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It is your responsibility to know how to respond in the event of accidental contamination of antineoplastic drugs.    Ensure you follow local policies, procedures and guidelines when responding to accidental contamination of colleagues, patients and carers.  Health surveillance refers to the monitoring of persons to identify changes in their health status due to the potential occupational exposure of a hazardous substance. The purpose of health surveillance is to minimise any adverse health effects to workers who routinely handle hazardous drugs or related waste and are at risk of occupational exposure.   It is important to know and follow both state legislation and local policy in regards to employee health surveillance.  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The patient experienced life threatening toxicities including: paraesthesia, bone marrow suppression, severe oral mucositis, paralytic ileus, bladder atony, myalgia  muscle weakness, high fever, derangements of various organs (liver, heart), hypertension, insomnia  The patient received symptomatic and supportive care and recovered from some of the toxicities. However the patient was left with residual paraesthesia in the extremeties.  Reference: Chae, L, Moon, H., Kim, S. (1998). Overdose of vincristine: Experience with a patient. Journal of Korean Medical Sciences, 13, pp 334-338. http://jkms.org/Synapse/Data/PDFData/0063JKMS/jkms-13-334.pdf. Viewed 12 November 2010. 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Dose adjustments are also made according to: the presence or absence of toxicity  factors that may affect drug elimination such as renal and hepatic function  concomitant medications  Reference: Clinical Oncological Society of Australia (2008) Guidelines for the Safe Prescribing, Dispensing and Administration of Cancer Chemotherapy ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_802","class":"TODO::Senthil","instance":"SmartShape_802","title":"X ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si77611","class":"TODO::Senthil","title":"X ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si77622","class":"TODO::Senthil","title":"X ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SS_white3_1400","class":"TODO::Senthil","instance":"SS_white3_1400","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_803","class":"TODO::Senthil","instance":"SmartShape_803","title":"There are points of controversy and inherent inaccuracies when measuring height and weight in the clinical setting.  Examples include lack of:   standardisation of timing to remeasure height (if applicable) and weight  regular maintenance and calibration of weight and height scales   another example is the variable techniques and equipment used when measuring height and weight in different clinical settings  Reference: Jastaniah, W. & Aseeri, M. (2010). ‘A cross-sectional study comparing variation in body surface area and chemotherapy dosing is pediatric oncology using two different methods’ Journal of Oncology Pharmacy Practice, vol. 16, no. 3, pp.189-193. American Society of Clinical Oncology / Oncology Nursing Society Chemotherapy Administration Safety Standards (2009). Oncology Nursing Forum, vol. 36, no. 6, pp. 651-658  Kaestner, S. A., & Sewell, G. J. (2007). Chemotherapy dosing part I: scientific basis for current practice and use of body surface area. Clinical oncology, 19(1), 23-37. 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The 2006 ABS survey showed that only 40% of men and 41% of women had a health literacy level that was considered adequate. This percentage was even lower in older age groups, and in those born in non-English speaking countries.   Patient and family members may:   They need to understand complex information, including unfamiliar medical terminology, and complex topics like weighing the potential risks and benefits of treatment.  They are in a stressful and emotional situation, which may affect how well they take in and understand any information. The patient may also be physically unwell, which may also affect their capacity to deal with information.  It is important to consider the issue of health literacy when providing education for the patient and family members. How are you going to ensure the patient’s health literacy level is taken into consideration while educating them?  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Planning the formal pre antineoplastic drug education session requires you to: consider if informed consent has been obtained review the treatment plan determine: what to include in the education where to conduct the education session when to give the education whom to include in the education session  The final step is to collect appropriate resources to give to your patient, family member and carer once the education session has finished. 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How anxious are they about the treatment? Will this affect their retention of the information provided? Is it an appropriate time to provide education? Are the circumstances appropriate for learning?   Patients and carers may find the amount of information provided overwhelming, leading to poor retention. Information may need to be repeated to emphasise important points and to revisit important details which may have been missed or forgotten.  