Chemotherapy in the home

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Are any of you currently initiating or DC'ing chemo in the home? Our agency currently has quite a few pts on chemo, most of whom have therapy initiated at the oncology clinic and then DC'd by us at home. Unfortunately, we do not have clear P&P on chemo, and none of our nurses have any specialized training. I'm looking for a website or other source of information about how to properly handle and dispose of the chemo, and special instructions for pts receiving chemo in the home. Thanks in advance...

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This sounds pretty dangerous to me. I remember when I was in the hospital and did chemo drugs, there were all sorts of protocols, labs, etc. Can I ask what specific chemo drugs are you talking about?

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Sorry for the delay... We have worked with 5FU, Methotrexate, Cytoxan, Adriamycin, to name a few.

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Have had clients wear continuous pumps but nothing the agency started or stopped. Sounds risky

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It's been a long time since I did chemo---but those drugs do ring a bell. I remember we had to have current labs, kidney functions, hydration guidlines, premeds---I just don't think I would be comfortable in the home doing chemo.

I think I would have to look further into that before I would do it.

Good luck, let us know.

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Specializes in Oncology.

Are you talking about IV infusions of chemo?

My hospital does not do IV chemo at home- inpatient, or chemo infusion clinic. It's not an appropriate setting as you're not able to handle rxns, extravication, or have proper PPE to handle it, much less a second RN to verify the order with.

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I am referring to IV chemo, typically the drug is initiated via a pump in the oncology clinic or chemo unit, it will run for a predetermined amount of time, and then the home health RN will DC it at the pt's home. The primary problem that has come to my attention has been disposal of the bag, tubing, etc. We have developed some staff education material but it is a little vague. It has been many years since I personally have had any training R/T chemo, and that was based on administration in a hospital setting. Fortunately, I'm not the one responsible here, either for handling it or educating the staff, but I am concerned about our staff's safety and of course the safety and care of our patients.

I know of one incident in which the "empty" bag and tubing were placed in a plastic biohazard trash bag and transported back to the office for disposal in the trunk of the nurse's car. There was another incident in which due to blizzard conditions we could not make it to the pt's rural home, and she was talked through the DC of the infusion on the phone, but disposal was apparently not discussed. The pt boxed up the pump with the bag and tubing still attached and used the return mailer to send it all back to the infusion provider.

I mentioned above that I had some chemo training years ago in an in-pt setting. If memory serves, it was two full days. I'm concerned that we are sending nurses out to deal with this with no specialized training at all, or at best a 30 minute inservice. I would really like to find some online resources to assist our clinical nursing supervisor in educating our staff. Specifically I need some detailed guidelines about disposal. We have some general info for the pts about washing contaminated linens, twice, separate from other laundry, bathroom/commode cleaning, cleaning spills, and so on, but more is always better. Thanks to everybody for your help.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

It's been 10 years since I did IV chemo in the home....

I searched online but unable quickly pull up info ---will sleuth in free time.

1. We had inservice provided by infusion company in how to handle their pumps and given list of medication protocals. I aslo took course at Fox Chase Cancer Center.

2. Infusion provider sent out yellow chemo waste container for chemo tubing and casette disposal. We also had nursing supplies: chemo gloves, gown, drape to place under tubing connection, plastic glasses or mask with faceshield ---tossed into yellow chemo waste bag, double bagged then in sturdy shipping carton. Everything shipped back to supplier if not directly picked up or in a pinch, brought to our office for pickup there if company needed pump turnaround quickly and patient in the country.

3. IV provider sent out teaching manual for patient with first drug shipment re medication, side effects, physician protocall, care of patient receiving chemo, safety in the home etc.

4. Extravasion kit sent out for patient with high risk meds.

5. All IV team nurses carried anaphylaxis kit.

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Thanks Karen, it sounds like a good place to start would be with our infusion companies, they have not been providing all those things.

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