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Chemotherapy Precautions

  • 1.  Chemotherapy Precautions

    Posted 29 days ago
    ​Would anyone be willing to share how their hospital and infusion center is handling blood/body fluid waste of patients receiving chemotherapy?  The ONC guidelines indicate that we should be double gloving and gowning to empty BSCs, hats, and urinals for the first 48 hours after chemo administration.  What precautions are you taking at your facility when drawing labs or disposing of urine or stool for active chemo patients?

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    Marie Hooper MSN RN
    Unit Director Inpatient Oncology
    Akron OH
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  • 2.  RE: Chemotherapy Precautions

    Posted 29 days ago
    Hi Marie
    We are rolling this out in our Infusion department and it's been relatively easy for the nursing staff. Our challenge (has been coming up with a good system for our NACs to know that a patient just received chemotherapy since a patient might get hydration afterwards.

    General recommendations for blood draws is to treat it as a biohazard. That being said, we very rarely draw blood on a patient AFTER they receiving chemotherapy; it's normally done prior to treatment--and our LPNs and RNs in the specimen collection area use standard bloodborne pathogen protection. For patients receiving a continuous infusion (e.g., 5FU), they must be seen in the Infusion department so that an oncology RN can (after full PPE) stop the pump, disconnect the chemotherapy, draw the blood, and reconnect. That being said, this is exceptionally rare.

    Seth

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    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
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  • 3.  RE: Chemotherapy Precautions

    Posted 2 days ago
    Thank you.​

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    Marie Hooper MSN RN
    Unit Director Inpatient Oncology
    Akron OH
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  • 4.  RE: Chemotherapy Precautions

    Posted 2 days ago
    Maria,

    I work inpatient and we double flush when it's a low-flow toilet, cover the toilet with a cover that goes into chemo receptacle as the splash is contaminated for 48 hours.  But we use standard precautions for pouring out urinals, we are not in full gowns for that.  There is very little chemo left in the urine unless it was something instilled directly into the urinal- in which case we use full gown and double gloves.

    For drawing labs, it is standard precautions as we have phlebotomists drawing patients blood within 48 hours of receiving chemo.

    Summer

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    Summer Vanslager RN
    Santa Cruz CA
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  • 5.  RE: Chemotherapy Precautions

    Posted 2 days ago

    Summer

    I respectfully disagree, and there is data to support this.


    A number of drugs are excreted in significant concentrations in urine after intravenous administration. Cyclophosphamide is one of them. In fact, there is enough unchanged CY in the urine of a patient receiving high dose CY for transplant in 24 hours to treat a breast cancer patient. I think that's significant. And other drugs are excreted in even higher concentrations.


    I suggest taking a look here for some eye-opening data on excretion.


    Seth






  • 6.  RE: Chemotherapy Precautions

    Posted 2 days ago
    Thank you Seth,


    I, unfortunately cannot access the article you are pointing me towards.  I just know what my facilities risk dept tells us.  Maybe they are putting us at risk.

    Summer

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    Summer Vanslager RN
    Santa Cruz CA
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  • 7.  RE: Chemotherapy Precautions

    Posted 2 days ago
    Hi Summer
    Sorry, there was a problem with that link. Try THIS one.

    I don't know anything about your facilities department, but I have found health & safety and other  departments in many hospitals are really not HD experts and sometimes operate on incorrect assumptions.

    Seth

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    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
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