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Careful assessment of a patient’s need for information will mean that you are less likely to: overload patients who may not want detailed information or provide insufficient information to patients who like a lot of detailed information  Although some patients do not want detailed information, it is important to provide key information such as  when to seek urgent medical attention, contact details of key personnel and details regarding their medications and safe handling of antineoplastic drugs and related waste in the health facility and at home. 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NOTE: Using a family member or non-professional interpreter may have a number of serious consequences: inferior quality of interpreting and inaccuracies due to lack of skills and familiarity with ethics, medical concepts and terminology altering, censoring, distortion and suppression of messages, especially when relatives act as interpreters inappropriate responsibilities being placed upon family members breach of patient/client confidentiality invalidity of consent invalidity of patient identification, correct procedure, correct site  Reference: NSW Health. Policy Directive – Standard procedures for working with health care interpreters. Viewed March 2018.  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Patient assessment is an extremely important process as it allows you to: establish a baseline for comparison throughout treatment determine if the patient is well enough to commence or continue with antineoplastic drug treatment  assist in managing common and drug specific side effects identify serious side effects in a timely manner e.g. oral mucositis and ototoxicity assess the effectiveness of supportive measures with the aim of improving quality of life improve patient outcomes by potentially reducing morbidity and mortality reinforce education strategies to support patients and families through antineoplastic treatment        i.e self management of side effects at home and care of a venous access device identify supportive care issues  offer an opportunity for patients and families to ask questions  ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_904","class":"TODO::Senthil","instance":"SmartShape_904","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_905","class":"TODO::Senthil","instance":"SmartShape_905","title":"If there is no local assessment tool eviQ provides the Antineoplastic drug patient assessment tool ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_906","class":"TODO::Senthil","instance":"SmartShape_906","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_284","class":"TODO::Senthil","instance":"Image_284","roles":{}},{"id":"SmartShape_911","class":"TODO::Senthil","instance":"SmartShape_911","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_912","class":"TODO::Senthil","instance":"SmartShape_912","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_913","class":"TODO::Senthil","instance":"SmartShape_913","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_914","class":"TODO::Senthil","instance":"SmartShape_914","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_237","class":"TODO::Senthil","instance":"Image_237","roles":{}},{"id":"SmartShape_516","class":"TODO::Senthil","instance":"SmartShape_516","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si64081","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si64092","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_732","class":"TODO::Senthil","instance":"SmartShape_732","title":"Assessing patients ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_626","class":"TODO::Senthil","instance":"SmartShape_626","title":"page 1 of 5 ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_907","class":"TODO::Senthil","instance":"SmartShape_907","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"white01_908","class":"TODO::Senthil","instance":"white01_908","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_909","class":"TODO::Senthil","instance":"SmartShape_909","title":"It is important you provide appropriate education to patients and families about caring for their CVAD. 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Well known examples include: Common Terminology Criteria for Adverse Events (CTCAE) Eastern Cooperative Oncology Group (ECOG) Performance Status  Other examples include:  Karnofsky Performance Status  Lansky Global Assessment of Functioning Score (GAF) for use in paediatric and adolescents up to 16 years old.  There are also a range of psychosocial assessment tools available.         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It is important to reinforce a multidisciplinary approach to coordinated communication to improve safe patient outcomes.  Refer to your local policies, procedures and practices. 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essential you are aware of the class of antineoplastic drug you are administering to ensure prompt recognition, assessment and treatment of any suspected or actual extravasation injury.  