40) Oncology Manual V4

JIMS/ MAN/ ONCO/
JAGANNATH GUPTA INSTITUTE OF Doc. No.

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Document Name : ONCOLOGY MANUAL
Document No. : JIMS/ MAN/ ONCO/ 40
No. of Pages : 26
Date of Implementation : 06/01/2023
Designation :DNS
Prepared By : Name :Sr Anita Pradhan
Signature :
Designation : MSVP
Approved By : Name : Dr. Soumitra Chatterjee
Signature :
Designation : Quality Manager
Issued By : Name :MrsShayantaniDatta
Signature :
Prepared by Approved By Issued By
DNS MSVP MANAGER QUYALITY

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AMENDMENT SHEET
Sl.No. Page No. Clause No. Date of Amendment Made Signature of
Amendment Reasons approval
authority
Contents
Introduction:.......................................................................................................................................................4

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Purpose:..............................................................................................................................................................4
Scope:.................................................................................................................................................................4
Job description of Oncology Nurse:...................................................................................................................4
Job description of in charge nurse:.....................................................................................................................6
Do’s and don’ts for chemo handling:.................................................................................................................7
Chemotherapy Administration Safety Standards:..............................................................................................8
Staffing-related standards...............................................................................................................................8
Chemotherapy planning: Chart documentation standards..............................................................................9
Chemotherapy order/prescription standards.................................................................................................11
Drug preparation...........................................................................................................................................12
Patient consent and education......................................................................................................................13
Control of Exposure to cytotoxic drugs...........................................................................................................14
Preparation of cytotoxic drugs:........................................................................................................................17
Common side effects caused by chemotherapy drugs include:.......................................................................18
CARING FOR IMPLANTED VENOUS ACCESS PORT SITE:..................................................................20
Introduction:
We acknowledge that individuals live with cancer in a variety of ways and that care is delivered and
documented with a patient focused approach regardless of treatment modalities and/or clinical setting. A
crucial element in the Oncology patient’s plan of care is the documentation which should include
assessments, plans, interventions and evaluations.

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Cytotoxic drugs are used to treat cancer and a number of other disorders. They act by killing dividing cells
by preventing their division, acting on normal as well as malignant cells. Cytotoxic agents may have
genotoxic, oncogenic, mutagenic and teratogenic properties. Their use therefore poses certain risks to those
handling and receiving them. The handling and administration of cytotoxic drugs are hazardous potentially
to the Health care professionals involved in their preparation and administration, and to the patients
receiving them. While the risks to patients are, in the main, well documented and can be balanced against
the clinical benefits, the risks to health care staff are largely theoretical. It is therefore prudent with the
present state of knowledge to take every reasonable precaution to protect staff from unnecessary exposure.
Purpose:
The purpose of this document is to provide guidance on the safe prescribing, dispensing and administration
of chemotherapy and related agents used in the treatment of cancer. The aim is to assist in the prevention of
medication errors and to improve patient safety with respect to the treatment of cancer.
Scope:
This manual defines the procedures and services provided in the Oncology Unit of jimsh. It also defines the
responsibilities of the care providers in the unit
Job description of Oncology Nurse:

Designation:- Chemotherapy Nurse.
Department:- Oncology
Report to:- ND
Job Specification
Qualification:-GNM /Graduate/Post Graduate in nursing.
Experience:-For GNM minimum 12 months experience.
For Graduate / Post graduate 6months experience.
SKILLS :-
 Good Communication

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 Computer Literate
 Willing to work in shifts, on Sundays & holiday and for long hours.
 Ability to handle stress
 Good typing speed
 Good Knowledge of Medical &surgical terms
 Good Knowledge about changes in lab. Parameters values in relation with
chemotherapeutic drugs.
 Performs chemotherapy administration, physician assistance, information gathering, sample
collection, patient education, patient follow-up, supply maintenance.
Job descriptions :
1. Chemotherapy Administration. Administers PO, SC injections, chemotherapy drugs, and other

