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Peripheral IV Administration of Chemo

  • 1.  Peripheral IV Administration of Chemo

    Posted 13 days ago
    Wondering what other facilities do for peripheral administration of IV vesicants.

    1. Does your institution require vesicant administration via central line only?
    2. If not, what do you have in policy and checklists for peripheral IV vesicant administration?
    3. Does policy on this differ for vesicant administration from inpatient to outpatient departments at your facility?
    4. Any resources on proper IV site placement/checklists/policy would be welcomed.
    5. Do you have a pre-assessment of IV site practice at your institution before first cycle to determine if central line is recommended?
    6. Any restrictions of IV push chemo for inpatient areas?  If you administer- what method do you use (direct push vs. side arm with gravity flow)?
    7. Are there any concerns to administer peripheral vesicants via gravity flow due to Joint Commission standards on utilization of pumps for safety?

    Thank you in advance for your expertise and help!

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    Melissa Arangoa, MS, ANP, ACNS-BC, AOCNS
    University of Chicago Medical Center
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  • 2.  RE: Peripheral IV Administration of Chemo

    Posted 12 days ago
      |   view attached
    ​Hi,

    I am attaching our Chemotherapy Policy.

    Val

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    Valerie Quigley BSN RN
    Infusion Manager
    The Valley Hospital
    Pompton Lakes NJ
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    Attachment(s)

    pdf
    21.10_chemo iv adult.pdf   316K 1 version


  • 3.  RE: Peripheral IV Administration of Chemo

    Posted 10 days ago
    I would very much like a copy of your policy on this as well.
    Please forward to cheryl.mohrlein@midhosp.org.
    Thx​

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    Cheryl Mohrlein MSN RN
    Union CT
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  • 4.  RE: Peripheral IV Administration of Chemo

    Posted 11 days ago
    HI
    There are only very few instances when we give vesicants peripherally.  Just this week I gave Adriamycin via pic because the patient could not be scheduled for a mediport placement before next week and the pt and her provider felt that the treatment should start ASAP.
    Our policy is to administer vesicants by free flow only while blood return is checked every few minutes and the pt is required not to move the arm whit the iv site.  The accessed should be on the forearm, not close to the elbow or writs joint.

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    Therese Sprunger RN
    Lacey WA
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  • 5.  RE: Peripheral IV Administration of Chemo

    Posted 9 days ago
    Below is an excerpt from our organization's IV chemo policy:

    X. Precautions for chemotherapy agents with increased potential for infusion-related tissue damage (e.g., vesicants, irritants with vesicant potential):

    1. Any vesicant agent that is ordered as a continuous infusion must be administered via a central line, preferably an external catheter.

    2. When a vesicant agent is to be administered via IV push, carefully monitor catheter placement by verifying blood return and patency immediately prior to administration and every 2 to 3 mL during the administration. Assess the site for swelling and/or redness and ask the patient about the presence of pain, burning, or change in sensation before, during, and after administration.
    a. If positive blood return is not obtained, do not administer any vesicant medication unless a port dye study verifies proper placement and patency.
    b. If the patient reports swelling or a change in sensation (e.g., pain, burning, stinging), stop the infusion and re-evaluate patency/integrity. If an extravasation is suspected, refer to OCSRI's Medication Infiltration/Extravasation Policy (CN-200) and implement the appropriate measures.

    3. Central venous access devices shall be utilized for IV administration of the following chemotherapy agents, due to their increased potential for adjacent tissue damage:
    a. Dacarbazine (DTIC)
    b. Dactinomycin
    c. Daunorubicin
    d. Doxorubicin (Adriamycin)
    e. Epirubicin
    f. Idarubicin
    g. Mechlorethamine (Mustargen)
    h. Mitomycin
    i. Oxaliplatin
    j. Trabectedin (Yondelis)
    k. Vincristine
    l. Vinblastine
    m. Vinorelbine (Navelbine)

    4. Central venous access devices are strongly preferred and considered best safe practice for IV administration of the below-listed chemotherapy agents. Volume and frequency of chemotherapy administration, number of treatment cycles, and patient venous status should be considered.
    a. Arsenic trioxide
    b. Bendamustine
    c. Bleomycin
    d. Carboplatin
    e. Cisplatin
    f. Cytarabine
    g. Docetaxel (Taxotere)
    h. Doxorubicin liposomal (Doxil)
    i. 5-fluorouracil (5-FU)
    j. Gemcitabine (Gemzar)
    k. Ifosphamide
    l. Mitoxantrone (Novantrone)
    m. Paclitaxel (Taxol)

    5. In the rare instance that a peripheral IV must be utilized to administer a chemotherapy agent with increased tissue damage potential, IV integrity and patency must be verified.
    a. Whenever possible, start a new peripheral IV.
    b. If using an existing IV site, avoid using an IV site greater than 24 hours old because it may be less reliable.
    c. Check for blood return and fluid flow by aspirating at a y-site close to the IV catheter. If positive blood return is not obtained, do not administer the medication. Use another access site if there is any doubt about the integrity of the IV site.
    d. If the patient reports swelling or a change in sensation (e.g., pain, burning, stinging), stop the infusion and re-evaluate line patency/integrity. If an infiltration is suspected, refer to OCSRI's Medication Infiltration Policy (CN-200) and implement the appropriate measures.

    I hope you find this information helpful.

    Kind regards,


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    Anne Moser BSN RN MPH
    Oklahoma Cancer Specialists and Research Institute
    Tulsa OK
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