Cytotoxic Drugs

Report
WHAT WE HAVE LEARNED??
ONCOLOGY CLERKSHIP
GROUP B
LIM KOK HAN
MD HASHIMIE BADDRUDIN BIN MAT HASSAN
SURESKUMAR A/L HARISKRISHANAN
CHAI YEE YIEN
CHUA SUE HOON
NABILAH BINTI JAMALUDIN
NIK NUR NASEELA FATHIN BINTI NIK MOHD SABRI
NUR FADHILAH ARSHAD
NUR HAIDAR BT AKBAR
TAN SIN YEIN
MOHAMAD SYAHIR BIN FADZIL
MOHD JAUZE BIN KOMA RUDIN
MUHAMMAD IMADUDDIN BIN CHE MOHD NASIR
LECTURER: Assoc Prof Saad Othman
What I have learned???
By LIM KOK HAN (95298)
Group B
ONCOLOGY PHARMACY CLERKSHIP
2010
What I have learned about cleanroom?
•
A Cleanroomis "a room in which the concentration of airborne particles is controlled,
•
A “Cleanroom” is a controlled environment in which the concentration of airborne
particles is controlled to specific limits- so that a desired level of cleanliness can be
achieved. The level to which these particles need to be removed depends upon the
standards required.
To control the contamination, the only way is to control the total environment. Air flow
rates and direction, pressure, temperature, humidity etc. all need to be controlled
carefully. The sources of these particles need to be controlled or eliminated whenever
possible. These sources are facilities, people, tool generated, fluids and products
generated.
Cleanrooms are planned and manufactured using strict protocol and methods.
Cleanrooms are specifically used in many areas such as electronics, pharmaceutical,
biopharmaceutical, medical device industries, operating rooms and other critical
manufacturing environments, which need the product to be produced at certain level
of “cleanliness”.
•
•
and which is constructed and used in a manner to minimize the introduction,
generation, and retention of particles inside the room and in which other relevant
parameters, e.g., temperature, humidity, and pressure, are controlled as necessary .“
Cont…
• Types is based on the airflow pattern, either
– Horizontal
– Vertical
– Mixed
• Classification based on the particles count in the room air
• Clean room have to be evaluated based on some
parameters such as air particulate count, air velocity / air
changes, temperature, humidity, pressure differences in
order to ensure all the controlling parameters are within
the normal range.
KEY ELEMENTS OF CLEANROOM
1)HEPA FILTERS- These filters are important for
maintaining contamination control. They filter particles as
small as 0.3 microns with a % 99.9995 (H14) minimum
efficiency. Used with central system or stand alone
2)AIRLOCK- An airlock is a passage which permits the
people to pass from non-controlled environment to
controlled environment and vice versa.
3)PASSBOX- Passbox is a device which enables objects,
parts, tools and other work items to be passed to and
from the cleanroom
4)PANEL WALLS, FLOORS, CEILINGS, LIGHTS etc
:Made of non contaminant, dust proof materials
MAINTENANCE OF THE CLEANROOM
• Maintenance of the cleanroom involves daily
cleaning, weekly cleaning, and monthly
cleaning, where all the cleaning work must be
done properly based on the established
standard cleaning procedure of cleanroom
• Wearing proper equipment while handling the
sample that require sterile environment is
highly necessary (example: TPN product ,
cytotoxic drug-PPE must be worn)
Parameters need to be controlled
• For example air particulate count here at clinical lab is
done every 6 month & an acceptable result should
shows that the Number of particles larger than 0.5
mcm should not be more than 10,000/ft3 or 350/l of air
• The air velocity should be maintained at 0.45 m/sec
±20% Air changes should be more than 20 times/hour.
• Temperature should be maintained at 18oC ± 2oC
• Humidity should be maintained at 50% - 60%
• Pressure differences should be maintained at 15 pascal
or more
What I had learned at HPP?
CYTOTOXIC DRUG REQUEST FORM(HPP)
Example of real cytotoxic drug request
* This is meant for educational purposes only…
Request form for cytotoxic drug
reconstitution
• Requested by the physician/doctor via a form(as
shown) and to be sent to the CDR unit for screening
and cytotoxic drug preparation
• Pharmacist at CDR unit will do prescription screening
from left right style.