There are four classes based on their potential to cause local toxicity  1. Vesicant any drug or substance that is capable of causing tissue destruction and necrosis when extravasated. They are sub classified according to the mechanism by which they cause cell damage i.e. DNA binding or non-DNA binding  2. Irritant with vesicant properties drugs which are difficult to classify as either a vesicant or irritant. They are capable of causing tissue damage and ulceration when extravasated   3. Irritant any drug or substance that causes stinging, aching, tightness and phlebitis but without necrosis when extravasated  4. 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The most common sites are:  the abdomen, the back of the upper arms, the upper buttock, outer side of the thigh.  There are various techniques for SC injections.  Follow manufacturers instructions and if need be read the accompanying leaflets. ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_315","class":"TODO::Senthil","instance":"Image_315","roles":{}},{"id":"Text_Caption_332","class":"TODO::Senthil","instance":"Text_Caption_332","title":"450 ","roles":{"textData":{}}},{"id":"SmartShape_1156","class":"TODO::Senthil","instance":"SmartShape_1156","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Text_Caption_333","class":"TODO::Senthil","instance":"Text_Caption_333","title":"900  ","roles":{"textData":{}}},{"id":"SmartShape_1157","class":"TODO::Senthil","instance":"SmartShape_1157","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1158","class":"TODO::Senthil","instance":"SmartShape_1158","title":"The following YouTube video may be of interest for you:  Injection Techniques ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_316","class":"TODO::Senthil","instance":"Image_316","roles":{}},{"id":"SmartShape_1159","class":"TODO::Senthil","instance":"SmartShape_1159","title":"Subcutaneous injection ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1249","class":"TODO::Senthil","instance":"SmartShape_1249","title":"page 1 of 4 ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1250","class":"TODO::Senthil","instance":"SmartShape_1250","title":"SC/IM/Topical ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1511","class":"TODO::Senthil","instance":"SmartShape_1511","title":"< Back ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si110022","class":"TODO::Senthil","title":"< Back ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1512","class":"TODO::Senthil","instance":"SmartShape_1512","title":"Next > ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si110075","class":"TODO::Senthil","title":"Next > ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_374","class":"TODO::Senthil","instance":"Image_374","roles":{}},{"id":"SmartShape_1576","class":"TODO::Senthil","instance":"SmartShape_1576","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si113552","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si113571","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Slide94034","class":"Normal Slide","instance":"Subcutaneous injection","thumbnail":"","children":["Text_Caption_91","Text_Caption_120","si94048","si94063","si94080","si94095","SmartShape_1155","Image_315","Text_Caption_332","SmartShape_1156","Text_Caption_333","SmartShape_1157","SmartShape_1158","Image_316","SmartShape_1159","SmartShape_1249","SmartShape_1250","SmartShape_1511","si110022","SmartShape_1512","si110075","Image_374","SmartShape_1576","si113552","si113571"],"roles":{"slide":{"durationInFrames":252},"navigation":{"navid":"Slide94034"}}},{"id":"si94452","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si94467","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si94484","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si94499","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1164","class":"TODO::Senthil","instance":"SmartShape_1164","title":"Administering intramuscular antineoplastic ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1165","class":"TODO::Senthil","instance":"SmartShape_1165","title":"Before administering an antineoplastic drug via IM injection a patient assessment should be conducted which includes: establishing if any contraindicating factors are present,  site selection and assessment. The common sites for administration are: Deltoid at the shoulder,  Ventrogluteal at the outer upper thigh, Vastus lateralis on the front of the thigh,  Rectus femoris site, anterolateral aspect of the thigh.  Ensure the z-track technique is used to reduce                                                                                                                                                  the risk of back flow up the injection track.  The evidence is inconclusive with respect of                                                                                                                                              aspirating or not before administrating an                                                                                                                                                             IM injection, ensures you refer to your local                                                                                                                                                        policies, practices and guideline for management. ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_319","class":"TODO::Senthil","instance":"Image_319","roles":{}},{"id":"SmartShape_1166","class":"TODO::Senthil","instance":"SmartShape_1166","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Text_Caption_336","class":"TODO::Senthil","instance":"Text_Caption_336","title":"If you’re interested, watch a demonstration of an IM injection using the  Z-track technique on YouTube (timing from 0 to 0.30) ","roles":{"textData":{}}},{"id":"Image_320","class":"TODO::Senthil","instance":"Image_320","roles":{}},{"id":"SmartShape_1251","class":"TODO::Senthil","instance":"SmartShape_1251","title":"page 2 of 4 ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1252","class":"TODO::Senthil","instance":"SmartShape_1252","title":"SC/IM/Topical ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1513","class":"TODO::Senthil","instance":"SmartShape_1513","title":"< Back ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si110128","class":"TODO::Senthil","title":"< Back ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1514","class":"TODO::Senthil","instance":"SmartShape_1514","title":"Next > ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si110181","class":"TODO::Senthil","title":"Next > ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_373","class":"TODO::Senthil","instance":"Image_373","roles":{}},{"id":"SmartShape_1575","class":"TODO::Senthil","instance":"SmartShape_1575","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si113474","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si113493","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Slide94449","class":"Normal Slide","instance":"Administering intramuscular antineoplastic","thumbnail":"","children":["Text_Caption_91","Text_Caption_120","si94452","si94467","si94484","si94499","SmartShape_1164","SmartShape_1165","Image_319","SmartShape_1166","Text_Caption_336","Image_320","SmartShape_1251","SmartShape_1252","SmartShape_1513","si110128","SmartShape_1514","si110181","Image_373","SmartShape_1575","si113474","si113493"],"roles":{"slide":{"durationInFrames":252},"navigation":{"navid":"Slide94449"}}},{"id":"si94707","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si94722","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si94739","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si94754","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1167","class":"TODO::Senthil","instance":"SmartShape_1167","title":"Administering topical antineoplastic drugs ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1188","class":"TODO::Senthil","instance":"SmartShape_1188","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1189","class":"TODO::Senthil","instance":"SmartShape_1189","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Text_Caption_344","class":"TODO::Senthil","instance":"Text_Caption_344","title":"Topical antineoplastic agents can be prepared in a number of forms including:  creams gel eye drops ointments    ","roles":{"textData":{}}},{"id":"Text_Caption_345","class":"TODO::Senthil","instance":"Text_Caption_345","title":"Topical antineoplastic agents have been prepared for the direct purpose of application to the skin or mucous membranes (i.e. eye drops). These agents are absorbed through the skin / mucous membrane into the systemic circulation.   The use of topical agents helps minimise absorption of the agent allowing the drug to work locally at the site of application. When administering topical agents it is important to be aware of factors which may affect absorption therefore may require dose modification.  ","roles":{"textData":{}}},{"id":"Text_Caption_346","class":"TODO::Senthil","instance":"Text_Caption_346","title":"When administering topical agents consider:  children have an increased body surface area to weight ratio fragile skin in the elderly and neonates broken skin as a result of trauma and burns  ","roles":{"textData":{}}},{"id":"Image_326","class":"TODO::Senthil","instance":"Image_326","roles":{}},{"id":"SmartShape_1253","class":"TODO::Senthil","instance":"SmartShape_1253","title":"page 3 of 4 ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1254","class":"TODO::Senthil","instance":"SmartShape_1254","title":"SC/IM/Topical ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1515","class":"TODO::Senthil","instance":"SmartShape_1515","title":"< Back ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si110234","class":"TODO::Senthil","title":"< Back ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1516","class":"TODO::Senthil","instance":"SmartShape_1516","title":"Next > ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si110287","class":"TODO::Senthil","title":"Next > ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_372","class":"TODO::Senthil","instance":"Image_372","roles":{}},{"id":"SmartShape_1574","class":"TODO::Senthil","instance":"SmartShape_1574","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si113396","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si113415","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Slide94704","class":"Normal Slide","instance":"Administering topical antineoplastic drugs","thumbnail":"","children":["Text_Caption_91","Text_Caption_120","si94707","si94722","si94739","si94754","SmartShape_1167","SmartShape_1188","SmartShape_1189","Text_Caption_344","Text_Caption_345","Text_Caption_346","Image_326","SmartShape_1253","SmartShape_1254","SmartShape_1515","si110234","SmartShape_1516","si110287","Image_372","SmartShape_1574","si113396","si113415"],"roles":{"slide":{"durationInFrames":252},"navigation":{"navid":"Slide94704"}}},{"id":"si95604","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si95619","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si95636","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si95651","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1190","class":"TODO::Senthil","instance":"SmartShape_1190","title":"Application of topical antineoplastic drugs ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Text_Caption_350","class":"TODO::Senthil","instance":"Text_Caption_350","title":"In cases of contamination, topical antineoplastic agents need to be removed immediately with soap and water.  