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Hello everyone,

 I am looking for some guidance on how you all are managing infusions of Rituxan.  Rituxan is considered a "chemotherapeutic" agent.  How are you managing it?  How do you handle it?  Nurse training?  Nurse Precautions?  Monitoring? Waste disposal? Who can order the drug?  And how pharmacy checks it?

 Our organization is trying to look at it from a more global perspective rather than a cancer protocol perspective. Any thoughts or feedback???

 Thank you in advance!

We are an IV Outpatient

We are an IV Outpatient Center in a 360 bed Community Hospital.  We administer Rituxan weekly.  There are 4 RN's in the department, three are chemotherapy certified (via Oncology Nursing Society) the 4th is in training and will become certified this winter.  While Rituxan is not a chemotherapy, we do order, prepare, dispose, charge and chart as if it were.  It is ordered on a Chemotherpy order form as mg/m2.  It is prepared by the pharmacist under the hood and dispensed to us (requiring signatures for receipt and double checking by 2 RN's at the bedside, etc) per our chemo protocols.  We dispose of the bag/tubing in our yellow biohazard containers. Anyone can order the medication, however, it is usually the oncologists or hematologists who do so. For first dose, we start at 50 mg/hr for 30 min - monitoring VS baseline and every 30 minutes.  We escalate the rate by 50 mg/hr to a maximum dose of 400 mg/hr.  If no reaction, on subsequent treatments we start at 100 m/hr and escalate the rate every 30 minutes to a maximum dose of 400 mg/hr. We have a "flush bag" of 250 ml NS in case we have to intercede during reaction.  It's best if the pharmacy will reconstitue to 1 mg to 1 ml, hhowever, here at this hospital, they won't do that and reconstitue to the maximum recommended - it just makes it harder to calculate the rate when we hang it!  We administer via the Sigma pump.

Our patients usually receive Tylenol 650 mg PO and Benadryl 50 mg IV prior to infusion.  If there is a history of reaction, we sometimes add Solucortef or Solumedrol and if the reaction was severe, some patients are premedicated at home the night before with Decadron PO.  Reactions are treated with Demerol (sometimes additional Benadryl) and usually resolve quickly and we restart the infusion at the rate the patient was receiving prior to the reaction.  We have found that a patient can have a reaction at any time during the treatment (not just the firt 15 minutes as literature states) and any week of the cycle(s). Never take anything for granted!  If you would like to contact me, feel free to email me at: [email protected]


Chemo precautions/safe drug

Chemo precautions/safe drug handling issues--this is what ONS (2005) says about "biotherapy agents":

1.  Limited data are available regarding its effects on handlers.

2.  Most biologic agents do not affect DNA and do not cause genetic changes.

3.  Interferon is considered a hazardous drug because of its reproductive toxicity

We have collapsed chemo and bio drugs for cancer into a term "antineoplastic agents."  There's one monoclonal antibody which has a cytotoxic molecule attached to it; interferon DOES need to be handled safely.  So when we presented the evidence to our chemo RNs in our annual class several years ago, they said--treat all antineoplastics as "chemo."  So we use hazardous drug precautions/disposal on all.  That way, if a new drug comes out that might be an exception to a more casual handling, everyone is covered.  I sleep much better at night.

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