Chemo rounding - may round chemo DOWN to nearest vial if dose within ≤ 5% of ordered dose. Chemo doses will not be rounded up. (Approved 12/18)
High Alert Drug: Chemotherapeutic Agents - Parenteral
• Stored separately in pharmacy. • Pharmacist reviews literature in order to to verify calculations and dose prescribed. • Two pharmacists independently verify preparation. • No telephone orders. Pre-printed order sheet available. • Chemo is administered by specially trained RNs. • 2 RNs independently verify pump settings and drug on continuous infusions prior to administration. • IV sites are assessed every 2 hours. • Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.
Per policy, these medications require cardiac and/or special monitoring. (KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes
cytotoxic agents (chemotherapy) IV Push, IV Infusion (chemotherapy) Key: certified RN and 1N designated staff only
Y (CCU only)
N
N
Y (1N only)
N
N
Y
N
Per policy, these hazardous drugs have special waste requirements.
Generic (Brand)
Waste Requirements
CISplatin (Platinol)
If > 3% by weight of drug remains ⇒ BLACK BUCKET Trace amounts/uncontaminated PPE ⇒ YELLOW BUCKET
USP <800> Hazardous Drugs
Per Policy, these drugs have special handling requirements (any drug with an "AOR" is exempt from these requirements under normal circumstances).
generic (Brand) Route
Risk Level
AOR?
Warnings (hover over entry for details)
CISplatin (Platinol) IV
High
No
IARC-2ANTP-2FDA-D
Receiving
• Gloves: Single
Pharmacy: Preparation
• Gloves: Double
• Gown: Yes
• Ventilated Engineering controls: Yes, Class II bio-safety cabinet or compounding aseptic containment isolator
• Closed System Transfer Device: Yes
Nursing: Administration
• Gloves: Double
• Gown: Yes
• Eye/face protection: ---
• Closed System Transfer Device: Yes
Adult Extravasation Management
Generic (Brand)
Vesicant / irritant
Local Care
Comments / Treatment links
CISplatin (Platinol)
Vesicant at concentration > 0.4 mg/mL
Cold compress
• CISplatin extravasation treatment is ONLY for large volumes (> 20 mL) of a concentration solution (> 0.4 mg/mL). • Inject 2 mL intravenously into existing IV line for each 100 mg of CISplatin extravasated; consider also injecting 1 mL subcutaneously as 0.1-mL injections clockwise into the area around the extravasation, may repeat subcutaneous injections several times over the next 3-4 hours.
Last updated: Jun. 12, 2024
Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug
Chemo doses will not be rounded up. (Approved 12/18)
• Pharmacist reviews literature in order to to verify calculations and dose prescribed.
• Two pharmacists independently verify preparation.
• No telephone orders. Pre-printed order sheet available.
• Chemo is administered by specially trained RNs.
• 2 RNs independently verify pump settings and drug on continuous infusions prior to administration.
• IV sites are assessed every 2 hours.
• Drugs are transported in plastic bags/designated transport containers labeled with sticker indicating CHEMOTHERAPY DRUG.
(KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
IV Push, IV Infusion (chemotherapy) Key: certified RN and 1N designated staff only
(CCU only)
(1N only)
Trace amounts/uncontaminated PPE ⇒ YELLOW BUCKET
(hover over entry for details)
Preparation
Administration
• Inject 2 mL intravenously into existing IV line for each 100 mg of CISplatin extravasated; consider also injecting 1 mL subcutaneously as 0.1-mL injections clockwise into the area around the extravasation, may repeat subcutaneous injections several times over the next 3-4 hours.