• In the request form, the physician(prescriber) has to fill
up some of the details required, which includes:
1) General information on patient demographic
data
2) Information about the requested drug(s)
1)General information on patient demographic
data that need to be filled by prescriber:
•
•
•
•
•
•
•
•
•
•
•
•
•
Chemo administration date:
Ward& Bed. No :
Patient’s Name & I/C:
Gender
Age
Weight(kg)
Height(cm)
BSA(m2)-to be calculated by the pharmacist based on patient’s weight and height
Diagnosis
Chemotherapy Protocol/Regimen
Interval: Days or Week
Cycle Number
Case : Old or New
•
*BSA formula used : (Body weight(kg) x height(cm)/ 3600)^0.5
•
2) Information about the requested drug(s) need to be
filled by prescriber based on the selected protocol
•
•
•
•
•
•
Name of the drug
Dosage & Frequency
Chemo Day
Route IVI/IVB
Diluent Final Volume
Duration(hrs)
**At the bottom of this form, the prescriber must
hand down their signature, name, chop(if any)
and date the request has made
Particulars to be filled by the
pharmacist in this form include
1) Reconstitution information
-product batch no
-no of ampoules/vial & strenght
-reconstitution solution used & volume for
cytotoxic drug that is available in powder form
such cyclophosphamide
-final volume of drug added
-infusion solution used & volume : 2 types : 0.9% NS
or D5W solution
-expired date of final product
Cont..things to be filled by pharmacist
2) product information
• -trade name/manufacturer
• -batch no.
• -expiry date
Once the screening and all the particulars need to be calculated and written by the
pharmacist have been completed, the pharmacist in-charge for processing this request
need to hand down his/her signature, name and date it was done
If there is any drug-related problem(s) detected in the cytotoxic request form, the
pharmacist needed to contact the prescriber(the physician that make the order),
inform them about the potential problems and recommend the intervention to be
done. All form of communication between pharmacist and the physician regarding any
changes to the prescription must be written in a box provided.
….
• Thus in regard to this request form, the pharmacist at Cytotoxic
Drug Reconstitution(CDR) unit must provide the best
pharmaceutical care to the patient which include the through
screening on the prescription and check for any
errors/discrepancies/doubtful
• Thus, here screening process is still a part of the functions that
pharmacist working at CDR unit .
• To ascertain certain information and to clarify the values written,
this prescription will be needed to be prepared by another
pharmacist
• Since this issue has involved pharmacokinetic formulas, thus as
pharmacist we have to make sure that error is at minimal level
while deliver the most effective drugs to the patient at safe
recommended drug level.
THANK YOU…
• Prepared by LIM KOK HAN
• ( 95298)
•
•
ONCOLOGY PHARMACY CLERKSHIP 2010
GROUP B
CDR
CALCULATION
MOHAMAD SYAHIR BIN
FADZIL (UF 070007)
18
Patient’s Profile
1)Name
: ABC
2)I/C
: 07-5510
3)Gender
: Male
4)Weight
: 63 kg
5)Height
: 123cm
6) BSA
:1.47m2
7)Diagnosis : Breast Cancer
8) Protocol/Regime
:FEC
9)Chemo Administration Date : 29/9/2010
10)Ward & Bed No
: C19 (In Patient)
MOHAMAD SYAHIR BIN FADZIL (UF 070007)
19
FEC Regimens
Cytotoxic Drug
Dose (mg/m2)
Prepared in
Duration
5FU
600
500mL NS
Over 1 hour
Epirubicin
75
500mL NS
Over 1 hour
Cyclophosphamide
600
500mL NS
Over 1 hour
 All day 1 only
 Recycle 3 weekly
MOHAMAD SYAHIR BIN FADZIL (UF 070007)
20
Drug available in Penang GH.
Cytotoxic Drug
5 FU
Strength
1g/20mL
Epirubicin
50mg/25mL , 10mg/5mL
Cyclophosphamide
1g/50mL , 200mg/10mL
MOHAMAD SYAHIR BIN FADZIL (UF 070007)
21
Final Volume of Drug Needed
I.
5FU
Amount required in mg
600 mg/m2 x 1.47m2 = 882mg
≈ 880mg
Volume need to withdrawn from vial stock solution
= 880mg X 20mL
1000mg
= 17.6 mL
≈ 17.5 mL
MOHAMAD SYAHIR BIN FADZIL (UF 070007)
22
II. Epirubicin
Amount required in mg
= 75 mg/m2 x 1.47m2 = 110.25mg
≈ 110 mg
Volume needed to withdrawn from vial stock solution is 55 mL
as shown in table below.
