Frightening events during chemotherapy - page 2

An oncology nurse friend told me a patient can seem fine, walking and talking yet die in the first twenty minutes of chemotherapy infusion. Can someone tell me more? Has it happened to your... Read More

  1. by   caroladybelle
    Onco Gal,

    Chemo certification is not the same thing as Oncology certification!

    There is Oncology certification - I am OCN, also. What I was referring to is Chemo certification. As I recall, there is very little on the OCN exam regarding chemo - and most of it deals with very general knowledge. Please reread the posts that I wrote.

    Chemo certification is generally done specifically by the institution. While many people think that taking the ONS chemo and biotherapy course, and passing the test counts as "chemo certification", to be certified, one must be observed administering various forms of chemo. (please see info at RealNurseEd.com - Cyndi Cramer is an ONS course provider) As very few courses outside one's own institution will permit chemo hangs/administration on patients by a nurse not of that institution d/t liability issues, actual certification for chemo is usually done on a institutional basis.

    Again, as the depth of information needed to properly care for cancer patients receiving chemo (both the oncology knowledge, and knowledge of chemo, not to mention rad and surgical intervention, transplant issues, these patients should be in the care of chemo and onco savvy nurses.
  2. by   onco gal
    I don't know how long you have been involved in nursing or oncology. I have been an oncology nurse for many years and have also worked bone marrow transplant and given chemo in the home. I am not out to prove anything. In addition, I am currently involved in setting up a new oncology orientation program in a local hospital over and above my current duties. Please do not speak to me as if I was not informed or very well experienced in my field.
    Last edit by gwenith on Jan 6, '05 : Reason: personal attack
  3. by   caroladybelle
    Sorry if I disturbed you - However I never said that there was no official oncology certification, if you read post #10 completely - as I pointed out. I am also clarifying that there is a difference between onco and chemo, as someone as well experienced as you are know.

    I have nothing to prove. But it behooves all of us to strive for the best care possible for oncology patients and chemo patients. And it only helps others to educate them. if they ask questions, they should be answered. And we should encourage nurses to make sure the only chemo savvy nurses care for chemo patients and their special needs.

    And as an answer to your question. I have been a Registered Nurse for over 10 years, an Oncology nurse (chemo educated and qualified by my institutions) for 8 years, worked BMT off and on during it, and have volunteered for Hospice throughout. I have oriented quite a few nurses to oncology and observed them hang chemo following required classes.

    I wish for you good luck in setting up your orientation program - the country needs more oncology nurses.
  4. by   onco gal
    No offense taken, however, it concerns me greatly to read that there are nurses out there that are caring for and being told to give chemo to our patient population. Frankly I do not think that ONS is doing much to elevate our certification and importance as in most hospitals we are not considered "critical care". I currently work part time bone marrow transplant, in addition to heme-onco in another hospital. I am also required to do telemetry and cardiac drips on the heme-onco unit and be ACLS certified as well.
  5. by   RN2B2005
    My mother had a spectacular anaphylactic reaction to Taxol in an outpatient setting. She'd had all of the pre-med regimen and had previously had uneventful treatments. Fortunately, she was receiving the tx at a well-respected and well-staffed clinic attached to a major hospital, and she did fine...but the complications, and ensuing problems, were enough to make me think twice about ever administering chemo without LOTS of training.

    I've read about American patients buying Taxol in Mexico for home use and it gives me the willies. I also worked in an outpatient multispecialty clinic where two oncologists administered chemo, using IV therapy nurses for monitoring...something I didn't think was a problem at the time, but that I wouldn't be comfortable with now.
  6. by   caroladybelle
    When people are told that there is no curative treatment, they frequently clutch at straws. Have had two cases in six weeks - pt had incurable ca - relative/friend/etc. found "cure" available in Mexico on internet - pt went down, took treatment, became ill and were told to get radiation in US (no one questioned why the US?) - came back and were dying of renal/cardiac/hepatic failure. And still the family insisted that all they needed was radiation and that they would be cured.

    Also, chemo is extremely expensive - even the "old line" drugs of cisplatin and adriamycin. I don't even want to contemplate cost of newer drugs like Taxol w/ associated premeds - The first line antiemetics (Anzemet/Kytril/Zofran) are terribly expensive so I can understand why people might attempt to buy out of the country. But would they be sure of what they are getting?

    I have known a few people that bought chemo drugs South of the border - wanted to prove that it could be done - and had them tested - you don't even want to know the results - needless to say sometimes you get what you pay for.

    As an example, Suzanne Somers reports that she uses an unapproved injectable "treatment" for breast cancer, derived from mistletoe. Does anyone question where she gets it or what longterm effects that it has?
    Last edit by caroladybelle on Feb 3, '03
  7. by   BernieO
    I have been an RN for almost 30 years. My experience is in Cardiac Care, Med-Surg, Pediatrics, Substance Abuse, and Administration. I have been reading this site for personal reasons. I have just completed 6 cycles of Taxol and Carboplantin for OVCA 2A.