After the required contact time patients should be advised to shower rather than bath, to ensure they are not soaking in residual drug.     ","roles":{"textData":{}}},{"id":"SmartShape_1193","class":"TODO::Senthil","instance":"SmartShape_1193","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1194","class":"TODO::Senthil","instance":"SmartShape_1194","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1195","class":"TODO::Senthil","instance":"SmartShape_1195","title":"Topical antineoplastic agents need to be applied: as directed by the manufacturer or pharmacy so as to avoid contact with eye and other mucous membranes (unless otherwise indicated) to minimise contact with patients clothing (to avoid cross contamination) to avoid contact with unaffected areas       ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Text_Caption_351","class":"TODO::Senthil","instance":"Text_Caption_351","title":"Areas with greater uptake of topical agents and increased risk of side effects are:  the groin armpits insides of the elbow backs of the knee  ","roles":{"textData":{}}},{"id":"SmartShape_1196","class":"TODO::Senthil","instance":"SmartShape_1196","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Text_Caption_352","class":"TODO::Senthil","instance":"Text_Caption_352","title":"In these areas antineoplastic agents should be applied sparingly.  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An intraventricular reservoir may be used instead when lumbar puncture procedure is challenging. The commonly used devices are an Ommaya or a Rickham reservoir.  A risk for patients with leukaemia and lymphoma is the spread of cancer cells into the CSF. In some solid tumour, cancer cells can also occasionally spread in the CSF, the membranes surrounding the brain and spinal cord which known as leptomeningeal metastases.   Many antineoplastic drugs are not able to cross the blood brain barrier limiting efficacy of other administration routes in treating disease in the CSF. ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1230","class":"TODO::Senthil","instance":"SmartShape_1230","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1231","class":"TODO::Senthil","instance":"SmartShape_1231","title":"See your locally developed resources or if none available see the following eviQ resources: Clinical Procedure - Intrathecal Administration of Antineoplastic Drugs Patient Information - Intrathecal Chemotherapy ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1232","class":"TODO::Senthil","instance":"SmartShape_1232","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_334","class":"TODO::Senthil","instance":"Image_334","roles":{}},{"id":"Image_335","class":"TODO::Senthil","instance":"Image_335","roles":{}},{"id":"SmartShape_1233","class":"TODO::Senthil","instance":"SmartShape_1233","title":"It is important patients receive education about the intrathecal route of administration as well as the lumbar puncture procedure. Patient should be deemed fit for treatment and written consent should be obtained by the treating team. ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SS_Show_Intravent_1234","class":"TODO::Senthil","instance":"SS_Show_Intravent_1234","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"ss_white_1235","class":"TODO::Senthil","instance":"ss_white_1235","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1236","class":"TODO::Senthil","instance":"SmartShape_1236","title":"         ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_336","class":"TODO::Senthil","instance":"Image_336","roles":{}},{"id":"SmartShape_1237","class":"TODO::Senthil","instance":"SmartShape_1237","title":"X ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si97339","class":"TODO::Senthil","title":"X ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si97350","class":"TODO::Senthil","title":"X ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1238","class":"TODO::Senthil","instance":"SmartShape_1238","title":"An intraventricular reservoir is a small plastic device that is placed under the scalp that provides direct access to the brain, spinal cord or the CSF. An intraventricular reservoir is inserted in the operating theatre under a general anaesthetic. This reservoir has a small silicone  area where a needle can be inserted, and to give antineoplastic  drug directly into the fluid in the brain & spinal cord.  Only health care professionals who have attained competency  and are approved as per local institutional guidelines in  intraventricular administration of antineoplastic drugs and the  recognition and management of complications should perform  this procedure.  