Question about two chemo meds

[happyhaeju]

Hanging two chemo med --doxorubicin and cyclophosphamide-- which one has to hang first. And what is the rational would be?.Thank you for any response.

[mzjennx, BSN, RN]

Hanging two chemo med --doxorubicin and cyclophosphamide-- which one has to hang first. And what is the rational would be?.Thank you for any response.

Don't you got chemo orders with instructions? Our oncologist has specific orders. Usually premeds hydration doxcirubicin then cytoxan. If in doubt double check with doc and pharmacy and your colleague nurse resources.

[KelRN215, BSN, RN]

What does the protocol say? Our chemo orders are VERY specific and lay out these guidelines.

[Sarah RN,OCN]

At our facility we push the Adria over 20 mins and then hang the Cytoxan....although, as others have stated, we have specific protocols.

[OCNRN63, RN]

We do it however it works the best. Sometimes at lunch, you don't have the staff to sit and push the Adria, so it works out better to hang the Cytoxan. Other times, it doesn't really matter. Generally, we do the push first, then hang the Cytoxan. I do agree, it depends on the physician's directions.

[jodpers]

We always hang the doxorubicin first then the cyclophosphamide. Rationale is simple doxorubicin is a vesicant so likely to do more damage if it extravasates so it needs to be given while you are sure the line is still good and Cyclophosphamide is an irritant so not such a drama. This is especially important if the patient has a peripheral line in but we still follow a policy of giving vesicants before irritants if the patient has a central line as it's all about safety for the patient. I work in a small private hospital and the doctors don't always have specific orders regarding in what order the chemo is to be given.

Hope this helps

[ittybittynurse]

In my facility (outpatient) we push adria. Over 30 minutes while hydration drips. Cyclophosphimide hangs in a bag after adriamycin.

[mappers]

OCRN, this is how we do it. Our policy is that if a vesicant is to be pushed through an IV (shudder) only the nurse who starts the IV can do it. Sometimes if that nurse is busy, we'll hang the cytoxan first. But we prefer to do the Adria first to get it over with. Our physicians don't care in this instance.

[globalRN]

Our patients have PICCs or central lines or port a caths now.

I haven't seen peripheral ivs for Adriamycin and Cytoxan.

If it is given peripherally:

the nurse that started the IV would give the Adriamycin first, IV push,( because he/she would know if that was a good iv start) then flush the line and hang or iv push cytoxan

[NelletheNurse, ADN, BSN, MSN, APRN, NP]

OCRN, this is how we do it. Our policy is that if a vesicant is to be pushed through an IV (shudder) only the nurse who starts the IV can do it. Sometimes if that nurse is busy, we'll hang the cytoxan first. But we prefer to do the Adria first to get it over with. Our physicians don't care in this instance.

Interesting, I really like the policy regarding the nurse that starts the IV pushes the vesicant.

[NelletheNurse, ADN, BSN, MSN, APRN, NP]

I've always pushed dox first, then cytoxan. As stated above, b/c the dox is a vesicant.