Saturday, 2 July 2011

Chemotherapeutic Drug Preparation And Handling

When preparing chemotherapeutic drugs, take extra care, both for the patient's safety and for your own. Patients who receive chemotherapeutic drugs risk teratogenic, mutagenic, and carcinogenic effects, but the people who prepare and handle the drugs are at risk as well. Although the danger from handling these drugs hasn't been fully determined, chemotherapeutic drugs can increase the handler's risk of reproductive abnormalities. These drugs also pose environmental threats, and the best method for handling them hasn't been determined.
Transition Metal Complexes as Drugs and Chemotherapeutic Agents (Catalysis by Metal Complexes)
The Occupational Safety and Health Administration (OSHA) has set down guidelines for handling chemotherapeutic drugs. Although these guidelines are simply recommendations, adhering to them will help ensure both your safety and that of your environment.
The OSHA guidelines outline two basic requirements. The first is that all health care workers who handle chemotherapeutic drugs must be educated and trained. A key element of such training involves learning how to reduce your exposure when handling the drugs. The second requirement states that the drugs should be prepared in a class II biological safety cabinet.
Equipment
Prescribed drug or drugs • patient's medication record and chart • long-sleeved gown • latex powder-free surgical gloves • face shield or goggles • eyewash • plastic absorbent pad • alcohol pads • sterile gauze pads • shoe covers • impervious container with the label CAUTION: BIOHAZARD for the disposal of any unused drug or equipment • I.V. solution • diluent (if necessary) • compatibility reference source • medication labels • class II biological safety cabinet • disposable towel • hydrophobic filter or dispensing pin • 18G needle • syringes and needles of various sizes • I.V. tubing with luer-lock fittings • I.V. controller pump (if available).
Have a chemotherapeutic spill kit available that includes water-resistant, nonpermeable, long-sleeved gown with cuffs and back closure • shoe covers • two pairs of gloves (for double gloving) • goggles • mask • disposable dustpan • plastic scraper (for collecting broken glass) • plastic-backed or absorbable towels • container of desiccant powder or granules (to absorb wet contents) • two disposable pads • punctureproof, leakproof container labeled BIOHAZARD WASTE • container of 70% alcohol for cleaning the spill area.
Implementation
  • Remember to wash your hands before and after drug preparation and administration.
  • Prepare the drugs in a class II biological safety cabinet.
  • Wear protective garments (such as a long-sleeved gown, powder-free gloves, and a face shield or goggles), as indicated by your facility's policy. Don't wear the garments outside the preparation area.
  • Don't eat, drink, smoke, or apply cosmetics in the drug preparation area.
  • Before you prepare the drug (and after you finish), clean the internal surfaces of the cabinet with 70% alcohol and a disposable towel. Discard the towel in a leakproof chemical waste container.
  • Cover the work surface with a clean plastic absorbent pad to minimize contamination by droplets or spills. Change the pad at the end of the shift or whenever a spill occurs.
  • Consider all the equipment used in drug preparation as well as any unused drug as hazardous waste. Dispose of them according to your facility's policy.
  • Place all chemotherapeutic waste products in labeled, leakproof, sealable plastic bags or other appropriate impervious containers.

Special considerations
  • Prepare the drugs in accordance with current product instructions, paying attention to compatibility, stability, and reconstitution technique.
  • Take precautions to reduce your exposure to chemotherapeutic drugs. Systemic absorption can occur through ingestion of contaminated materials, skin contact, and inhalation. You can inhale a drug without realizing it, such as while opening a vial, clipping a needle, expelling air from a syringe, or discarding excess drug. You can also absorb a drug from handling contaminated stools or body fluids.
  • For maximum protection, mix all chemotherapeutic drugs in an approved class II biological safety cabinet. Also, prime all I.V. bags that contain chemotherapeutic drugs under the hood. Leave the hood blower on 24 hours a day, 7 days a week.
  • If a hood isn't available, prepare drugs in a well-ventilated work space, away from heating or cooling vents and other personnel. Vent vials with a hydrophobic filter, or use negative-pressure techniques. Also, use a needle with a hydrophobic filter to remove solution from a vial. To break an ampule, wrap a sterile gauze pad or alcohol pad around the neck of the ampule to cut the contamination risk.
  • Make sure the biological safety cabinet is examined every 6 months or any time the cabinet is moved by a company specifically qualified to perform this work. If the cabinet passes certification, the certifying company will affix a sticker to the cabinet attesting to its approval.
  • Use only syringes and I.V. sets that have luer-lock fittings. Label all chemotherapeutic drugs with a CHEMOTHERAPY HAZARD label.
  • Don't clip needles, break syringes, or remove the needles from syringes. Use a gauze pad when removing syringes and needles from I.V. bags of chemotherapeutic drugs.
  • Place used syringes and needles in a punctureproof container, along with other sharp or breakable items.
  • When mixing chemotherapeutic drugs, wear latex surgical gloves and a gown of low-permeability fabric with a closed front and cuffed long sleeves. When working steadily with chemotherapeutic drugs, change gloves every 30 minutes. If you spill a drug solution or puncture or tear a glove, remove the gloves at once. Wash your hands before putting on new gloves and any time you remove your gloves.
  • If some of the drug comes in contact with your skin, wash the involved area thoroughly with soap (not a germicidal agent) and water. If eye contact occurs, flood the eye with water or an isotonic eyewash for at least 5 minutes while holding the eyelid open. Obtain a medical evaluation as soon as possible after accidental exposure.
  • If a major spill occurs, use a chemotherapeutic spill kit to clean the area.
  • Discard disposable gowns and gloves in an appropriately marked, waterproof receptacle when contaminated or when you leave the work area.
  • Don't place any food or drinks in the same refrigerator as chemotherapeutic drugs.
  • Become familiar with drug excretion patterns, and take appropriate precautions when handling a chemotherapy patient's body fluids.
  • Give male patients a urinal with a tight-fitting lid. Wear disposable latex surgical gloves when handling body fluids. Before flushing the toilet, place a waterproof pad over the toilet bowl to avoid splashing. Wear gloves and a gown when handling linens soiled with body fluids. Place soiled linens in isolation linen bags designated for separate laundering.
  • When providing home care, empty waste products into the toilet close to the water to minimize splashing. Close the lid and flush two or three times. Place soiled linens in a washable pillowcase; then launder them twice, separately from other household linens. Wear gloves when handling contaminated linens, bedclothes, or other materials.
  • Women who are pregnant, trying to conceive, or breast-feeding should exercise caution when handling chemotherapeutic drugs.
Home care
When teaching your patient about handling chemotherapeutic drugs, discuss appropriate safety measures. If the patient will be receiving chemotherapy at home, teach him how to dispose of contaminated equipment. Tell the patient and his family to wear gloves whenever handling chemotherapy equipment and contaminated linens or bedclothes. Instruct them to place soiled linens in a separate washable pillowcase and to launder the pillowcase twice, with the soiled linens inside, separately from other linens.
All materials used for the treatment should be placed in a leakproof container and taken to a designated disposal area. The patient or his family should make arrangements with either a hospital or a private company for pickup and proper disposal of contaminated waste.
Complications
Chemotherapeutic drugs may be mutagenic. Chronic exposure to chemotherapeutic drugs may damage the liver or chromosomes. Direct exposure to these drugs may burn and damage the skin.
Documentation
Document each incident of exposure according to your facility's policy.