Registered Nurse The Role of the...
Transcript of Registered Nurse The Role of the...
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The Role of the OncologyRegistered Nurse
In Outpatient Medical Oncology
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The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
AAcckknnoowwlleeddggeemmeennttss The Role of the Oncology Registered Nurse in Outpatient Medical Oncology would not have been possible without the input and expertise provided by Eric Berger, Bridget Culhane, Cynthia Fisher, Laura Fennimore, Ilisa Halpern, Kris Hartigan, Gail Mallory, Pearl Moore, Julie Painter, Dianne Richardson, Paula Sherwood, Kathleen Shuey, and Karen Stanley.
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The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
Table of Contents
Introduction 1
Section One: Pretreatment 3
Section Two: Treatment 18
Section Three: Additional Clinical Responsibilities 28
Section Four: Oral Chemotherapy 34
Section Five: Case Study 36
Definitions 40
References 44
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The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
IInnttrroodduuccttiioonn
A diagnosis of cancer is a frightening and life-changing event. The individual and his/ her family fear the worst as they face the unknown, undergo a variety of treatment options and procedures and experience the side effects of therapy that can alter their quality of life. The impact of cancer on an individuals life correlates with the degree of change and disruption experienced. In todays world, patients in the midst of treatment continue to care for families, work, and face life with the resources that are available. The registered nurses ability to provide patient and family education across the illness and treatment continuum assists patients to adjust to the realities of the illness, cope more effectively, and reduces anxiety. The registered nurses skills in thorough assessment and intervention significantly impact patient outcomes. Research verifies that ongoing nursing communication, assessment, and intervention can reduce readmission rates and assist in the early diagnosis of problems so that patients experience fewer complications. The purpose of this document is to provide information on the unique needs of cancer patients and their families and the responsibility and unique contributions of the registered nurses who care for them. This document has been developed through a collaborative partnership between nurses representing the Oncology Nursing Society and US Oncology. The mission of both organizations is to promote quality patient care. The document explains and details services that may be provided during the care of the patient and family in an outpatient oncology setting/facility. Of note are the numerous interventions (such as delivery of chemotherapy/biotherapy, treatment of a disease by means of chemical substances or drugs, and management of side effects of therapy) requiring the unique contribution of the registered nurse with oncology specific training and competencies. Registered nurses enhance quality care by utilizing state-of-the-art knowledge and the skills of assessment, planning, intervention(s), and evaluation and provide the safest environment for the patient and family. Chemotherapeutic agents used for treating cancer are available in various forms. The form (route of administration) may depend on patient capability to receive the medication in that way or the requirements of a specific chemotherapeutic regimen/ treatment plan. Routes of chemotherapy administration include: topical (rubbed onto the skin), oral (by mouth in pill form), intravenous (administered through a catheter inserted into the patients vein in the arm, neck or chest), intrathecal (administered via a catheter inserted into the patients cerebrospinal fluid), via ommaya reservoir (administered through a device that allows the medication to enter ventricular spaces in the brain), and intraperitoneal (administered into the peritoneal /abdominal cavity). All routes of chemotherapy require safe and consistent delivery. Many patients will require surgical or radiologic placement of central venous access devices (intravenous devices that are placed into large veins in the upper chest) while other devices such as peripherally inserted central catheters may be placed by a specially trained registered nurse into a large vein in the arm. As these devices provide a direct line of infusion to major blood vessels supplying the heart, they
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The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
require meticulous care to prevent infection, regular dressing changes, and intermittent flushing with solutions that prevent the blood from clotting and keep the line open. This document is divided into key sections or treatment phases. Each phase details specific healthcare provider interventions and essential registered nurse interventions along the continuum of outpatient medical oncology care.
Section One, the Pre-Treatment phase, addresses interventions prior to the actual initiation of chemotherapy.
Section Two, the Treatment Phase, addresses those interventions that occur from the time therapy is initiated until all drug delivery devices (catheters used to deliver therapy into a vein, the cerebrospinal fluid, or ventricular spaces in the brain) are removed from the patient.
Section Three, Additional Clinical Responsibilities, addresses interventions that might occur more frequently and/or intermittently across the treatment continuum ongoing education, reinforcement of previously given information, symptom/side effect management, management of intravenous devices, and other issues as they arise, as well as those responsibilities focusing on documentation and telephone triage.
Section Four, Oral Chemotherapy, addresses those unique interventions required when patients are self-administering chemotherapy in the home setting.
Section Five includes case scenarios with examples of patient treatment experiences and nursing interventions.
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The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
The
follo
win
g se
ctio
ns d
escr
ibe
the
resp
onsi
bilit
ies
of t
he r
egis
tere
d nu
rse
in m
edic
al o
ncol
ogy
and
acti
viti
es a
ssoc
iate
d w
ith
cari
ng f
or p
atie
nts
rece
ivin
g ch
emot
hera
py o
r bi
othe
rapy
. S
ome
of t
he a
ctiv
itie
s de
scri
bed
can
be p
erfo
rmed
by
clin
ical
sta
ff
othe
r th
an t
he r
egis
tere
d nu
rse
(e.g
., a
pha
rmac
ist)
or
by t
echn
ical
sta
ff w
ho a
re s
uper
vise
d by
the
reg
iste
red
nurs
e.
