CHEMOTHERAPY

Chemotherapeutic administration
1. Oral route
2. Intramuscular or Subcutaneous injection
3. Intravenous – most common, provides better absorption
Risk: Infection & Phlebitis

Management: IV administration
1. Smallest needle gauge
2. Aseptic technique
3. Monitor IV site frequently
4. Change IV fluid q4hrs

4. Central Venous Catheter Infusion

-A.K.A. “Central Line”; peripherally inserted central catheter line goes
into the arm & runs all the way to a large vein near the heart.
- A thin tube (port) with 1 or 2 discs on one end places on the chest, just
under the collarbone.
 Risk: Central Venous Catheter Infusion
-Infection
-Catheter clot
-Sepsis
-Needle malposition

✔ Management:
a. Aseptic technique
b. Monitor site daily
c. Flush catheter daily/ between use
d. Assess for signs of infection
5. Venous Access Device (VADs)
- for prolonged infusion
Risk: infection
infiltration from malposition

6. Intra-arterial Route
- delivers agents directly to tumor in high concentration while
decrease drug systemic toxic effect.

Risk: infection
bleeding at catheter site
clotting at site

Management:
1.dressing change daily and assess infection
2. Irrigate/flush catheter
3. Avoid kinks in tubing
 7. Intraperitoneal
- used for ovarian and colon CA
- high concentration of agents delivered to peritoneal cavity via catheter,
then drain

Chemotherapy Safety Guidelines

1. Obtain special training
2. Wear: gloves
disposable, closed, long-sleeved gown

3. Label prepared drugs appropriately

4. Double bag drugs prepared – transport
5. Clean any accidental spill
6. Dispose all used materials appropriately
7. Dispose all syringes and needles intact
Side Effects of Chemo and Nursing Management
1. GI System
a. Nausea and Vomiting

- antiemetics 4-6 hrs before initiated

- Withhold fluids/foods 4-6 hours before

- Support food preferences
- Small frequent feeding/ meals – Calories and CHON

b. Diarrhea due to toxicity

- antidiarrheal
- everyday perieneal care
- Monitor K, Na, & CL level
✔Constipation due to drug affecting nerve endings of GIT (ex.Vincristine- Vinka
alkaloids)
-increase fiber and fluids
-Have stool softeners

c. Stomatitis
- good oral hygiene
- rinse with lidocaine before meals
- cleansing rinse with plain water or dilute a water-soluble lubricant
after meal
- petroleum jelly to cracked lips
- avoid spicy and acidic foods
2. Hematologic System
1. Thrombocytopenia
Platelet ( below 150T –300T)

a. Avoid bumping/bruising skin

- shorter life span
b. Protect from physical injury
c. Avoid aspirin product
d. Avoid IM injection
e. Monitor blood count
f. Assess/teach bleeding tendencies

2. Leukopenia (below 5T-10T)

a. Careful handwashing technique/aseptic technique

b. Reverse isolation
c. Assess for respiratory infection
d. Avoid crowds or people with infection
 Anemia
a. Adequate rest
b. Monitor hgb and hct count
c. Oxygen PRN

3. Intergumentary System
1. Alopecia (2-3 wks)
- temporary
- support and encouragement
- wear wig

2. Leukopenia
3. Anemia
4. Renal System
Direct damage to kidney (excretion)
- frequent voiding
- increase oral fluid intake
- Allopurinol (Zyloprim) to prevent uric acid formation

5. Reproductive System
- infertility/mutagenic damage to chromosomes
- banking sperm

6. Neurologic System (due to repeated use of vincristine)

- hearing loss
- paralytic ileus
- loss of tendon reflex