Safety Precautions
Chemotherapy is hazardous — protect staff, patient, environment. PPE: double gloves (chemo-rated), gown (back-closing, impermeable), eye protection, N95 for powders. Use closed-system transfer devices (CSTDs). Biologic safety cabinet for prep. Dispose in chemo waste. Pregnant staff should not administer. Spills: chemo spill kit.
Administration Routes
IV: most common. Vesicant (tissue necrosis if extravasated) — central line or well-functioning PIV. Irritant: local inflammation. Non-vesicant: minimal reaction. Oral: wear gloves. Intrathecal: CNS leukemia — NEVER confused with IV vinca alkaloids (fatal if given intrathecally). Verify: two-RN check of drug, dose, route, patient.
Extravasation Management
Stop immediately. Leave catheter. Aspirate 3-5 mL. Assess: vesicant type, volume, time. Antidotes: dexrazoxane for anthracyclines (IV within 6h), hyaluronidase for vinca alkaloids/taxanes (SC), sodium thiosulfate for nitrogen mustards, phentolamine for vasoconstrictors. Warm/cold compress. Elevate. Surgical consult. Document, photos, incident report.
Important Notes
- Vinca alkaloids (vincristine, vinblastine) MUST NEVER be given intrathecally — it is uniformly fatal.
- Dexrazoxane must be given within 6 hours of anthracycline extravasation — after that, tissue damage is irreversible.
Clinical Tips
- A chemo spill kit should be available wherever chemo is stored, administered, or disposed of.
- Cold compresses for anthracycline extravasation, warm for vinca alkaloid extravasation.
Summary
Chemotherapy administration requires PPE, closed-system transfer devices, two-RN verification, and immediate extravasation management with specific antidotes.
