Safe Administration of Systemic Cancer Therapy Part 2: Administration of Systemic Treatment and Management of Preventable Adverse Events

Guideline Objective

To provide guidance on processes, technologies and devices for the prevention and control of adverse effects that can happen during or following the administration of systemic treatment to adult cancer patients.

Patient Population

Adult patients who are going to receive chemotherapy treatment or are already receiving chemotherapy treatment for cancer.

Intended Guideline Users

• Organizations that provide systemic cancer treatment, including chemotherapy, targeted therapy, and biologics to patients.
• Clinicians and healthcare providers (e.g., nurses, pharmacists, physicians, administrative support) involved with the administration of systemic cancer treatment, and hospital administrators.

Research Question(s)

Area of interest 1: Selection, use and management of vascular access devices, including potential complications, during the administration of systemic cancer treatment

• What are the most effective and safe access devices to administer chemotherapy?
• When is access assessed?
• What options are presented to patients?
• What are the most effective techniques for insertion and management of access devices to prevent infection, lumen occlusion and venous thrombosis as well as for reducing error rates?
• What are the most effective intravenous (IV) access devices for patients (central vs. peripheral devices)?
• What are the indications for insertion of a peripheral access device in the delivery of chemotherapy?

Area of interest 2: Extravasation, phlebitis, flare, allergy and hypersensitivity complications of chemotherapy administration

• What are the best strategies for the prevention of extravasation?
• What are the best strategies for the detection and differential diagnosis of extravasation?
• What are the best strategies for the management of extravasation once it has occurred?
• What are the best strategies for documenting extravasation?
• What are the best strategies for the prevention and treatment of irritation and flare reaction?
• What are the best strategies for the prevention and treatment of allergic/hypersensitivity reactions to chemotherapy?

Area of interest 3: Nursing practices before, during and immediately after the administration of systemic cancer treatment, including verification and maintenance of the treatment plan

• What are the most effective nursing strategies for reducing errors of administration of systemic cancer treatment agents to cancer patients while using volumetric pumps and other devices (e.g., elastomeric pumps)?
• What are the most effective strategies for double checking calculations prior to administration of chemotherapy drugs?
• What are the best strategies for the preparation and administration of pre-medications?
• What are the best strategies to prevent errors during the administration of systemic cancer therapy?
• What are the best strategies for post care (e.g., hydration)?
• What are the best strategies for management of error-related toxicity?
• What are the best strategies for the verification and maintenance of treatment (e.g., identification of needs, support measures to help maintain the treatment)?