medications as ordered by physician.
2. Physician Assistance. Assists physician as needed. Ensures that all information is available.
3.Information Gathering. Obtains patient histories. Takes and records various readings such as heart and
respiratory rate, blood pressure, weight, body temperature, mental status, etc. Obtains laboratory results.
 Sample Collection. Collects samples from patients including blood, urine, etc. Prepares samples for
analysis or shipment.
 Patient Education. Provides educational information to patients, family, etc. pertaining to the
administration of chemotherapy. Answers inquiries and provides advice as needed.
 Patient Follow Up. Schedules radiological studies. Makes follow up patient appointments, .
Answers routine questions from patients, and family. Obtains referrals, etc.
 Supply Maintenance. Orders and accounts for medical supply stock. Orders chemotherapy
administering supplies.
 Consultation. Consults with other medical personnel and may provide expert information about
chemotherapy, side effects, etc.
 As Needed. Performs various duties as needed to successfully fulfill the function of the position.
Education & Training:

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 Liaise with Pharmacist and take responsibility to educate and train nurses on matters of cancer
patient care.
 Training to reduce drugs error.
 Training of new joinee about the system, policy and procedure of chemo drugs handling in the
ward.
 Attend CNE classes, workshops for updating knowledge.
 Take part in organizing workshop and classes on this subject.
Additional Duties:-
 To participate in flexible working hours

 To share professional excellency on oncology nursing.
 To undertake other reasonable duties within the framework of the post as directed by superiors.
 The Oncology Nurse will be required to undertake any other duties according to the needs of
service and as situation demands.
This job description is not intended to be an exhaustive list of activities, but rather an outline of the main
areas of responsibility. Any reasonable changes will be discussed and agreed with the post holder before any
variations to the job description are made.
Job description of in charge nurse:

1. Taking Handover from last shift Incharge/Supervisor of the unit including unit stock of consumable
and reusable items, equipment’s (like BP, stethoscope, Pulse oxymeter, Glucometer etc.) in the unit
and electronic devices(like Pulse generator, Infusion pump, Syringe pump, nebulizer,BiPAPetc)
2. Unit round to ensure structural safety, cleanliness and adherence of HIC Policy
3. Bedside round to Check patient clinical status and ensure patient’s treatment is well coordinated.
4. Checking of competency of allocated nurse on basis of patient’s diagnosis, investigation, procedure
and administration of medications.
5. Receive new joinee staff in the unit and guide as mentor, and help nurses and technicians in
procedure as an instructor.
6. Inform NS/DNS in case of any employee is sick, and act as a coordinator/liaison person for the
allocated unit.
7. Report incidents/ occurrence variance promptly with details.

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8. Properly endorses the special cases in the ward to the concerned persons and departments. (e.g. VIP
seeking special attention, Communicable disease etc. )
9. Responsible for staff appraisal, safety, security and confidentiality.
10. Promotes her own and staff’s professional skills and educational development.
11. Demonstrate competence in performing CPR, IV cannulation, and all the unit specific procedures.
12. Implementation of appropriate policies and procedures to achieve the hospital’s goals and objectives
in pursuit of standard care.
13. Ensure that all staff nurses knows and understand departmental policies and procedures concerning
emergency codes (like Code blue, Code yellow, Code red)
14. Follow accreditation body’s standards (e.g. NABH)
15. Participate in emergency mock drill, and be part of Continuous staff training.
16. Duties after working hours.
i. Refers unusual problems, incident (i.e. disaster management, sentinel events, breach of policy
etc) to the NS/DNS/Administration on call.
ii. In absence of the administrator and DN in charge will act in behalf of nursing administration.
iii. The Incharge will also handle any emergency, death or incidents within their duty hours.
iv. The in charge is delegated the administrative authority, responsibility and accountability
necessary for carrying out his/her assigned duties as planning and directing departmental
operations.
Do’s and don’ts for chemo handling:

