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Chemotherapy Administration FAQs

Q:  How can we administer an oral cancer medication to a cancer patient who has just had an NG tube inserted? For safety reasons, we were told not to crush tablets or open capsules.  

Oral cancer medications that are considered hazardous or cytotoxic should not be manipulated outside of a containment cabinet (ie. Biological Safety Cabinet) due to the risk of generating Hazardous Drug (HD) powder residue causing possible HD contamination and exposure. You may try dissolving or suspending the tablet/capsule particles in an enclosed system (i.e. syringe plus water) and administering the liquid through the NG tube.

If line occlusion occurs and impedes cancer drug administration you could consider holding the drug for a few days. For example; tamoxifen has an elimination half-life of ~ 5-7 days and the half-life of its active metabolite is ~ 9-14 days, so it is possible to hold tamoxifen therapy for ~2 weeks.

If the oral cancer medication cannot be withheld, it may be possible to compound it into a liquid dosage form. All activities likely to result in particle or aerosol generation, such as crushing tablets/capsules or compounding/pouring of oral solutions should be performed in a Biological Safety Cabinet (BSC) or Isolator. Oral solutions for hospital inpatients should be prepared in the pharmacy and dispensed to the ward in unit dose syringes. The nurses should not measure doses from a bottle.

Reference:

BCCA Division of Pharmacy. BCCA Pharmacy Practice Standards for Hazardous Drugs. 2008. 

 
Frequently asked questions about Baxter Elastomeric INFUSORS® (“Infusors”).

Q: We recently had an incident where the wrong Infusor was selected for a patient. We had another incident where the incorrect diluent (normal saline) was selected instead of D5W. What other sources of errors should we watch for when providing Infusors to patients?

A: The following checklist can be used to help prevent rate errors from occurring with Infusors.

Q: We occasionally encounter Infusors that have either run too fast or too slow. How can we determine what caused this?

A: The following checklist can be used to determine possible causes of deviations from the expected infusion rates for Infusors. 


Contact Baxter (1-888-719-9955) to log an Infusor failure. You will be sent a canister for shipping the infusor to Baxter for testing.

Q: There is no Infusor designed to deliver a 72 hour (3 day) infusion of fluorouracil. Can we fill a 96 hour (4 day) Infusor 75% full to deliver the 72 hour infusion? We have a patient who started out getting 1000 mg/m2/day for 4 days. The oncologist has ordered a dose reduction to 75%, giving 1000 mg/m2/day for 3 days for a total of 3000 mg/m2.

A: No. Under-filling Infusors will result in them infusing faster than the intended rate. Infusors should be filled to at least the minimum volume listed on the Infusor. There are a couple of options you could consider:

  • Contact the oncologist to see if it would be possible to deliver a 75% dose by giving 750 mg/m2/day for 4 days for a total of 3000 mg/m2.
  • Use more than one Infusor to deliver the dose:
    • use one 24 hour (1 day) tubular Infusor daily for 3 days, which will require having the patient come back daily
    • use one 48 hour (2 day) Infusor for the first 2 days, and one 24 hr (1 day) Infusor for the 3rd day

Q: What is dose banding? 

A: Dose banding specifies a predetermined standard dose that will be dispensed when an individual calculated dose is within a specific range or band.  All calculated doses within a certain band are substituted with the standardized dose indicated for that dose range.  Capecitabine is an example of a medication that is dispensed using dose banding; the dose calculated for an individual, based on BSA, is rounded to a standardized dose to accommodate the tablet strengths available.

The BCCA has implemented dose banding for fluorouracil for Gastrointestinal  (GI) protocols that include a 46-hour infusional fluorouracil treatment.  For these protocols, the dose bands are in 400 mg increments (for doses between 3000 – 5500 mg) so that dose adjustments are within 200 mg (i.e., a difference of 5% or less) of the calculated dose.  Doses outside 3000 – 5500 mg are not dose banded.  LV5 Infusors are used to prepare all doses.  All other protocols with an infusional fluorouracil treatment component do not include a dose banding alternative, and the Infusor will continue to be prepared with the exact calculated dose.


Q: How do you select the correct fluorouracil Infusor?

A: The BCCA protocols and preprinted orders with dose banding for Infusors have been updated to include the following dispensing options:

1. Dose banding alternative

  • LV5 Infusors* filled to a final volume of 230 mL for all doses
2. Non- dose banding alternative 
  • LV5 Infusors* filled to a final volume of  230 mL for doses greater than 4400mg
  • SV2 Infusors** filled to a final volume of  92 mL for doses less than or equal to 4400mg 
Infusor Codes:
*   LV5 Infusor: Large Volume 5 mL/hour fixed flow rate
**SV2 Infusor: Small  Volume 2 mL/hour fixed flow rate

When selecting the appropriate Infusor to dispense for the involved GI protocols with 46-hour infusional fluorouracil treatment, follow the practice determined for the individual facility where you are practicing.
In the BCCA Centres use the dose banding alternative:
    • Dose banding 
      • select LV5 Infusor
In Communities Oncology Network (CON) facilities the practices may vary. CON facilities may choose to use either the dose banding or the non-dose banding alternative. 
    • Dose banding 
      • select LV5 Infusor
    • Non-dose banding 
      • select LV5 infusor for doses greater than 4400 mg
      • select  SV2 infusor for doses less than or equal to 4400 mg
In all cases compare the Infusor code on the BCCA preprinted order with the code on the Infusor.

To get a better understanding of how doses are rounded off for dose banding, please refer to the fluorouracil orders in the GIAJFFOX preprinted order.

Please refer to the following resources for further information about dose banding at BCCA: 
    • Dose Banding of Infusional Fluorouracil for Gastrointestinal (GI) protocols: September 2014 issue – page 2
    • Dose Banding of Infusional Fluorouracil: October 2014 issue – page 3
BCCA Policy III-140 Dose Banded Chemotherapy Treatments [Systemic Therapy – Policies & Procedures]

Further information about Infusors can be found online as outlined below:


Revised May 3, 2017



 
SOURCE: Chemotherapy Administration FAQs ( )
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