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chemo per gravity

I have made application for infusion nurse at a rural Cancer Center. I am concerned that they have no infusion pumps. I would be the only nurse and expect 6-8 patients per day. I would be mixing chemo in an adjacent room. I feel a sense of liability. I am hesitant to accept this position based on this one issue. Anyone with experiences like this? Anyone with knowledge of ONS Guidelines on this issue?

I think you have lots of

I think you have lots of reasons for concern. The first red flag for me was your statement that you would be mixing chemo in an adjacent room. Is this a clean room that has a laminar air flow workbench and do you know how to work inside that environment? If not, you will be in violation of USP 797, a federal rule on how to safely compound sterile preparations. Also, do you understand the requirements for safe handling of chemo and the attire required for that? I would not be so concerned about the lack of infusion pumps. I have spent the day reviewing the literature on infiltration and extravasation. Pumps do not cause infiltration and extravasation but they can easily make the problem worse if these complications occur. I would be most concerned about the environment you will be mixing. These guidelines state that anything compounded outside of this environment must be given within 1 hour. Can you always meet that guideline? I would consult with a local pharmacist about this situation before I started. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

You don't state what your

You don't state what your experience is.  Are you chemo certified?  I agree with Lynn's comments.  I'm assuming since this is a camcer clinic they have a biological safety cabinet that meets the latest guidelines for flow and are you comfotable and experienced in mixing meds in that cabinet.  Also you will need to know how to mux the meds-typically the docs just write the orders-it would be your responsibility to do the drug calculations and mix in the proper fluid.  Perhaps you are already experienced and this is not an issue-if so I apologize for questioning your understanding and experience inn chemo administration.  Also you state that you are the onoy nurse that will be there-I would not want to mix chemo without some type of a "double check" from either another  nurse or MD to assure that my calulations were correct and the correct med and dosage was mixed.  Alot to think about.  Administering chemo via gravity is no poblem as long as you use some type of a flow regulator on the tubing.

Donna Fritz
chemo safety

Agree with Lynn and Debbie.  Chemo orders usually have several sets of eyes to review appropriateness, dosage calculation, etc.  It starts with the physician and we avoid having the one who wrote the order do any double checks after that, or the pharmacist that checked it during processing to be the bedside double check.  (Most hospital pharmacies have two pharmacists check the orders/label during their processes.)  I think it would be important to have at least one other person involved in this process, preferably two.  If you are mixing, then two other RNs should be chairside checking against the original physician's written order.

Is this rural cancer center hospital-based, free-standing or in a hem/onc's office?

It will be important for you to know regulations (pharmacy, OSHA, ONS) as it regards compounding and safe handling.  As Debbie stated, OSHA requires a "biologic safety cabinet" for chemo mixing that directs the air AWAY from the compounder.  My experience is that physician's offices tend to lag behind others facilities in implementing best practices or complying with safe handling regulations.

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