Vial strength No. of vial used
Amount (mg) Volume (mL)
50mg/25mL
2
100
50
10mg/5mL
1
10
5
110
55
MOHAMAD SYAHIR BIN FADZIL (UF 070007)
23
III.
Cyclophosphamide
Amount required in mg
= 600mg/m2 X 1.47m2
= 882mg
≈ 880mg
Volume needed to withdrawn from the vial stock
solution
= 880mg X 50mL
1000mg
= 44mL
MOHAMAD SYAHIR BIN FADZIL (UF 070007)
24
Medical apparatus/devices used in the reconstitution of
cytotoxic drugs
Below are some of common apparatus used:
 Syringe
 Syringe filters/ Injection filter
 Filter Straw
 Vial’s spike/Vial’s adapter/ Reconstitution device
 Needle
 Vials
 Ampoules
 Bottle of infusion liquid such as normal saline, dextrose 5%
 etc
PREPARED BY: NABILAH
JAMALUDIN
Syringe
• It is a medical instrument used to inject or withdraw fluids
• Types of syringes used in cytotoxic reconstitution:
 Disposible syringes (three parts) luer slip
 Disposible syringes (three parts) luer lock
 Disposible syringes (two parts)
• Packaging details: The syringes are packed individually in poly
bag or blister package
• Individual package is more easier to be handled as the syringe
is sterilized.
• The syringe that has been shown to us during clerkship is
disposable syringes luer lock of 10 ml and 50 ml
PREPARED BY: NABILAH JAMALUDIN
Available Size of Syringes
Types of syringes
Available size
Disposible syringes (three parts) luer 1 ml, 2 ml, 3 ml, 5 ml,
slip
10 ml, 20 ml, 30 ml,
50 ml, 60 ml, 100 ml
Luer slip connector
PREPARED BY: NABILAH JAMALUDIN
Types of syringes
Disposible syringes (three parts) luer
lock
Available Size
2 ml, 3 ml, 5 ml, 10
ml, 20 ml, 30 ml, 50
ml, 60 ml
Luer lock
PREPARED BY: NABILAH JAMALUDIN
Types of syringes
Disposible syringes (two parts)
Available size
1 ml, 2 ml, 3 ml, 5 ml,
10 ml, 20 ml, 30 ml.
PREPARED BY: NABILAH JAMALUDIN
Parts of syringe
PREPARED BY: NABILAH JAMALUDIN
Needle
• In cytotoxics reconstitution, needles is used to withdraw drug
liquid from the vial
• During clerkship, we have been shown the needles that been
packed individually.
Needle cap
Luer connector
PREPARED BY: NABILAH JAMALUDIN
• Needle gauge: Indicates the
diameter of the needle.
• Various needle lengths are
available for any given gauge
• Available needle gauge: Range
from 7 G (largest in diameter)
to 34 G (smallest in diameter)
needles
PREPARED BY: NABILAH JAMALUDIN
Syringe Filter/Injection filter
• Use: To filter the solution or liquids from particles
• There are also available type that use to filter gases, and
remove bacteria.
• It needs to be attached at the end of a syringe for use.
• The liquid is filtered by drawing it out from the syringe
through the filter into vials, bottles, etc
• Most common sizes available: 0.2 or 0.22 µm and 0.45 µm
pores. Membrane diameters of 10 mm, 13 mm, 25 mm are
common as well.
PREPARED BY: NABILAH JAMALUDIN
• It may have luer lock fittings at one side to fit into the luer
lock syringe. It consists of a plastic housing with a membrane
which serves as a filter.
Luer lock connector
PREPARED BY: NABILAH JAMALUDIN
Using filter syringes
Step
Diagram
Explanation
1
Draw a small amount of air (about 1 ml)
into the syringe. This air is used to purge
the filter ensuring maximum sample
throughput.
2
Load the sample into the syringe. Note
the visible air pocket ready to purge the
filter.
PREPARED BY: NABILAH JAMALUDIN
Step
Diagram
Explanation
3
Attach the filter to the syringe at the luer
lock connector.
4
Hold the assembled syringe and filter
vertically to wet the membrane. This
prevents air blocks and promotes high
flow rates.