 Not a good idea: Eating, drinking, smoking or applying cosmetics in the prep area violates OSHA
recommendations.
 Do it before hand: Put on protective equipment before beginning to work in the BSC. Before
preparing the drugs, clean the internal surface of the cabinet with 70% alcohol and a disposable towel;
do the same after you're finished, and after any spill.
 Wash thoroughly: If the drug comes in contact with skin, wash skin thoroughly with germicidal soap
and water. If eye contact occurs, flood the eye with water or isotonic eyewash for at least 5 minutes
while holding the eyelid open.
 Post exposure action: After any accidental exposure, obtain a medical evaluation as soon as possible.
 Other safety precautions:
1. Use aseptic technique when preparing drugs.
2. To extract solutions from vials, vent with a hydrophobic filter.
3. When you break ampules, wrap a sterile gauze pad or alcohol sponge around the neck of the
ampule to decrease the chances of droplet contamination.
4. Wear facemask and goggles to protect yourself against splashes and aerosolized drugs.

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5. Don't clip needles, break syringes or remove needles from syringes used in drug preparation.
Place tubing, syringes, and all connected needles into the waste container for sharps disposal;
don't remove or recap needles.
6. Use only syringes and IV sets that have luer-lock fittings. Label all chemotherapeutic drugs with
a chemotherapeutic hazard label.
 Transport Tactics: Transport the medication in a sealable plastic bag, prominently labeled as a
hazardous drug. Only employees who have been educated in the safe handling and disposal of
chemotherapeutic drugs should come in contact with them.
The spill or spills: Be sure your facility's protocol for spill is available in any area where chemotherapeutic
drugs are handled, including patient care areas. Chemotherapy spill kits should be available as well. If a spill
occurs in or out of the preparation area, follow your facility's protocol that is probably based on OSHA
regulations.
Chemotherapy Administration Safety Standards:
Staffing-related standards
1. The practice/institution has policies, procedures, and/or guidelines for verification of training and
continuing education for clinical staff.
A. Orders for parenteral and oral chemotherapy are written and signed by licensed independent practitioners
who are determined to be qualified by thepractice/institution according to the practice’s/institution’s
policies, procedures, and/or guidelines.
B. Chemotherapy drugs (oral or parenteral) are prepared by a doctor or nurse determined to be qualified
according to thepractice’s policies, procedures, and/or guidelines.
C. Only qualified physicians, physician assistants, advanced practice nurses, or registered nurses administer
chemotherapy.
D. The practice/institution has a comprehensive educational program for new staff administering
chemotherapy, including a competency assessment, or thepractice/institution uses an established educational
program regarding chemotherapy administration that ends in competency assessment. Education
andcompetency assessment regarding chemotherapy administration includes all routes of administration

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used in the practice/institution site (eg, parenteral,oral, intrathecal, intraperitoneal, intravesicular), and safe
handling of hazardous chemotherapy agents.
E. The practice/institution has a standard mechanism for monitoring chemotherapy administration
competency at specified intervals.
F. There must be at least one clinical staff member who maintains current certification in basic life support
on site during chemotherapy administration in thehealth care setting.
Chemotherapy planning: Chart documentation standards

2. Before the first administration of a new chemotherapy regimen, chart documentation available to
the practice/institution includes:
A. Pathologic confirmation or verification of initial diagnosis. If original pathology report is unobtainable,
note of explanation is in chart or a reference to primarysource pathology.
B. Initial cancer stage or current cancer status. Cancer stage is defined at diagnosis. Cancer status includes a
current description of the patient’s diseasesince diagnosis/staging, if relevant (eg, recurrence, metastases).
C. Complete medical history and physical examination that includes, at minimum, height, weight, pregnancy
screening (when applicable), and assessment oforgan-specific function as appropriate for the planned
regimen.
Example of assessment of organ-specific function as appropriate for the planned regimen: patient plan for
cisplatin requires pretreatment assessment ofkidney function.
D. Presence or absence of allergies and history of other hypersensitivity reactions.
E. Documentation of patient’s comprehension regarding chemotherapy regimens (and associated
medications), including information regarding disease.
F. Assessment regarding psychosocial concerns and need for support, with action taken when indicated.
Documentation of psychosocial concerns may include copy of distress, depression, or anxiety screening
form in the chart; patient self-report of distress,depression, or anxiety; or chart documentation regarding
patient coping, adjustment, depression, distress, anxiety, emotional status, family support andcare giving,
coping style, cultural background, and socioeconomic status.