Dut
ies
that
ar
e ex
clus
ivel
y th
e re
spon
sibi
lity
of t
he o
ncol
ogy
nurs
e ar
e no
ted.
In
addi
tion
, th
e fr
eque
ncy
of a
ctiv
ity
is li
sted
. A
ctiv
itie
s m
ay
occu
r on
the
fir
st d
ay o
f ch
emot
hera
py (
firs
t vi
sit)
, at
eac
h ch
emot
hera
py v
isit
, ea
ch t
ime
a ch
emot
hera
py a
gent
is g
iven
by
IV
push
or
IV in
fusi
on,
at e
ach
cycl
e (c
hem
othe
rapy
age
nts
are
give
n fo
r a
pred
eter
min
ed t
ime
fram
e [e
.g.,
a g
roup
of
chem
othe
rapy
ag
ents
may
be
give
n fo
r th
ree
days
eve
ry 2
1 da
ys a
nd t
he p
atie
nts
res
pons
e to
tre
atm
ent
eval
uate
d at
the
end
of
each
cyc
le])
, or
so
me
othe
r fr
eque
ncy.
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Pati
ent
asse
ssm
ent:
phy
sica
l and
psy
chos
ocia
l.
Com
preh
ensi
ve p
hysi
cal a
sses
smen
t:
X X
X
His
tory
and
phy
sica
l exa
min
atio
n (d
eter
min
es c
urre
nt c
ondi
tion
).
X X
X
Revi
ew o
f sy
stem
s: h
ead
and
neck
, sk
in,
resp
irat
ory,
car
diov
ascu
lar,
ga
stro
inte
stin
al,
geni
tour
inar
y, m
uscu
losk
elet
al,
lym
ph n
odes
and
re
late
d sw
ellin
g, b
lood
cel
ls,
nerv
ous
syst
em,
and
part
icul
ar b
ody
chem
istr
ies.
X X
X
Co
exis
ting
hea
lth
prob
lem
s (e
.g.,
car
diac
his
tory
, di
abet
es,
emph
ysem
a).
X X
X
Cu
rren
t al
lerg
ies
to m
edic
atio
n, f
ood,
and
env
iron
men
tal f
acto
rs.
X
X
Nut
riti
onal
sta
tus.
X
X X
Revi
ew a
nd u
pdat
e m
edic
atio
n lis
t an
d ch
eck
for
inco
mpa
tibi
litie
s or
dru
g in
tera
ctio
ns.
Dis
cuss
pot
enti
al in
tera
ctio
ns w
ith
phys
icia
n an
d/or
ph
arm
acis
t to
det
erm
ine
if c
hang
es n
eed
to b
e m
ade.
X
X
Cu
rren
tly
pres
crib
ed m
edic
atio
ns.
X
X
Ove
r-th
e-co
unte
r m
edic
atio
ns.
X
X
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The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Co
mpl
emen
tary
and
/or
alte
rnat
ive
med
icat
ions
or
ther
apie
s.
X
X
Obt
ain
and
revi
ew la
bora
tory
res
ults
to
dete
rmin
e if
the
y ar
e w
ithi
n an
ac
cept
able
ran
ge a
s se
t by
the
pra
ctic
e. C
hem
othe
rapy
des
troy
s ra
pidl
y di
vidi
ng c
ells
, bo
th n
orm
al (
hair
fol
licle
s, li
ning
of
the
gast
roin
test
inal
tr
act,
rep
rodu
ctiv
e tr
act,
and
blo
od c
ells
) an
d m
alig
nant
cel
ls.
Ass
ess
labo
rato
ry v
alue
s in
ligh
t of
exp
ecte
d si
de e
ffec
ts (
e.g.
, de
crea
sed
bloo
d co
unts
) an
d un
anti
cipa
ted
com
plic
atio
ns o
f pr
evio
usly
adm
inis
tere
d th
erap
ies.
Al
ert
the
phys
icia
n re
gard
ing
labo
rato
ry r
esul
ts t
hat
may
im
pact
the
che
mot
hera
py r
egim
en.
X X
X
Exam
ples
of
labo
rato
ry v
alue
s m
ay in
clud
e:
Com
plet
e bl
ood
coun
t: w
hite
blo
od c
ells
tha
t fi
ght
bact
eria
l and
vir
al
infe
ctio
n, r
ed c
ells
tha
t ca
rry
oxyg
en t
o th
e bo
dy a
nd h
elp
wit
h fa
tigu
e pr
oble
ms,
and
pla
tele
ts t
hat
assi
st w
ith
clot
ting
.
X X
X
X
Co
mpr
ehen
sive
met
abol
ic p
anel
(bl
ood
chem
istr
y te
sts)
. X
X
X X
Li
ver
func
tion
stu
dies
. X
X
X X
Re
nal f
unct
ion
stud
ies.