PREPARED BY: NABILAH JAMALUDIN
Step
Diagram
Explanation
5
Press the syringe plunger gently. If
possible, discard the first 0.25-0.5ml of
sample. If the back pressure ever
increases significantly, change the filter
as it may have plugged. Avoid pressing
excessively as this could cause the filter
housing to burst.
6
Push the air through the filter to purge
the housing and recover any remaining
sample.
PREPARED BY: NABILAH JAMALUDIN
Filter Straw
 Use: To withdraw and filter fluids from the
ampoules

Only be used to withdraw not to inject out
the liquid

It enhance patient safety by reducing the
potential for glass particle injection

It is a flexible straw, which can be angled
for easy use, is needle-free and latex free
promoting personnel safety
PREPARED BY: NABILAH JAMALUDIN
Size of the Filter straw
Size: 5 µm, 4.5 cm
Short filter straw for withdrawal
and filtration of fluids from small
ampoules
 4.5 cm filter straw
 5 µm filter hub attached
 Blunt plastic straw
Short Filter straw
Size: 5 µm, 10 cm
Long filter straw for withdrawal and
filtration of fluids from large
ampoules
 10 cm filter straw
 5 µm filter hub attached
 Blunt plastic straw
PREPARED BY: NABILAH JAMALUDIN
Filter hub
Long Filter straw
Vials
• Varies types of vials, such as screwed
neck vials, vials with snap cap, crimp
neck vials etc with or without rubber
septa for the closure.
• Available size/volume for injection
vials (crimp neck vials) to store the
cytotoxics: 2 ml, 4 ml, 5 ml, 10ml, 25
ml and 50 ml
• The vials can be used to store liquids
or soluble powders like
cyclophosphamide.
PREPARED BY: NABILAH JAMALUDIN
Vial’s spike/Vial’s adapter/
Reconstitution device
• Used for withdrawal or addition of
drug’s fluid from or into the vials in
the reconstitution process.
PREPARED BY: NABILAH JAMALUDIN
Ampoules
• Ampoules are made of glass
(clear or amber) or plastic.
• An ampoules may comes
with a break point or a
circular line around the
neck for the ease of
breaking it (the weakest
point).
Break line
• Available sizes: Ranges from
1 ml to 25 ml.
PREPARED BY: NABILAH JAMALUDIN
Break point
Bottle of infusion liquid
• For IV infusion administration, the
cytotoxics is directly injected into the
bottle of infusion liquid such as normal
saline or dextrose 5% for reconstitution
• This IV infusion bottle already equipped
with the hook at the bottom for
hanging purposes
• Usually, the bottle contains 500 ml of
infusion liquid.
PREPARED BY: NABILAH JAMALUDIN
Roles of oncology Pharmacist
In Hospital Pulau Pinang, oncology
pharmacy service is divided into two
subunit:
 Cytotoxic Drug Unit ( CDR unit )
 Clinical Unit
by CHUA SUE HOON
Roles in CDR unit:
• Receive prescription
• Screening prescription
• Calculation
• Drug reconstitution
• Labelling
• Teaching – mostly the undergraduated nurses or
pharmacy students from the college and
university.
• Provide information to the ward
• Monitor stock level
• Provide safety talk to the personnel
In Clinical part, most of the oncology pharmacist
involved in:
• Monitoring, mainly sign and symptom of the
patient.
• Ward round
• Counselling
- providing information, advice and assistance to
help patient for better adherence towards
their treatment
• Give suggestion to the doctor
In general, oncology pharmacist play a
significant roles in cancer treatment patient.
They not just dispensing the drugs but also
valuable information throughout the therapy;
including counseling of
side-effect and management
of proper handling technique.
Cytotoxic Drugs
• Cytotoxic drugs has a toxic effect on cells. It is
often used in the chemotherapy and
management of cancer patient.
• It may also produce unpleasant side effects
such as nausea, vomiting, hair loss and
suppression of bone marrow function.
Colour of Cytotoxic Drugs
During the clerkship, we have been exposed to few
of the chemotherapy drugs. The preceptor
emphasizes us on the importance of knowing the
color of chemotherapy drugs.
Most of the chemotherapy dugs are colorless.
There are only few drugs that have special
characteristic that oncology pharmacist should
take note of.