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G. The chemotherapy treatment plan, including, at minimum, chemotherapy drugs, doses, anticipated
duration, and goals of therapy.
H. For oral chemotherapy, the frequency of office visits and monitoring that is appropriate for the individual
and the antineoplastic agent and is defined in thetreatment plan.
I. Before initiation of an oral chemotherapy regimen, assessment of the patient’s ability to obtain the drug
and administer it according to the treatment plan isdocumented, along with a plan to address any identified
issues.Assessment includes socioeconomic, psychosocial, financial, administrative and regulatory factors
that may influence initiation and/or adherence toprescribed regimen.
General chemotherapy practice standards:
3. The practice/institution:
A. Defines standard chemotherapy regimens by diagnosis with references readily available, and/or
B. Identifies source(s) for chemotherapy regimens, including local or centralized institutional review board–
approved clinical research protocols or guidelines.
4. For orders that vary from standard chemotherapy regimens, practitioners provide a supporting reference.
Reasons for dose modification or exception ordersare documented.
Exception orders may include notation that standard treatment is contraindicated as a result of pre-existing
comorbidity, organ dysfunction, or prior therapy.
5. The practice/institution maintains written statements that determine the appropriate time interval for
regimen-specific laboratory tests that are:
A. Evidence based when national guidelines exist (eg, American Society of Clinical Oncology or National
Comprehensive Cancer Network guidelines), or
B. Determined by practitioners at the site.
Documentation of regimen-specific laboratory tests may be part of standardized regimen orders.

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6. The practice/institution maintains a policy for how informed consent is obtained and documented for
chemotherapy.
The practice/institution may provide options for consent (eg, use of chart documentation of patient consent
or a signed patient consent form) that allow for
variation among practitioners in the practice/institution.
7. If the practice/institution administers chemotherapy that is prepared (mixed) off site, the
practice/institution maintains a policy for quality control of that chemotherapy.
8. If practice/institution manages its own pharmacy, the practice/institution has a policy regarding the
storage of chemotherapy (including separation of look-alikeproducts, sound-a-like products, and agents
available in multiple strengths). Chemotherapy is stored in a designated area according to
regulatoryguidelines.
Chemotherapy order/prescription standards
Complete orders must include:

A. Patient’s full name and a second patient identifier (eg, medical record number, DOB)
B. Date
C. Diagnosis
D. Regimen name and cycle number
F. Appropriate criteria to treat (eg, based on relevant laboratory results and toxicities)
G. Allergies
H. Reference to the methodology of the dose calculation or standard practice equations (eg, calculation of
creatinine clearance)
I. Height, weight, and any other variables used to calculate the dose
J. Dosage
L. Route and rate (if applicable) of administration
M. Length of infusion (if applicable)
N. Supportive care treatments appropriate for the regimen (including premedication’s, hydration, growth
factors, and hypersensitivity medications)

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O. Sequence of drug administration
Drug preparation
Important points need to keep in mind before handling cytotoxic drugs:

1. Minimum Handling of cytotoxic drugs
2. Minimum motion with cytotoxic drugs
3. Place the drugs in safest area to avoid breakage and spillage before and after preparation.
4. Don’t place the cytotoxic drugs over food trolley.
5. Chemo trolley must be separate and known by all to become cautious.
6. Preparation of cytotoxic agents must take place in filtered vertical LAMINAR flow air with wearing PPE
(above 6 points added on 28.4.16)
A second person (a practitioner or other personnel approved by the practice/institution to prepare or

administer chemotherapy) independently verifies each order for chemotherapy before preparation, including
confirming:
A. Two patient identifiers

B. Drug names
C. Drug dose
D. Drug volume
E. Route of administration
F. Rate of administration
G. The calculation for dosing (including the variables used in this calculation)
H. Treatment cycle and day of cycle
Chemotherapy drugs are labeled immediately upon preparation:
A. Patient’s full name and a second patient identifier (eg, medical record number, DOB)
B. Full generic drug name
C. Drug administration route
D. Total dose to be given

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E. Total volume required to administer this dosage

