800> and NIOSH) — Standards governing the safe handling of hazardous drugs (chemotherapy, hormone agents, monoclonal antibodies, immunosuppressants, etc.) to protect healthcare workers, clients, and the environment. Requirements include chemotherapy-rated PPE (gown, double gloves, eye and respiratory protection), closed-system transfer devices for compounding and administration, designated yellow chemotherapy waste containers, immediately available spill kits, trained staff, and alternative-duty options for pregnant or breastfeeding staff per facility policy.
Chemotherapy Extravasation Management — Vesicant chemotherapy escape into surrounding tissue can cause severe tissue necrosis, tendon/nerve damage, and long-term disability. Recognition: pain, burning, swelling, redness, loss of blood return. Immediate response: STOP infusion, LEAVE the catheter in place, aspirate residual drug through the catheter, notify provider, follow agent-specific antidote (dexrazoxane for anthracyclines; hyaluronidase for vinca alkaloids; sodium thiosulfate for nitrogen mustards) and temperature (cold compress for most; WARM for vinca alkaloids and oxaliplatin), photograph and mark the site, and refer to plastics for significant injury.
Two-RN Chemotherapy Verification — Chemotherapy is on the ISMP high-alert medication list. Standard practice requires verification by two chemotherapy-trained RNs at the bedside before initiation: the prescriber order; the drug name; the dose and the dose calculation (BSA, weight, kidney/liver adjustment); route; rate; client identity (two identifiers); informed consent; recent relevant labs (CBC, BMP, organ function); and pre-medications administered (anti-emetic, hydration, etc.). Documentation of this verification is mandatory.