Canterbury DHB
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Cytotoxic agents are renowned for their side effects. You should make yourself familiar with these. Some of the more common side effects include:
Guidelines relating to sperm and ovary storage, hormone replacement therapy, and osteoporosis prevention are all available and should be consulted.
Special care needs to be taken in particular with haematological diseases. Patients with thrombocytopenia should not be given non-steroidal anti-inflammatory drugs, including aspirin. Intramuscular injections should be avoided. Paracetamol is safe in thrombocytopenia.
Some agents have specific toxicities, for example:
These should be looked for, anticipated if possible, and prevented.
Note: Bone marrow suppression following busulfan may be permanent. Extra care is needed with this drug.
No guidelines can be comprehensive. Personnel involved in giving cytotoxics should make every effort to familiarise themselves with the indications, specific methods of administration, and possible side effects of each agent they give. Remember that reactions to drugs may be idiosyncratic.
Some drugs have maximum dose for a single dose (e.g. 2 mg for vincristine).
Most haematology patients will have central venous catheters for giving cytotoxics, but peripheral veins may have to be used. Extravasation of cytotoxics can be disastrous. The utmost care must be taken while infusing them.
Select a peripheral arm vein, avoiding sites distal to a recent venepuncture, as leakage at the latter site may occur. The distal forearm is the best site to use. Avoid the back of the hand and the antecubital fossae for drugs that may extravasate. Do not inject into the arm veins of patients with superior vena cava obstruction or lymphoedema. A foot vein will be required in those cases.
Bolus injections should be given via a 21-gauge 'butterfly' needle. Always flush the needle with 5 mL normal saline before giving chemotherapy to ensure you are in the vein. During the injection of cytotoxics, check at intervals that you are still in the vein by drawing back a small amount of blood. Inject slowly over 3 to 5 minutes. Flush between each agent and especially after the last agent, with 5 to 10 mL of normal saline.
Note: If you are not sure you are in the vein, stop and select a new vein.
Give anthracyclines into a fast-running drip if being administered peripherally. Vincristine is given as a short infusion.
It is the responsibility of the person physically giving the cytotoxic drug to check each treatment with the chemotherapy chart and confirm the correct dosages and drugs have been prepared. These checks include the:
If the patient is more than 30% above ideal body weight, use adjusted body weight (see Calculating the Dose of Cytotoxic Drugs). This is in addition to checks carried out by the consultant and pharmacist.
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Topic Code: 5723
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