Chemo Prep and Safe Handling

8/10/2019 Chemo Prep and Safe Handling

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Maj Salman


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All cytotoxic drugs should be prepared in one central area, located as

near to the distribution area as possible.

If possible, an isolated hood where only chemotherapy agents areprepared should be designated.

Warning signs designating the area as a chemotherapy agent-

preparation area, which should not be entered by unauthorized staff,should be clearly posted.

Procedures for handling spills should also be posted.


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Personnel should refrain from applying cosmetics in the work area.

Cosmetics may provide a source of prolonged exposure if contaminated.

Eating, drinking, chewing gum, smoking or storing food in areas where

cytotoxic agents are handled should be prohibited. Each of these can be a

source of ingestion if they are accidentally contaminated

Contact lenses may NOT be worn during preparation or administration of

cytotoxic drugs, even if eye protection is worn, contact lenses can absorb

aerosolized material and keep this material in constant contact with the

eye.


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All mixing of cytotoxic agents should be performed by only a properly

trained health care worker, in a Class II biological safety cabinet usingappropriate aseptic technique (ie. care must be taken to not obstructthe aspirating (vertical) airflow). The Class II biological safety cabinetshould have a panel to protect the personnel & should be located in anarea with minimal traffic and air turbulence. The biological safety

cabinet must be certified by qualified personnel semi-annually or anytime the cabinet is physically moved and should be vented outside.


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Drug preparations should not be performed within the least efficientarea of the cabinet in terms of product and personnel protection,

which is within three inches of the sides near from opening.

Cabinets should be left running 24 hours per day. If shut off, theblower should be turned on 15 minutes before beginning work in thecabinet.


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Clean surfaces of the cabinet using Wescodyne & 70% alcohol orZochlor and a disposable towel before and after preparation. Discardtowel into a hazardous chemical waste container.

Prepare the work surface of the biological safety cabinet by covering itwith an absorbent pad. This pad should be changed when the cabinetis cleaned or after a spill.


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All materials needed to complete the procedure (ie. drug and requireddiluents, labeled syringes, primed IV bags, needles, etc.) should beplaced into the biological safety cabinet before beginning work to avoidinterruptions of cabinet airflow. Allow a two-to-three minute periodbefore beginning work for the unit to purge itself of airborne

contaminants. A bag should also be placed in the safety cabinet tocollect all the materials that have had drug contact, this includes empty

vials and needles that were used to compete the procedure.


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Syringes and IV sets with Luer-lock fittings should be used wheneverpossible to avoid spills due to disconnection. Syringes should always belarge enough so that they should never be more than three-fourths full.

Entry into and exit from the cabinet should be in a direct mannerperpendicular to the face of the cabinet. Rapid movements of thehands in the cabinet and laterally through the protective air barriershould be avoided.


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Hands must be washed thoroughly before gloving and after gloves areremoved.

Disposable surgical latex gloves (without powder) that extend over thecuffs of the gown and Chemo Plus Latex gloves are recommended forall procedures involving cytotoxic agents. Gloves should be changedapproximately every 30 minutes when working steadily with cytotoxicagents. Gloves should be immediately removed after contamination.Care must be taken to avoid puncturing of gloves and possible self-inoculation. When a wide variety in permeability in glove lots existsdouble gloving is recommended.

Individuals with known or suspected latex sensitivity should use glovesmade from an alternate material such as nitrile, or they should doubleglove, wearing PVC gloves under the latex gloves (the patientsrisk oflatex sensitivity also should be assessed).


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Eye and face barriers should be worn if splashes are likely to occur or

sprays or aerosols are used. Protection (eg. face shield) should coverthe face completely. Regular eyeglasses with side shields are notadequate.

Check drug(s) and solutions used for reconstitution to verify thatexpiration dates have not been reached. Examine the vials and

ampules for cracks or particulate matter before reconstitution. No food or drink is allowed in chemo mixing area or the medication

area. Drinks or snacks are allowed at nursing charting area. Patientsare allowed drinks or food at bedside area.


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Before opening ampules, inspect the ampule prior to opening to ensurethat the tip is free of solution. The contents of an ampule should begently tapped down from the neck and top portion of the ampulebefore it is opened. The neck of the ampule should be wiped off withalcohol. A sterile, disposable sponge should be wrapped around the

neck of the ampule to reduce aerosolization. Ampules should bebroken in a direction away from the body.

When reconstituting powders in glass ampules or vials, the diluentshall be added slowly down the wall of the container to thoroughly wetthe powder before to avoid splatter of drug powder. A filtered needle

should be used when withdrawing contents from the ampule to avoidglass pieces being drawn into the syringe.


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The volume of cytotoxic solution shall be adjusted while the needle isin the vial so that no excess drug shall be drawn up. If excess drug isdrawn up, the excess liquid shall be returned to its vial wheneverpossible or in the case of ampules discarded into a closed container (ie.empty sterile vial should be available in the biological safety cabinet).Placing excess drug in any type of open container, even while workingin the hood is INAPPROPRIATE. Discarding excess drug into thedrainage trough of the hood is also inappropriate. These practicesunnecessarily increase the risk of exposure to large amounts ofhazardous drug.

To minimize aerosolization utilize negative pressure techniques. Use

large bore needles (ie. 18 or 20 gauge) to ensure that high pressurebuild up of solutions during dilution is avoided. Care should be takento avoid dripping solutions when large bore needles are used. In orderto minimize aerosolization and avoid needle stick injuries do not clipor re-cap needles or break syringes.


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After completing the preparation, the external surfaces of syringes andIV bags or bottles and pumps especially the access points shall be

wiped clean of any drug contamination with an alcohol wipe.

All glass bottles should be kept in the nursing preparation/medicationroom until ready to be hung and not at patient bedside to avoid

breakage.

The administration sets should be attached and primed prior to thecytotoxic drug being added to the IV fluid. If the cytotoxic drug hasbeen added prior to the set being primed, then priming can beperformed by removing the distal tip or needle cover before priming

and releasing only the first drop into a sterile, alcohol dampened gauzesponge and discarding the gauze pad as cytotoxic waste. Otheracceptable methods of priming such as closed receptacles (ie.evacuated containers) or back-filling of IV sets may be utilized. Do notprime sets or syringes into the sink or any open receptacle.


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Place contaminated glass vials and needles in a leak-proof, puncture-proof cytotoxic container appropriately marked as hazardous chemical

waste. All other contaminated wastes, (ie. syringes, paper toweling,gloves, sterile pads) should be placed in red bio-hazardous garbagebags.

Chemo Prep and Safe Handling

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