F. Date of administration
G. Date and time of preparation
H. Date and time of expiration when not for immediate use
Immediate use must be defined by institutional policy, state, and federal regulations (eg, use within 2 h)
I. Special handling instructions as appropriate
J. Administration instructions (oral agents)
K. Number of refills (oral agents)
Patient consent and education
Before initiation of a chemotherapy regimen, each patient is given written documentation, including, at
minimum:
A. Information regarding his or her diagnosis
B. Goals of therapy
C. Planned duration of chemotherapy, drugs, and schedule
D. Information on possible short- and long-term adverse effects, including infertility risks
E. Regimen- or drug-specific risks or symptoms that require notification and emergency contact
information, including:
● How to contact the practice or organization
● Symptoms that should trigger a call
● Who should be called in specific circumstances (oncologist or other provider)
F. Plan for monitoring and follow-up, including appointments with practitioners or laboratory testing.

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Control of Exposure to cytotoxic drugs

The following guidance applies to all staff handling cytotoxic drugs during administration, handling of
patient waste and cleaning of spillage.
Recommended Good Practice:

 Work should be organized to minimize quantities of drugs used.
 The number of employees potentially exposed and duration of exposure should be kept to a
minimum.
 All staff should ensure the safe handling, storage and transport of cytotoxic drugs and waste material
containing or contaminated by them.
 Good hygiene practices and suitable welfare facilities should be provided to ensure that staff eating,
drinking and smoking are prohibited in all areas where cytotoxic drugs are handled
 Staff working with cytotoxic drugs must be trained on the risks and precautions to take when
handling cytotoxic chemotherapy
Hand protection (Gloves) :
Cuts and scratches on the skin should be covered with a waterproof dressing to prevent infiltration of the
skin if gloves are damaged.
Hands must be washed thoroughly with liquid soap before and after procedure.
Gloves must:
 Always be disposable and preferably powder free
 Be worn at all times when contact with cytotoxic drugs is possible
 Be changed regularly, always between patients and immediately after they become damaged or
contaminated.
 If the inner surface of a glove becomes contaminated, exposure will occur. Therefore once
disposable gloves are removed, they should not be re-applied. They should fit appropriately and be
close fitting.

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Eye protection
The use of eye protection should be considered whenever splashes or sprays of cytotoxic drugs might be
generated, for example during intracavitary administration and when clearing up cytotoxic spillages.
Torso protection (Plastic aprons)
Disposable plastic aprons will provide limited protection and prevent absorption into clothing..
Disposal of Cytotoxic Waste
Used Disposable Equipment
While wearing gloves and plastic apron place any needles, syringes, giving sets, empty
ampoules/vials or infusion bags into a rigid sharps disposal box. Giving sets should not be removed from
infusion bags prior to disposal.
The black disposal bag must have a labeling of cytotoxic waste so it can be incinerated at 1000ºC to ensure
degradation of the cytotoxic agent.
Sharps disposal boxes containing cytotoxic waste must be regularly collected.
Contaminated Non-Disposable Equipment/Items

Re-usable plastic or metal trays should be rinsed with cold water into a sluice (to remove traces of cytotoxic
agents) and then washed with detergent and hot water (to prevent cross-infection).
Wear gloves and apron.
If non-disposable equipment or items are sent to another department for terminal cleaning, they must be
transported in sealed leak-proof bags or containers. These should be clearly labeled indicating that they are
potentially contaminated by cytotoxic drugs.
Patient Waste/Body Fluids

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Patient waste e.g. urine, faeces, vomit may contain high concentrations of cytotoxic drugs or active
metabolites both during administration and up to seven days after treatment has ceased. Particular care
should be taken with patients receiving high dose chemotherapy or intravesical treatment.
It has been shown that these unchanged cytotoxic drugs or active metabolites can be irritant to the skin, eyes
and mucous membrane.., all staff handling waste should take reasonable precautions to limit exposure and
ensure absorption does not occur.
Personal Accidents.
Skin
 Remove any contaminated clothing immediately.
 The contaminant must be removed as rapidly as possible by flushing the affected area with
a large volume of cold water. If running water is not immediately available, bottles or bags
of sterile water or normal saline should be kept as an alternative.
 After initial copious flushing with water, the contaminated skin should be thoroughly
washed with liquid soap or antiseptic scrub and water. After rinsing, the process should be
repeated.
 Shower facilities should be available for use if large areas of skin are contaminated.
 Do not use hand creams and emollients as these may aid absorption of the drug.
 Medical attention must be sought from the nearest Accident & Emergency Department.
Eyes
 An eye-wash kit should be available in all areas where chemotherapy is administered.

