Safe Handling
Personal protective equipment (PPE): double chemotherapy-tested gloves, gown with closed front and cuffs, eye protection if splash risk. Use Luer-lock connections. Prepare in BSC (biological safety cabinet) or CSTD (closed system transfer device). Dispose in designated chemotherapy waste containers. Pregnant staff should not handle chemo. Spill kit available.
Vesicants & Extravasation
Vesicants cause tissue necrosis if extravasated: doxorubicin, daunorubicin, vincristine, vinblastine. Irritants cause local inflammation but no necrosis. Signs of extravasation: pain, burning, swelling, redness, blistering. Management: STOP infusion, disconnect tubing (leave cannula), aspirate residual drug, administer antidote (dexrazoxane for anthracyclines, hyaluronidase for vinca alkaloids), cold/warm compress per drug, elevate, document, plastic surgery referral.
Common Side Effects
Bone marrow suppression: nadir 7–14 days (nadir = lowest point). Monitor CBC, neutropenic precautions. Nausea/vomiting: anticipatory (conditioned), acute (<24h), delayed (>24h). Give antiemetics BEFORE chemo. Alopecia: 2–3 weeks after treatment. Mucositis: oral care, soft diet. Peripheral neuropathy: vincristine, taxanes. Cardiotoxicity: doxorubicin (cumulative dose limit). Secondary malignancies: leukemias years later.
Dose Calculation
Most chemotherapy dosed by body surface area (BSA): mg/m². BSA calculated from height and weight (Mosteller formula). Dose adjustments for renal/hepatic function. Maximum lifetime cumulative dose: doxorubicin 450–550 mg/m² (cardiotoxicity). Bleomycin 400 units (pulmonary). Verify: drug, dose, route, rate, date, patient identifiers. Independent double-check for all chemotherapy.
Patient Education
Hand hygiene (neutropenia precautions). Avoid crowds, sick contacts. Temperature monitoring: call if >100.4°F. Bleeding precautions (thrombocytopenia). Oral hygiene q4h. Nutrition: small frequent meals. Hydration. Hair loss preparation. Reproductive: contraception during and after treatment (teratogenic). When to call: fever, bleeding, severe nausea/vomiting, SOB, pain at IV site.
Important Notes
- Extravasation: STOP, aspirate, antidote, compress — every minute counts. Vesicant tissue necrosis can require skin grafts or amputation.
- Doxorubicin cardiotoxicity: cumulative dose. Monitor ECHO/MUGA scan. Lifetime max 450–550 mg/m².
Clinical Tips
- Chemotherapy nadir: "7-14-21" — WBC nadirs at day 7–14, recovers by day 21. Monitor CBC closely during this window.
Summary
Chemotherapy administration requires safe handling, vesicant management, side effect monitoring, and patient education. Extravasation is a nursing emergency requiring immediate action. Double-checks are mandatory.
