carbo/taxol/avastin order of admin

[mykidzmom]

Today we had a first time taxol, carboplatin, Avastin. We always give the drugs in that order. Today, I needed to ask the doc a question about the Avastin (if we could give it a little faster than the usual 90 min. first time) and the doc was shocked that we were JUST NOW starting the Avastin. I explained that the pt. got everything else already. He insisted that the proper way to give Avastin was FIRST. Our discussion was our that's-how-we-always-do-it to his well-it-doesn't-make-sense-google-it. we're so mature. i finally asked him where the evidence was to indicate changing the order ("google it" says the doc). well. i HAVE googled it. can't find anything to say when to give it. i might give a call to our avastin rep, but you know, they say whatever they think will make you happy. Any of you wonderful professionals have any evidence? I would especially appreciate links to web sites. or journal articles. I am a relative newbie to outpatient oncology and just starting to be confident to have these types of discussions with our illustrious docs. thanks!

[SteffersRN87, BSN, RN]

I work outpatient oncology and our focus is blood cancers. I would try www.chemoregimens.com and see what it has to say. We check all of our chemo orders against the site to make sure it is a valid drug. Good for you for standing up and asking the physician to back-up his words.

[WittleOnesRN]

I have read that is certain chemo meds are given in a special order they work more effectively. On our unit we try to give the drugs in the order they are listed on the order.

[Nitengale326]

For us...inpatient unit...we always do avastin last...run it over 30-45 mins and then scoot them out the door. Let me do some research and I'll get back with you. Good luck with your "google" doc...sounds like a peach!!!

[luvbug9956]

Taxanes are always given before carboplatin, or severe pancytopenia can occur. We actually give the Avastin FIRST in our clinic. We do this for convenience, as we do not wait for the patient's lab results and can start the drug immediately, then giving the rest of the chemo after the labs come back.

[bottomsup]

At our outpatient clinic convenience dictates that we start the Taxol/Carbo first as the CBC results are generally back before the UA dip for protein which we need before we can administer the Avastin (that's when the docs remember to order the UA dip!!! then its another delay for that to occur)