 Anthracyclines group such as doxorubicin, epirubicin
have red color of solution. Besides, idarubicin have a
slightly red-orange colors of solution.
Idarubicin
Methotrexate, an antimetabolites cytotoxic drug
have yellow color of solution.
Mitoxantrone, an anthracenedione has a blue
color of solution.
By having knowledge in term of colors of each
cytotoxic drusg, we can reduce the wrong
drug error by identified the colors. Thus, can
reduce the unnecessary wastage as
cytototoxic drugs usually are expensive.
By: Chua Sue Hoon
ONCOLOGY CLERKSHIP INDIVIDUAL REPORT
NAME: MD HASHIMIE BADDRUDIN BIN MAT HASSAN
M/N: 95304
How to Break
an Ampoule
What types of standard ampoules
• Ampoules can be:
• self breakable (type of opening)
– OPC –„one point cut“, with a cut at
the place of breakage
– CBR – „color break“ with colored
ring at the breakage point
• with code rings (CR) for easier
identification
• with screen print
Breaking procedures
You suppose to wrap the ampoule cap with gauze or tissue in order
to avoid injuring during opening the ampoule.
Topic:isolator
• By Chai Yee Yian
Isolator in HPP
Air flow after pass thru HEPA filter
Barometer,
temperature, &
humidity meter
Light to show pass-box’s
inner door can open or not
Image of general isolater used,
similar with isolator in HPP
Gloves
Pass box with 2
side doors
(inner and
outer)
•A closed system
•Not necessary put in cleanroom
•Everything bring into pass box need swab
with alcohol
air
recirculated
Switch open
pass box doors
by step on it
Reconstitution Solvent
• Sodium Chloride (normal saline)
• Dextrose solution (dextrose 5% water, D5W)
Cytotoxic waste includes:
 Expired drugs and aborted dosages
 unused cytotoxic pharmaceuticals
 sharps and syringe
 intravenous infusion sets and containers
 ampoules and vials
 personal protective equipment and clothing
 dressings and bandages
 Caps, gloves, swabs
Adequate, leak-proof waste disposal containers:
•
•
sharps and solids containers
distinctive plastic waste bags
 must be available in every area where cytotoxic drugs are prepared, administered
or stored, and all cytotoxic drug-related waste must be placed into these
containers or bags.
Any excreta from a patient being treated with cytotoxic drugs that is handled by a
worker must be treated as cytotoxic drug-related waste
Items to be placed in shape container:
• Needles
• syringes and breakable items
• glass vials
before they are stored in the waste bag
• Storage of cytotoxic waste in should be in a
dedicated, and secure area which can also be
easily cleaned and maintained.
• Waste bins should be sealable.
Waste Disposal
• Incineration is the only acceptable technology for
treating cytotoxic waste
• The waste are burn at 1000-1100 ⁰C
• Patient waste such as urine, faeces, vomitus and
the contents of colostomy and urostomy bags
may be disposed of in the normal sewage system
STORAGE OF CYTOTOXIC
DRUG
Prepared by:
NUR HAIDAR BINTI AKBAR
GROUP B
Cytotoxic drugs are required to be stored:
• In a locked refrigerator that must be at 4 ⁰C OR
• At room temperature ( below 30 ⁰C) must be
stored in locked cupboard in an appropriate
room for the storage of medicines
CYTOTOXIC DRUG STORAGE
Fridge items(4⁰C)
Non-fridge items(<30⁰C)
Docetaxel
Carbopletin
Paclitaxel
Cytarebine
Doxarubicin
Etoporoside
epirubicin
Irinofecam
dacarbazine
Oxaciplastin
vincristine
Ifosfomide
Venorelbine
Daunorubicin
Docetaxel
Bleomycin
Gemcitabine
5-Fluorouracil
Methotrexate
Prepared by Nik Nur Naseela Fathin binti Nik Mohd Sabri
TEMPER EVIDENT CAP LOCK
SYRINGE
Ref: http://www.freepatentsonline.com/6585691.html
• A temper evident cap lock syringe in cytotoxic drug unit
is used to prevent any mishandle by health practitioner.
• Once the cap has been locked into the nozzle of the
syringe, the cap will keep rotating at the same direction
and will not responsive to counter rotation.
• It has its own method to use by which a sound will be
produced once it is opened.
• If the lock is already tampered, it means that someone
have utilized it.
