Chemo

iluvivt, BSN, RN · Nov 24, 2008

Of course there is a risk. There is always a risk with any patient and some pose more as in this case. First,as in every case you can be exposed to bodily fluids,and that includes blood. To minimize this you need to follow standard precautions and in this case,it definitely includes the goggles. Next you have the risk of chemotherapy exposure,especially if patient is pulling out his IVs during the chemotherapy administration. You have the risk of inhalation and skin contact. Of course the degree and type of risk will have so many variables,such as type of chemotherapy,amount of exposure and length of exposure etc. With careful and thoughtful nursing care you probably can manage these issues.

blondy2061h, MSN, RN · Nov 24, 2008

If you're truely concerned about the patient pulling out his line while getting chemo, he needs a 1:1 sitter during the infusions. You also should really be assessing ANY patient receiving chemo q15 minutes, at least briefly, during the infusion. Just peak in on them.

And of course usual chemo precautions apply- gown, double gloves (or special chemo gloves), double checking the chemo with another RN, verifying blood return in the port before, during, and after chemo, all that stuff.

It doesn't sound like you're on a floor that does chemo a lot. Are you guys chemo qualified?

If you're pregnant or trying to get pregnant you absolutely should not be hanging chemo.

I'm not sure where you got the bloody nose idea, but even with chemo-induced thrombocytopenia, we really don't see a ton of nose bleeds, even in our patients with single digit platelet counts.

notsure · Nov 24, 2008

Thank you so much for replying.

Do you know of anywhere in books, web sites or some sort of nursing guidelines where is states if your trying to have a baby, you should not be around chemo or where it has the risks?

Thank you.

blondy2061h, MSN, RN · Nov 24, 2008

Thank you so much for replying.
Do you know of anywhere in books, web sites or some sort of nursing guidelines where is states if your trying to have a baby, you should not be around chemo or where it has the risks?
Thank you.

What kind of setting are you in? No offense, but you seem to lack basic knowledge regarding chemo, in much the same way I lack basic knowledge of say, labor and delivery. I'm getting the impression oncology isn't your specialty. Are you an inpatient or outpatient setting? Not hanging chemo if you're pregnant or trying to get pregnant is common knowledge amongst oncology nurses. Check any of the ONS publications on safe chemotherapy practices for this.

If you're not in an environment where people aren't chemo certified, you shouldn't be hanging chemo at all.

Blee O'Myacin, BSN, RN · Nov 25, 2008

What kind of setting are you in? No offense, but you seem to lack basic knowledge regarding chemo, in much the same way I lack basic knowledge of say, labor and delivery. I'm getting the impression oncology isn't your specialty. Are you an inpatient or outpatient setting? Not hanging chemo if you're pregnant or trying to get pregnant is common knowledge amongst oncology nurses. Check any of the ONS publications on safe chemotherapy practices for this.
If you're not in an environment where people aren't chemo certified, you shouldn't be hanging chemo at all.

The OP never states she was a nurse. I had to re-read the original post b/c I assumed so as well. This begs a bigger question, who consented the chemo if the patient is unable/unwilling to tolerate the treatments? As a parent of a child "on the spectrum", I can't imagine leaving him alone with an aide if he needed treatment - even when he's an adult. If this is a ward of the state issue, it needs to go to ethics committee. Deaccessing your own port is a loud and clear "Stop doing this to me!!".

Blee

LikesToSwim · Nov 27, 2008

here's what the ons has to say (quoted directly from their website):

is it safe for nurses to administer chemotherapy if they are pregnant or trying to conceive?

the issue of whether nurses should administer chemotherapy while trying to conceive or during a pregnancy is one of the more controversial topics in chemotherapy administration.

ons directly addresses this issue in the ons chemotherapy and biotherapy guidelines and recommendations for practice (2005), page 62, as j) "allow employees who are pregnant, actively trying to conceive, or breast-feeding or who have other medical reasons for not being exposed to hazardous drugs to refrain from preparing or administering those agents or caring for patients during their treatment with them upon request. (no information is available regarding the reproductive risks of workers who use currently recommended precautions [osha, 1995; welch & silveira, 1997]). alternate duty that does not include cytotoxic preparation or administration must be made available to both men and women involved in planning a pregnancy when requested."

the american society of health-system pharmacists, (ashp) "ashp guidelines on handling hazardous drugs" states "because reproductive risks have been associated with exposure to hazardous drugs, alternative duty should be offered to individuals who are pregnant, breast-feeding, or attempting to conceive or father a child. employees' physicians should be involved in making these determinations." this report is available on-line at: http://www.ashp.org/s_ashp/bin.asp?cid=6&did=5420&doc=file.pdf, and the full citation is american society of health-system pharmacists. ashp guidelines on handling hazardous drugs. american journal of health-system pharmacists. 2006; 63:1172- 93.

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i worked full time at a cancer hospital and gave chemo often when i was pregnant. i was careful to follow the rules for safe handling. i also avoided administering antineogenesis agents (because they could impact the placenta and the developing baby a lot); i knew i couldn't clean up spills (due to the risk of inhalation from aerosolization); and i didn't administer any investigational vaccines (or for that matter, investigational drugs at all.) i never felt overwhelmed or rushed, and i had plenty of support for double-checks of my work. i felt like the environment i worked in was extremely safe, so i was okay with administering chemo. if i worked somewhere were i didn't feel supported or safe, i would have passed on administering chemo. i have the rest of my life to be a nurse (if my back holds up!), but only 40 weeks to form a healthy baby....

(and yes, i did deliver a happy and healthy baby)

blondy2061h, MSN, RN · Nov 27, 2008

Unless you work in like an outpatient chemo infusion clinic, I can't see that there'd be such a need to hang chemo very often. I work in a BMTU. We also get a lot of newly diagnosed leukemic admits. I could easily avoid giving chemo if I had to. We still just don't hang much of it. Most of it is high dose chemo that we give inpatient, so they only get a few days of actual chemo infusions, and most of the time is chilling out waiting for count recovery.