    My initial surgery for staging was done at a University hospital by a Gyne/Onc. This hospital is 90 miles away so I had my chemo monitored by a heme/onc at the local cancer center attached to our community hospital. This cancer clinic is affiliated with the same university hospital that did my surgery.

    My last cycle of Carbo, with only about 100 cc left of the infusion, I developed a reaction. My numbness & tingling subsided about 15 mins after infusion was stopped. The nurses are hopspital based trained only but seemed to know exactly what to do. The staffing ratio is always 1 RN to 2 Chemo patients.

    Of interest is also the cost of Cancer Care. Each Cycle of Taxol & Carbo with the pre blood work, pre-chemo meds, nursing care & physician visit along with the chemo meds was slightly over $10,000 each time. I can understand what drives patients without comprehensive health care coverage to Mexico to seek cheaper sources. The cost of fighting cancer in this country is expensive. But when you consider the alternative....
  8. by   onco gal
    I had to sound like cynical but, the Doctors are making a fortune by giving chemo on an op basis. 8-9 yrs ago it was being given in op setting in the hospitals, now nurses are mixing and giving it in the Drs offices. Chemo is "another drug", but they need to be respected and ONLY Chemo ceritifed RN's should be giving it and monitoring the patients for side effect.
  9. by   das
    I work in a Hem/Onc office with an OP dept. There are 2 chemo certified RNs and 2 triage RNs, also chemo certified (plus 2 LPNs) We have 12 available chemo chairs (and sometimes there are 12 patients in them and the triage nurses work with us when there are that many patients) I have worked in ICU and the ED and my partner did Med/Surg and Peds. We have 18-20 years nursing each. We Start the IVs, draw blood, mix chemo and administer it. We have had drug reactions and cardiac arrests in the clininc and the hospital. I think what makes the difference is the person you are working with and the response of EMS/code team. Read the directions follow the recommendations and use your head. Start new drugs slow and monitor the patient. We do not have a crash cart, wall suction or wall O2. We have ambu bags, cylinder O2 and 911. Reactions and deaths occur, it's part of the process. we just do the best we can to stop and avoid them at all costs.
  10. by   stevierae
    Quote from canoehead
    I'm glad to hear someone in the know agrees that nurses should have special education to give chemo. Part of the reason I left a job a few years back was that they wanted me to give chemo, without education, or having ever dealt with it before. I felt that I knew so little that I didn't know what I didn't know. (if that makes sense). The NM was very upset, asking me why I had a problem, after all "it's just a drug- you look it up and follow the guidelines". I didn't have a counter argument, just a feeling that I was moving into risky territory, and needed something more formal.
    I had that same experience working for Apria (home infusion.) They were to provide training, but the "training" consisted of reading the policy and procedure manual and "see one, do one, teach one." The director said the smae thing--"Nothing special about chemo--you give it like you would any other IV drug." Yeah, right. I was out of there before orientation was over---the director said she had a hard time recruiting and retaining infusion nurses--wonder why!!!
  11. by   stevierae
    Quote from das
    I work in a Hem/Onc office with an OP dept. There are 2 chemo certified RNs and 2 triage RNs, also chemo certified (plus 2 LPNs) We have 12 available chemo chairs (and sometimes there are 12 patients in them and the triage nurses work with us when there are that many patients) I have worked in ICU and the ED and my partner did Med/Surg and Peds. We have 18-20 years nursing each. We Start the IVs, draw blood, mix chemo and administer it. We have had drug reactions and cardiac arrests in the clininc and the hospital. I think what makes the difference is the person you are working with and the response of EMS/code team. Read the directions follow the recommendations and use your head. Start new drugs slow and monitor the patient. We do not have a crash cart, wall suction or wall O2. We have ambu bags, cylinder O2 and 911. Reactions and deaths occur, it's part of the process. we just do the best we can to stop and avoid them at all costs.
    DAMN!!! I am not an oncology nurse, but an OR nurse--but it seems to me you should have suction--even if it's just an old fashioned gomco! I mean, if a patient starts vomiting, and/or seizing, and aspirates, you have a very real airway emergency, and one now complicated by a potential chemical pneumonia--meaning the patient will need to be admitted to ICU on a ventilator. Death from aspiration is an AVOIDABLE death--even in someone who is terminal.
  12. by   gwenith
    I agree with Stevirae here - minimum is suction - twinovac or something - crikey a foot pum would be better than nothing. So, you have ambubags, fine, tell me how are you going to manage the airway of a full on anaphylaxis who has laryngospasm???
  13. by   leslie :-D
    my mother, on her 3rd day of continuous infusion started c/o abd pain, radiating to her flanks.
    they gave her morphine.
    on day 5 the pain was intolerable and that's when they decided to get her a ct scan which showed gross colitis of the lg and sm bowel.

    why didn't they get her that ct scan on day three rather than just medicate?
    she ended up dying from the toxic effects of the chemo but will never understand why they didn't run any tests when she first started c/o pain?

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