• Thus, it is safe and effective to be applied to special
drugs like cytotoxic drugs which can be administered
by specialized people only.
Protocol/Regime in Chemotherapy
What is Chemotherapy regime/protocol?
The chemotherapy protocol describes in detail the aim, the modalities, the
complications and the expected results of the medical treatment which is going to
be prescribed. It is used as a reference throughout the prescription.
What it is used for?
It is used for calculation of the dose need to be given to cancer patient. The amount
of needed drugs times with the body surface area (BSA) gives the recommended
dose for the patient.
Prepared by MUHAMMAD IMADUDDIN BIN CHE MOHD NASIR
Protocol/Regime in Chemotherapy
Example of regime/protocol
FEC – consists of Fluorouracil (5-FU), epirubicin, cyclophosphamide
FEC regime is usually prescribed for treatment of breast cancer.
Information given on each protocol’s page:
1)
2)
3)
4)
The amount of drug e.g; 10 mg
Infusion and reconstitution solution e.g; Normal Saline
Day(s)
Cycle Number
Spillage Management
Mohd Jauze bin Komarudin
UF070008
840622015795
Cytotoxic Spill Kit
Contents of Cytotoxic Spill Kit
•
•
•
•
•
•
•
•
•
•
•
•
1 x Goggles
1 x Heavy Duty gloves
1 x Vinyl Gloves
1 x Respiratory Mask
1 x Biohazard Bag
3 x Spill Towels
1 x Plastic Rubbish Bag
1 x Gown
1 x Shoe Covering
1 x Scoop
1 x Report Card
2 x Cytotoxic Waste Labels
Spillage Management
Spillage Management: Surface Spills
1. Minimize air flow to area by shutting doors and windows.
2. Call for help to get the nearest cytotoxic spill kit
3. Open the kit and display the "Cytotoxic spillage" sign near
the spill area
4. Put on the following from the kit in this order: a pair of
gloves (inner), mask, goggles (spectacles may not be used
instead of goggles), the gown, overshoes, and a pair of
blue gloves (outer).
5. For small volume spills (less than 5ml or 5g)
i) Cover liquid spill with absorbent towels but avoid
splashing.
ii) Pick up solids with a moistened absorbent towel (wet
with water or sodium chloride 0.9%)
Spillage Management: Surface Spills
6.
For large volume spills (more than 5ml or 5g)
i) For liquids, cover the spill with chemotherapy absorbent gel pads.
ii) For solids, place an absorbent towel moistened with water or
sodium chloride 0.9% on top of the cytotoxic material. Then cover
with chemotherapy absorbent gel pads. Wait for the pad to be
transformed into a gel and scoop up using plastic scoop. Ensure all
of the residual gel is removed.
7. Scoop up any sharps using either the plastic scoop or swabs and
place in a sharp plastic
8. Work from the outside inwards, clean the spill area with soap and
water at least three times. Place all used absorbent towels in one of
the yellow bags. Take care to avoid contamination of the bucket of
water by only placing new absorbent towels in the water. If
contamination does occur rinse the bucket thoroughly.
Spillage Management: Surface Spills
9. Place all contaminated material (including gown,
outer gloves, mask, goggles and overshoes) in
yellow bag. Then place filled bag and inner gloves
in the other yellow bag
10. Wash hands
11. Fill in adverse event form, inform Occupational
Health Department and record spill in
departmental records. Fill out incident report
card in spill kit and return to Oncology Pharmacist
TOPIC : PULSE TECHNIQUE & LABELLING by TAN SIN
YEIN
Pulse Technique
To maintain negative pressure inside the vial. The purpose on doing
this is to avoid the spillage of cytotoxic drug out from the vial.
Step :
For example the pharmacist need to fill in 10 ml drug into the
syringe
First pull out 10 ml air from the syringe.
Then press in 1/3 of the syringe and pull out the plunger to fill in
the 1/3 space of the drug.
Repeat the above step to fill in 10 ml of the cytotoxic drug.
After finish filling all the 10 ml drug. Don’t straight away pull out
syringe from the vial. Pull out the plunger with extra air until 18 ml.
Then only pull out the syringe.