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 The contaminant must be removed as rapidly as possible by flushing the eyes and surrounding areas
with a large volume of sterile normal saline using an eye wash station where available. Alternatively
cold tap water can be used if necessary.
 Medical attention must be sought immediately from the nearest Eye Clinic or Accident & Emergency
Department.
 An adverse incident report form must be completed and the Head of Department informed.
Clothing
 Any contaminated clothing must be removed immediately. Put on gloves and an apron. Rinse the
clothing under running tap water in the sluice. Squeeze dry and place in a yellow
 Plastic bag if being sent for laundering as contaminated waste.
 Uniforms or hospital linen should be double bagged in the appropriate laundry bags and sent to the
hospital laundry according to the procedures.
 Personal clothing should be taken home for laundering. Such items should be laundered twice where
possible. The first wash should be separate from other clothing. They may be laundered with other
items for the second wash.
 Dispose of gloves and apron into a blue bag.
 If there is a likelihood that the drug has soaked through the outer clothing, underwear must be
removed and treated as above, and the area of skin treated as above.
Preparation of cytotoxic drugs:
 All prescriptions should be received in pharmacy in a timely fashion according to policy.
 Preparation of cytotoxic agents must take place in filtered vertical laminar flow air or isolators
situated in a specifically controlled and monitored environment. The equipment must be certified at
least annually.
Transportation of cytotoxic drugs
Prepared cytotoxic agents must be transported in designated transport bags or boxes. These should be sturdy,
secure and leak-proof and should be clearly labeled: CYTOTOXIC DRUGS - HANDLE WITH CARE.

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Additional precautionary labels should be added to the containers and the transport bags or boxes as
appropriate, for example room temperature or refrigerated storage required.
All staff involved in the transportation of cytotoxic drugs must be trained to follow the ‘Cytotoxic Spillage’
procedure.
Any cytotoxic drugs received on the ward or day units, but not administered, must be safely returned to the
Pharmacy Department or disposed of as soon as possible.
Common side effects caused by chemotherapy drugs include:
Fatigue: Fatigue (a persistent sense of tiredness or exhaustion) is the most common symptom reported by
patients receiving chemotherapy.
Pain: Chemotherapy can cause pain for some people, including headaches, muscle pain, stomach pain, and
pain from nerve damage, such as burning, numbness, or shooting pains (most often in the fingers and toes).
Pain usually diminishes over time, but some people may have symptoms for months or years after
chemotherapy has finished due to permanent damage to the nerves.
Sores in the mouth and throat. Chemotherapy can damage the cells that line the mouth and throat.
The sores (also called mucositis) usually develop five to 14 days after receiving chemotherapy. Although the
sores may become infected, they usually heal completely when treatment is finished. Patients receiving
chemotherapy who have unhealthy diets and/or poor dental hygiene increase their risk of mouth and throat
sores.
Diarrhea.Certain chemotherapy causes loose or watery bowel movements. Preventing diarrhea or treating
it early helps a person avoid becoming dehydrated (the condition when the body does not get the amount of
fluids it needs) or developing other problems.
Nausea and vomiting. Chemotherapy can cause nausea (an urge to vomit or throw up) and vomiting—a
risk that depends on the type and dose of chemotherapy. With appropriate medications, nausea and vomiting
can be prevented in nearly all patients.

