Chemotherapy

"Chemotherapy-Induced Nausea and Vomiting: Challenges and Opportunities for Improved Patient Outcomes," available as a journal article and podcast, reviews evidence-based guidelines for assessing and managing chemotherapy-induced nausea and vomiting (CINV). The latest developments in CINV therapy and the expanding knowledge of CINV pathophysiology also are discussed.
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This 18-minute slideshow provides an overview of management principles for chemotherapy-induced nausea and vomiting (CINV) in two parts (1 and 2). The discussion focuses on highly, moderately, and low emetogenic chemotherapy regimens and management strategies for them. A key point is prevention of CINV as the goal of care, with an emphasis on a proactive rather than reactive approach.  
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This 13-minute slideshow reviews patient- and treatment-related factors that influence an individual’s risk for chemotherapy-induced nausea and vomiting (CINV). Also see “Emetogenic Risk of Chemotherapy and Biotherapy Agents,” a guide for calculating a regimen’s risk for causing CINV.
This three-minute slideshow walks you through the pathophysiology of chemotherapy-induced nausea and vomiting (CINV), including the neurologic pathways involved in CINV.
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Researchers are looking at new ways to deliver some antiemetics for managing chemotherapy-induced nausea and vomiting (CINV). The 5-HT3 receptor antagonist granisetron is available orally and now as a transdermal patch. Studies have shown that the patch, which is placed on a patient’s skin 24–48 hours before chemotherapy, is just as effective as the oral capsule, which will be beneficial for patients who are unable to swallow pills (Hawkins & Grunberg, 2009).
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Estimates suggest that more than 70% of patients receiving chemotherapy will experience at least some level of chemotherapy-induced nausea and vomiting (CINV) (Rogers & Blackburn, 2010). For patients, CINV is among the most feared and distressing side effects, yet many healthcare providers underestimate its toll and severity and therefore manage it inadequately.
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Vincristine sulfate is a vesicant. Therefore, it is extremely critical that the IV needle or catheter is properly inserted prior to the vincristine injection or infusion. Any leakage into surrounding tissues during the infusion may cause substantial injury. It is crucial that extravasation precautions are employed when administering vincristine. These include
Despite vincristine labeling requirements and increased awareness of harm that occurs when vincristine is accidentally administered intrathecally, wrong-route vincristine errors continue to occur. See the journal article “Preventing Vincristine Administration Errors: Does Evidence Support Minibag Infusions?” for a discussion on risk-reduction strategies using minibag infusions to reduce potential errors in vincristine administration.  
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In 2005, the Joint Commission issued a Sentinel Alert regarding the prevention of administration errors associated with vincristine.
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There are several very critical points to be aware of when administering vincristine sulfate, also commonly known as Vincasar PFS and Oncovin.
Vincristine sulfate for injection is the salt of an alkaloid from the flowering periwinkle plant (also known as Vinca rosea Linn). It was originally known as leurocristine and is now sometimes also referred to as LCR or VCR. The trade name for vincristine is Vincasar PFS®; the drug is also commonly known as Oncovin. Vincristine is used for the treatment of a number of types of cancerous conditions, and is FDA-approved for patients with the following cancers.
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The oral mucosa is made up of epithelial cells that regenerate every 7–14 days, making them easily damaged by chemotherapy and radiation therapy. When unable to regenerate, the oral mucosa becomes thinner and ulceration can occur, giving pathogens entry into the body. People with ulcerations in their oral mucosa are at significantly increased risk of infection, which can become severe and even life-threatening.
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Nurses can minimize exposure to hazardous drugs with the use personal protective equipment and careful technique. Spill kits should be available wherever chemotherapy is located. Although they are commercially available, clinicians can assemble their own kits (American Society of Health-System Pharmacists, 2006). A hazardous drug spill kit should include the following contents.
Because many biotherapy agents are still relatively new in the treatment of cancer, there is still quite a bit of variability in how these agents are handled. However, it is important to note that some biologic agents are considered hazardous while others are not.
Recommendations for what personal protective equipment (PPE) to wear when handling chemotherapy or contaminated materials are consistent across several groups, including the National Institute for Occupational Safety and Health (NIOSH), Occupational Safety and Health Administration (OSHA), American Public Health Association, and ONS. These recommendations don’t differentiate between high- and low-risk situations, as there is no known minimum safe exposure and always the potential for contamination. 

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