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Retuximab administration help

Oncology   (293 Views 4 Comments)
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Our floor is not a chemo floor, but we often get renal kids needing retuximab. Per my research and collaboration with other units and chemo experts, this us not technically a chemo and can be administered w standard PPE and precautions. Is this consistent with what others are doing? Maybe this is the wrong thread, cause we give for nononcological uses. Either way, is it cytotoxic and is there a need for chemo precautions?

 

Any advice would be helpful. 

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OK to put this in context I am replying from Australia.

I work on an oncology unit that also at times has to administer antineoplastic therapies on other wards and our practice is to treat all therapies the same. 

Also to add to this the Cancer Nurses Society of Australia put out a statement several years ago in relation to the administration of immunotherapies that basically said that due to the newness of these therapies and therefore the lack of long term data on incidental exposure to these agents that they should be treated the same as cytotoxic chemotherapies.

In other words best to be safe than sorry and treat it like chemotherapy.

We also wouldn't let anyone administer this that hasn't done appropriate courses to be qualified to administer this type of therapy.

Hope this helps

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Our hospital had a policy that if it isn't for cancer, then any nurse can administer it, like how some patients gets oral chemo for sickle cell.

 

That said, it doesn't specify PPE in our policy. Pharmacy doesn't prime it like a chemo either. I still gown up and use the connectors like any other chemo.

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Here you go:

The National Institute for Occupational Safety and Health (NIOSH) has established universal standard recommendations in regard to handling, preparation, and administration of potentially hazardous agents. Classification of what is determined to be hazardous is based on three drug groups: antineoplastic drugs, non-antineoplastic drugs, and drugs that primarily pose a reproductive risk to men and women who are actively trying to conceive and women who are pregnant or breast feeding, because of the risk of excretion in breast milk.1 Furthermore, hazardous drugs must meet the criterium of being one of the following: carcinogenic; teratrogenic or have other developmental toxicities, reproductive toxicity, organ toxicity at low doses; and genotoxicity.

Whereas there have not been any new changes to the NIOSH guidelines for PPE use, agents such as rituximab were removed from the hazardous list, given that they do not meet the criteria for hazardous drugs. Rituximab is a genetically engineered medication used to produce humanized antibodies. However, these agents do not interact directly with the transcription of DNA or RNA and are not expected to be mutagenic or teratrogenic, and they do not mimic the traditional cytotoxic, antineoplastic cancer chemotherapy treatments that are considered to be hazardous. It was recommended that these medications could be handled with the same level of specialization as aseptic products. 

Bioengineered drugs target specific sites in the body and do not directly superimpose a risk to the clinician administering the drug. Rituximab was removed from the hazardous drug listing, especially that it is administered in non-oncology settings. However, NIOSH does take the position that any safety handling procedures should be in correlation with institutional policies and any additional recommendations included in the manufacturer's safety data sheets. —Jiajoyce R. Conway, DNP, CRNP, AOCNP

https://www.oncologynurseadvisor.com/advisor-forum/personal-protective-equipment-guidelines-handling-mabs/article/415331/

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