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Constipation. Chemotherapy—as well as some drugs to treat nausea and vomiting, pain, depression,
diarrhea, and high blood pressure—may cause constipation (the infrequent or difficult passage of stool).
Patients may also increase their risk of constipation by not drinking enough fluids, not eating balanced
meals, or not getting enough exercise.
Blood disorders. Chemotherapy affects the production of new blood cells in the bone marrow, the
spongy, inner mass of the bone. Symptoms and complications arising from low blood counts are among the
most common side effects of chemotherapy.
A second type of test, called a platelet count, measures the number of platelets (blood cells that stop
bleeding by plugging damaged blood vessels and helping the blood to clot) in your blood. People with
thrombocytopenia (a shortage of platelets) bleed and bruise more easily.
These conditions can be treated with medications that stimulate the bone marrow to make more blood-
forming cells that develop into RBCs, WBCs, and platelets.
Nervous system effects. Some drugs cause nerve damage, resulting in one or more of the following
nerve- or muscle-related symptoms:
 Tingling
 Burning
 Weakness or numbness in the hands and/or feet
 Weak, sore, tired, or achy muscles
 Loss of balance
 Shaking or trembling
 Stiff neck
 Headache
 Visual problems
 Walking problems
 Difficulty hearing
 Clumsiness
These symptoms usually improve when the chemotherapy dose is lowered or treatment is stopped; however,
in some cases, the damage is permanent.

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Changes in thinking and memory.Some patients experience difficulty thinking clearly and
concentrating after chemotherapy. Cancer survivors often refer to this side effect as "chemo brain," while
doctors may refer to it as cognitive changes or cognitive dysfunction.
Sexual and reproductive issues.Chemotherapy can affect sexual function and fertility (a woman’s
ability to conceive a child or maintain a pregnancy and a man’s ability to father a child). In addition,
chemotherapy is capable of harming a fetus (unborn baby) during pregnancy, particularly if given during the
first trimester of pregnancy when the fetus' organs are still developing. Women should take precautions to
avoid pregnancy during treatment and tell their doctor if they become pregnant.
Appetite loss.People receiving chemotherapy may eat less than usual, not feel hungry at all, or feel full
after eating only a small amount. Ongoing appetite loss can lead to weight loss, malnutrition, and loss of
muscle mass and strength, which can hinder the body’s ability to recover from chemotherapy.
Hair loss.Patients receiving chemotherapy may lose hair from all over the body, gradually or in clumps.
This side effect most often starts after the first several weeks or rounds of chemotherapy and tends to
increase one to two months into treatment.
Long-term side effects. Most side effects of chemotherapy disappear at the end of treatment. However,
some side effects may continue, come back, or develop later. For instance, certain types of chemotherapy are
associated with permanent organ damage to the heart, lung, liver, kidneys, or reproductive system. In
addition, some people find that cognitive functions (such as thinking, concentrating, and memory) remain a
challenge for months or years after treatment. Nervous system changes can also develop after treatment, and
children who have received chemotherapy may experience late effects (side effects that occur months or
years after cancer treatment). Cancer survivors also have a higher risk of developing second cancers later in
life.
CARING FOR IMPLANTED VENOUS ACCESS PORT SITE:

 The area where port is placed must be checked daily for signs of infection and other problems.
 Must clean the skin and change the bandage while the port site heals.

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 Must wash hands with soap and water before touching the port site or the area around it. Once port
site heals, it is not needed to bandage to cover the site.
 When port is not being used, and the area has healed, patient may return to their normal activities.
Patient may able to bathe, shower, swim, and do other water activities.
Accessing implanted venous access port:
To access the port, patient may need to do the following:
• Should see for the skin over or around the port if it breaks open.
• If pain or burning at the Port site, with or without use.
• If fever.
• should check for changes in skin color around your port, or fluid is leaking from port.
• have chest pain or trouble breathing that is getting worse over time.
• have shoulder pain on the side where your port was placed.
• if port site is red, warm, or swollen.
• Avoid applying pressure or lying on the side where port is inserted at least for 2months after port
insertion.
Educate patient the following on discharge:

 Take daily bath and wear clean dresses.
 Minimum handling of the dressing and catheter.
 Do not wet the dressing while showering.
 Report in case of fever, catheter displacement, pain, any discharges from exit site or bleeding.
 Get dressing done on every 4th day.