See your locally developed resources or if none available see the  following eviQ resources. Clinical Procedure - Administration of  Antineoplastic Drugs via an Intraventricular Reservoir ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1257","class":"TODO::Senthil","instance":"SmartShape_1257","title":"page 1 of 2 ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1258","class":"TODO::Senthil","instance":"SmartShape_1258","title":"Intrathecal ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1519","class":"TODO::Senthil","instance":"SmartShape_1519","title":"< Back ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si110446","class":"TODO::Senthil","title":"< Back ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1520","class":"TODO::Senthil","instance":"SmartShape_1520","title":"Next > ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si110499","class":"TODO::Senthil","title":"Next > ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_370","class":"TODO::Senthil","instance":"Image_370","roles":{}},{"id":"SmartShape_1572","class":"TODO::Senthil","instance":"SmartShape_1572","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si113240","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si113259","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Slide95798","class":"Normal Slide","instance":"Administering intrathecal antineoplastic drugs ","thumbnail":"","children":["Text_Caption_91","Text_Caption_120","si95812","si95821","si95832","si95841","SmartShape_1228","SmartShape_1229","SmartShape_1230","SmartShape_1231","SmartShape_1232","Image_334","Image_335","SmartShape_1233","SS_Show_Intravent_1234","ss_white_1235","SmartShape_1236","Image_336","SmartShape_1237","si97339","si97350","SmartShape_1238","SmartShape_1257","SmartShape_1258","SmartShape_1519","si110446","SmartShape_1520","si110499","Image_370","SmartShape_1572","si113240","si113259"],"roles":{"slide":{"durationInFrames":252},"navigation":{"navid":"Slide95798"}}},{"id":"si96969","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si96978","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si96989","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"si96998","class":"TODO::Senthil","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1239","class":"TODO::Senthil","instance":"SmartShape_1239","title":"Clinical procedure of intrathecal administration ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1240","class":"TODO::Senthil","instance":"SmartShape_1240","title":"Staff must be specifically trained, accredited and experienced in cancer treatment to prescribe, prepare, dispense, deliver, receive, check or administer intrathecal antineoplastic drugs. Ensure you are aware of any specific training requirements in relation to administration of intrathecal antineoplastic drugs.  The lumbar puncture procedure and instillation of antineoplastic drugs is usually performed by a medical officer however appropriately trained and certified Nurse Practitioners may perform the procedure in some instances. The role of the nurse is to provide assistance to the medical officer as required, perform medication and time out checks, observe the patient throughout the procedure and monitor the patient post procedure.   The COSA Guidelines for the Safe Prescribing, Dispensing and Administration of Cancer Chemotherapy  state that \"methotrexate, cytarabine, hydrocortisone and dexamethasone are commonly given by the intrathecal route. Occasionally rituximab and thiotepa may be given by this route.\"  ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1241","class":"TODO::Senthil","instance":"SmartShape_1241","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1242","class":"TODO::Senthil","instance":"SmartShape_1242","title":"See your locally developed resources or if none available see the following eviQ resources: Clinical Procedure - Intrathecal Administration of Antineoplastic Drugs Patient Information - Intrathecal Chemotherapy See the safety alert from Australian Commission on safety and Quality in Health Care ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1243","class":"TODO::Senthil","instance":"SmartShape_1243","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"Image_337","class":"TODO::Senthil","instance":"Image_337","roles":{}},{"id":"SmartShape_1244","class":"TODO::Senthil","instance":"SmartShape_1244","title":" ","roles":{"click":{"subtype":"button"},"textData":{}}},{"id":"SmartShape_1245","class":"TODO::Senthil","instance":"SmartShape_1245","title":"“The consequences of inadvertently administering antineoplastic drugs not intended for intrathecal use can be FATAL. 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Gonzalez, T., Chemotherapy extravasations: prevention, identification, management, and documentation. Clinical Journal of Oncology Nursing. 17(1): p. 61-6. Griggs, J.J., et al., Appropriate Chemotherapy Dosing for Obese Adult Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology, 2012. 30(13): p. 1553-1561. Hahn, J.C. and A.B. Shafritz, Chemotherapy extravasation injuries. Journal of Hand Surgery - American Volume. 37(2): p. 360-2.  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British Journal of Nursing. 20(17): p. S16, S18-22. Thompson, A., et al., Guidelines for the diagnosis, prevention and management of chemical- and radiation-induced cystitis. Journal of Clinical Urology, 2014. 7(1): p. 25-35. Yarbro, C.H., Wujcik, D. & Gobel, B.H. 2011, Cancer Nursing Principles and Practice 7th Edn, Jones and Bartlett, MA, USA. Waugh, A., & Grant, A. (2014). Ross & Wilson Anatomy and Physiology in health and illness. Elsevier Health Sciences.  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