I'm an IV /PICC nurse educator at a 400-bed hospital. At another campus of our hospital is a Regional Infusion Center. About a year ago, when the hospital split into two campuses, outpatient chemo patients who don't go to the local Cancer Center go to the Infusion Center instead of our hospital oncology unit to get their chemo. Rarely, they will have a patient who is to receive a vesicant peripherally. In the main hospital, only chemo certified, IV therapy nurses give this peripherally. I was recently directed to "check off" ALL the infusion center nurses on giving peripheral vesicants. They have all taken a "chemo class".
 Who's giving peripheral vesicant chemo in other hospitals and infusion centers? What training do you have to go through in order to do this? I'm uncomfortable teaching so many nurses to do a somewhat dangerous procedure that they each will do only rarely.
Several comments/questions . . . then I'll answer yours.
1. Most chemo is now done outpt; only those regimens requiring either complex, multi-drug, multi-day regimens and/or continuous infusions of something other than 5FU are considered for inpt administration
2. What "chemo class" did they take? and how long ago? ONS now has a chemo provider 2 day training course and administration of vesicants (PIV and CVC administration) is included in that.
3. It is not clear in your post if you, yourself, are an experienced chemo nurse or what training you have had to be able to evaluate their practice.
4. ONS chemo/bio guidelines give specific guidelines about administering vesicants via peripheral infusions, indicating that short infusions via PIVs cannot be longer than 60 min (our policy is 30 min), the RN remains with the pt during vesicant infusions to observe the site, and only gravity drip--no infusion pump--for administration, among others.
Our nurses have completed the ONS chemo/bio course and are observed by a skilled and experienced chemo nurse for 3 administrations of chemo, hopefully, at least one of them being a vesicant. We use the appendix in the ONS guideline book (2009) which is a Clinical Practicum Evaluation (Appendices 5 & 6). If they have done this, they are deemed competent to administer any anti-neoplastic drug to a patient via appropriate routes (RNs do not give intrathecal or intrapleural chemo). PIV vesicants (either IVP or short infusion) are given quite frequently by our chemo RNs--and very safely, I might add. The last two extravasations we had were with CVCs, which, unless assessed appropriately, can give nurses a false sense of security when giving vesicants.
Admittedly, most new chemo nurses are a bit frightened when asked to give vesicants via PIV because all those ugly pictures shown during the class are frightening. To think the I, as a nurse trying to help people, could cause this, is not something new chemo RNs like to face. So I certainly understand your reticence. However, if the guidelines are followed, the risks of admininstering extravasation are greatly reduced.
In our BMT/Infusion Center our nurses are required to take the 2 day ONS training. We require observation of three chemo administrations and they must check their chemo for one year with a nurse who has greater than one years experience with chemo administration.
Barbara Tinsley
I also am a ONS trainer, and I frequently find that the issue of administering vesicant drugs is a big concern for new chemo nurses. What I always try to point out to participants in my class is that there are quite few non-chemotherapy vesicant drugs that are given out on the floors all the time. Antibiotics (vancomycin) anitemetics (phenergan) and cardiac gtts (dopamine) are given frequently given through peripheral veins. Once they put that into perspective it often decreases the fear factor. ONS, as Donna stated, has very clear guidelines and recommendations for the administration of vesicant drugs both peripherally and through a central line.
Sarah Jones
Manager APN/Infusion Services/ ET
Oncology CNS
Thank you all for your input. I just finished the chemo vesicant peripheral admin. training and it went quite well
T. Nauman RN, CRNI