LABELLING
The label on the drug contains the drug name, drug strength, duration for
infusion, patient name, patient registration number, patient identity card
number (last 6 digits)
The label must be stick on upside down direction of the Normal saline
Infusion label
CYTOTOXIC DRUG
Intravenous Fluid : Normal Saline/ _______________________
Drug(s) added
Amount
_______________mg
__________________
_______________ml
__________________
Final Volume : 1 pint (500 ml)__________________
Date and time Prepared: ________________
Expires
: ________________
Duration of Infusion
: _________________
Name
:
Ward
:
R/N:
Labelling for Intravenous Bolus
Drug
Route _____________________mg in
_______________ml_____________
Prepared__________Expired_______
Name_________________
Ward___________R/N____________
CYTOTOXIC DRUG
Handle with care
The intravenous bolus will fold and stick on the syringe after well
prepared the cytotoxic drug to the patient.
What I learn in Oncology
clerkship?
Sures kumar a/l Hariskrishanan
95369
What is HEPA filter?
• EPA filters are composed of a mat of randomly
arranged fibres.
• The fibres are typically composed of fiberglass
and possess diameters between 0.5 and 2.0
micrometer.
• Key factors affecting function are fibre diameter, filter
thickness, and face velocity. The air space between
HEPA filter fibres is much greater than 0.3 μm.
• The common assumption that a HEPA filter acts like
a sieve where particles smaller than the largest
opening can pass through is incorrect.
Unlike membrane filters, where particles as wide as the
largest opening or distance between fibres cannot pass
in between them at all, HEPA filters are designed to
target much smaller pollutants and particles.
These particles are trapped (they stick to a fibre) through a
combination of the following three mechanisms:
• Interception, where particles following a line of flow in the air stream
come within one radius of a fibre and adhere to it.
• Impaction, where larger particles are unable to avoid fibres by following
the curving contours of the air stream and are forced to embed in one of
them directly; this effect increases with diminishing fibre separation and
higher air flow velocity.
• Diffusion, an enhancing mechanism is a result of the collision with gas
molecules by the smallest particles, especially those below 0.1 µm in
diameter, which are thereby impeded and delayed in their path through
the filter; this behaviour is similar to Brownian motion and raises the
probability that a particle will be stopped by either of the two mechanisms
above; it becomes dominant at lower air flow velocities.
• Diffusion predominates below the 0.1 μm diameter particle size.
Impaction and interception predominate above 0.4 μm. In between, near
the Most Penetrating Particle Size (MPPS) 0.3 μm, both diffusion and
interception are comparatively inefficient. Therefore, the HEPA
specifications use the retention of these particles to define the filter.
My understanding about
negative pressure
• Negative Room Pressure to
Prevent CrossContaminantion A negative
pressure room includes a
ventilation system designed
so that air flows from the
corridors, or any adjacent
area, into the negative
pressure room, ensuring that
contaminated air cannot
escape from the negative
pressure room to other parts
of the facility.
• Negative pressure is created by balancing the room’s ventilation
system so that more air is mechanically exhausted from a room
than is mechanically supplied.
• This creates a ventilation imbalance, which the room ventilation
makes up by continually drawing in air from outside the room.
• In a well-designed negative pressure room, this air is pulled in
under the door through a gap (typically abot one half-inch high) for
that purpose.
• Other than this gap, the room should be as airtight as possible to
prevent air from being pulled in through cracks and gaps, such as
those around windows, light fixtures, and electrical outlets.
• Leakage from these sources can compromise or eliminate room
negative pressure, even if the system is balanced to achieve it.
MEDICAL
SURVEILLANCE
• Everyone who works in cytotoxic unit should be monitored
in a systemic program of medical surveillance.
• It is to identify the earliest reversible biologic effects so it
can be reduced or eliminated before sustains irreversible
damage.
• Medical evaluation should be perform before starting job at
cytotoxic unit, every 6 months periodically during
employment, following acute exposure, transfer to other
units and at time of job termination at cytotoxic unit.
PREPARED BY: NUR FADHILAH BINTI ARSHAD•85301•GROUP B
PERSONNEL ACCIDENTAL
EXPOSURE
• Contact with cloth – remove any cloth
soaked with cytotoxic drug
• For skin contact – wash with soap and
plenty of water
• For eye contact – wash with plenty of
water or normal saline and immediately
see a doctor
• Report the incident and do medical
check up
PREPARED BY: NUR FADHILAH BINTI ARSHAD•85301•GROUP B
GROUP B-ONCO CLERKSHIP

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