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Management of chemotherapy extravasations:ESMO– EONS Clinical

PracticeGuidelines
An extravasation is a known potential risk associated with chemotherapy administration and

one that professionals must know how to minimise, recognise and manage appropriately
Possible patient consequences following an extravasation
PREVENTION
 Most extravasations can be prevented with the systematic implementation of careful, standardized,
evidence-based administration techniques.

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 In order to minimize the risk of extravasation, the staff involved in the infusion and management of
cytotoxic drugs must be trained to implement several preventive protocols [4, 7, 9].
 Should an extravasation occur, it is important to remember that the degree of damage is dependent
on the type of drug, the drug concentration, the localization of the extravasation and the length of
time a drug develops its potential for damage.
Table 3. Preventive protocols to minimize the risk of extravasations
• ‘Site of insertion’: Identification of the most appropriate cannulation site should be undertaken
before insertion. If venous access continually proves difficult, placement of a central venous access device
should be considered. The following are among the conditions of the cannulation site:
a) Large veins in the forearm are recommended for peripheral administration.

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b) Cannulation should be avoided over joints.

c) The inner wrist and the lower extremities should not be used.
d) Veins in the anticubital fossa or on the dorsum of the hand, particularly for vesicant drugs, are not
recommended.
e) Avoid cannulation where lymphoedema is present.
f) Cannulation on the side of a mastectomy is still a matter of discussion.
‘Cannula’.- Preventive measures related to the type of cannula include:
a) Winged steel infusion devices (‘butterfly’ needles) must not be used for infusion of vesicant drugs as
the needle can be easily displaced or puncture the venous wall.
b) Flexible cannula should be used.
c) For infusion of vesicant drugs of longer duration (e.g. 12–24 hours) the central venous access is
highly recommended.
‘Procedures’:
a) After cannulation, check for blood flow. Then, flush with 10-ml normal saline and check for signs of
extravasations.
b) Flushing with 10–20 ml of saline solution between different drug infusions is recommended.
c) A blood return (flashback) should always be obtained before drugs are administered and checked
regularly throughout the bolus infusion.
d) Continue monitoring of the cannula insertion site and check regularly for the appearance of
symptoms such as swelling, pain or redness sluggish infusion rate. This is highly recommended during
infusion of all drugs.
e) Bolus dosages of vesicant drugs may be administered concurrently with a fast-running infusion of
compatible i.v. fluid.

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JIMS/ MAN/ ONCO/

JAGANNATH GUPTA INSTITUTE OF Doc. No.

Document Name : ONCOLOGY MANUAL

Document No. : JIMS/ MAN/ ONCO/ 40

Date of Implementation : 06/01/2023

Prepared By : Name :Sr Anita Pradhan

Approved By : Name : Dr. Soumitra Chatterjee

Designation : Quality Manager

Issued By : Name :MrsShayantaniDatta

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

DNS MSVP MANAGER QUYALITY

Job description of Oncology Nurse:

DNS MSVP MANAGER QUYALITY

1. Chemotherapy Administration. Administers PO, SC injections, chemotherapy drugs, and other

Education & Training:

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

 To participate in flexible working hours

Job description of in charge nurse:

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

Do’s and don’ts for chemo handling:

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

Chemotherapy Administration Safety Standards:

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

Chemotherapy planning: Chart documentation standards

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

General chemotherapy practice standards:

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

Chemotherapy order/prescription standards

Complete orders must include:

DNS MSVP MANAGER QUYALITY

O. Sequence of drug administration

Important points need to keep in mind before handling cytotoxic drugs:

A second person (a practitioner or other personnel approved by the practice/institution to prepare or

A. Two patient identifiers

Chemotherapy drugs are labeled immediately upon preparation:

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

E. Total volume required to administer this dosage

Patient consent and education

Prepared by Approved By Issued By

DNS MSVP MANAGER QUYALITY

Control of Exposure to cytotoxic drugs

Recommended Good Practice:

Hand protection (Gloves) :

 Always be disposable and preferably powder free

 Be worn at all times when contact with cytotoxic drugs is possible

DNS MSVP MANAGER QUYALITY

Torso protection (Plastic aprons)

Used Disposable Equipment

Contaminated Non-Disposable Equipment/Items