What's your protocol for pregnancy?

[Double-Helix, BSN, RN]

I work in PICU, where we give chemotherapy rather rarely, but we currently have two children receiving chemo. We also have several nurses who are pregnant, and assignments can be a challenge. Our unwritten policy is that pregnant nurses should not administer or handle chemotherapy, but they can care for patients receiving chemotherapy with appropriate precautions (chemo gloves, which we all use anyway). We don't have a written policy and many nurses are uncomfortable assigning a pregnant nurse to a chemo patient.

So, since you're all in oncology I'm sure you have much more information about this than I do. What's your policy regarding pregnant nurses administering and caring for patient receiving chemotherapy?

[caroladybelle, BSN, RN]

Per several studies/OSHA, there is no danger to pregnant nurses from hanging chemo or caring for chemo patients if ALL PEOPLE HANDLING THE CHEMO AND PT FOLLOW PROPER CHEMO PRECAUTIONS. Please note the capitalized words. In many places, nurses/pharmacy gets careless or are lax in precautions, or employers do not provide appropriate/adequate PPE.

My oncology unit recently went

through a year, in which at various times, 9 staff members were pregnant. It would have been virtually impossible to avoid assigning a pregnant nurse to a chemo pt. We allowed those that did not want hang it, to defer that duty, but most would care for the pt afterward/ or before the administration. We do not have

pregnant nurses give IVP chemo as it has more danger of exposure. As a note, none had miscarriages or defects, despite the fact that 5 of the 9 were well over 30, with one over 40 yo. And all of the older nurses, it was a first birth. Several are pregnant again.

On our unit, chemo comes up in a special bag. We check it in the bag, through the plastic, then wrap it in a chux, don a chemo gown, chemo gloves (double gloved, with one under the cuff of the gown, and one over), mask. The tubing is set up with special phaseal antireflux attachments, and all connections are tightened. The cover bag is opened at the end, and chemo bag (with another antiaerosolation device on the opening for the spike) is spiked while still mostly contained in the cover bag. Chemo is back primed, so no loss or aerisolation. Used chemo supplies go in the empty cover bag and any used old chemo administration bags with tubing/syringes are disconnected safely with the phaseal, wrapped in the chux and go in the bag as well, taken to the chemo disposal. Pt is considered contaminated for up to 48 hrs after last chemo given, linens and soiled clothing should be handled with gloves, and toilet should be double flushed, while covered (to prevent aerisolization) after pt has used it.

[Daisy_08, BSN, RN]

Our policy states that any nurse who is pregnant or trying to get pregnant may refuse to take care of pts on chemo. However as long as you use precautions it should not be an issue.

[OCNRN63, RN]

ONS guidelines are pretty much the same, but where I work, nurses can refuse to hang/push chemo from the moment the start contemplating pregnancy and through breastfeeding. It's a pretty big unit, and sometimes there have been multiple people in the "contemplation" through "breast feeding" phase.

[KelRN215, BSN, RN]

No policy/protocol per se, but pregnant nurses are allowed to refuse to take care of chemo patients if they are uncomfortable.

[RNOnc78]

Hello, I have been hanging chemo for almost a month now. our PPE includes the gowns used for contact precautions and gloves. We don't use mask. what type of mask are you using on your unit?

[JaniceRN1]

"Per several studies/OSHA, there is no danger to pregnant nurses from hanging chemo or caring for chemo patients if ALL PEOPLE HANDLING THE CHEMO AND PT FOLLOW PROPER CHEMO PRECAUTIONS."

The ONS recognizes that individuals with regular occupational exposure to chemotherapy are at a significantly increased risk of developing blood cancers. In addition, the ONS recognizes an increased risk to the fetus through occupational exposure. While they don't flat out advise pregnant women to avoid administering chemotherapy, they do go to great lengths to describe the different levels of harm occupational exposure can cause. There is no way to completely eliminate the risk of chemotherapy exposure.

I am oncology certified, and did not administer chemotherapy while pregnant.

That being said, our hospital does not have a policy, but our pregnant nurses do not administer chemotherapy. It's one of those "it's just how we've always done it" practices.