X
X
X X
Tu
mor
mar
ker
stud
ies
(som
e ca
ncer
s ha
ve m
arke
rs t
hat
indi
cate
the
re
duct
ion
or p
rogr
essi
on o
f th
e ca
ncer
); a
sses
smen
t fr
eque
ncy
vari
es
base
d on
dis
ease
.
X X
X
X
Dev
elop
or
revi
se t
he p
lan
of c
are
base
d on
ass
essm
ent
data
and
con
sult
w
ith
othe
r m
embe
rs o
f th
e he
alth
care
tea
m a
s ne
cess
ary.
Bas
ed o
n a
com
preh
ensi
ve p
atie
nt a
sses
smen
t, t
he p
hysi
cian
and
/or
regi
ster
ed n
urse
m
ay f
ind
it n
eces
sary
to
alte
r th
e tr
eatm
ent
plan
(e.
g.,
adju
stin
g ch
emot
hera
py d
osag
es o
r de
lay
of t
reat
men
t) o
r pr
ovid
e pr
etre
atm
ent
inte
rven
tion
s (e
.g.,
blo
od t
rans
fusi
on).
X X
X
Com
preh
ensi
ve p
sych
osoc
ial a
sses
smen
t of
pat
ient
and
fam
ily:
X X
X
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The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Ps
ycho
logi
c di
stre
ss t
hat
incl
udes
sad
ness
, de
pres
sion
, an
xiet
y, a
nger
, an
d fe
elin
gs o
f lo
ss o
f co
ntro
l.
X X
X
D
isru
ptio
n of
fam
ily d
ynam
ics
(e.g
., r
ole
chan
ges)
. X
X X
N
eed
for
outs
ide
serv
ices
. X
X X
Valid
ate
pati
ent
and
fam
ily c
once
rns
and
feel
ings
. A
llow
ade
quat
e ti
me
for
liste
ning
. X
X X
Mak
e ap
prop
riat
e re
ferr
als
or c
onsu
ltat
ions
in c
olla
bora
tion
wit
h th
e m
ulti
disc
iplin
ary
heal
thca
re t
eam
for
mor
e co
mpr
ehen
sive
ass
essm
ent
and
inte
rven
tion
as
nece
ssar
y.
X X
X
Prep
roce
dure
edu
cati
on (
may
be
rein
forc
ed p
ostp
roce
dure
).
Conf
irm
pat
ient
iden
tifi
cati
on.
X X
X
Asse
ss le
arni
ng n
eeds
, an
d de
velo
p an
d ga
ther
app
ropr
iate
mat
eria
ls.
X X
X D
iscu
ss w
ith
pati
ent
and
fam
ily a
nd p
rovi
de w
ritt
en m
ater
ials
as
need
ed:
X X
X
Canc
er o
r di
seas
e pr
oces
s an
d im
pact
on
the
indi
vidu
al.
X X
X
Prev
enti
on o
r de
tect
ion
mea
sure
s fo
r co
ncer
ned
fam
ily m
embe
rs.
X X
X
Gen
eral
med
icat
ion
side
eff
ects
(fo
r an
y pr
escr
ipti
ons
curr
entl
y ta
ken)
. X
X
X
D
rug
and/
or d
ieta
ry in
tera
ctio
ns t
hat
may
occ
ur a
nd t
heir
m
anag
emen
t.
X X
X
Impo
rtan
ce o
f m
aint
aini
ng a
ppro
pria
te s
ched
ule
as p
resc
ribe
d an
d no
tifi
cati
on o
f he
alth
care
tea
m if
tha
t is
not
pos
sibl
e (e
spec
ially
whe
n or
al c
hem
othe
rapy
dru
gs a
re p
resc
ribe
d).
See
Sect
ion
Four
.
X X
X
X
Chem
othe
rapy
and
adm
inis
trat
ion
issu
es:
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The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Si
de e
ffec
ts a
nd t
oxic
itie
s.
X X
X
X
IV-r
elat
ed c
ompl
icat
ions
(e.
g.,
swel
ling,
red
ness
, di
scol
orat
ion
of
vein
s).
X
X
X
Ve
sica
nt d
rug
issu
es:
Som
e ch
emot
hera
py a
gent
s ha
ve t
he p
oten
tial
to
cau
se s
ever
e ti
ssue
dam
age
if a
ccid
enta
lly le
aked
into
tis
sue
arou
nd t
he v
ein;
des
crib
e sy
mpt
oms
such
as
burn
ing
or s
ting
ing
at t
he
site
so
that
the
pat
ient
may
not
ify
the
nurs
e if
the
y oc
cur
duri
ng
adm
inis
trat
ion
of t
he c
hem
othe
rapy
age
nt.
X
X
Trea
tmen
t sc
hedu
le (
e.g.
, da
ily f
or f
our
days
, ev
ery
Tues
day
for
four
w
eeks
):
X X
X
X
O
ngoi
ng p
lan
esta
blis
hed
by p
hysi
cian
and
pat
ient
. X
X X
X X
Po
tent
ial f
or c
hang
es in
the
reg
imen
or
sche
dule
bas
ed o
n la
bora
tory
va
lues
or
othe
r di
agno
stic
tes
ts.
X X
X
X
X
Supp
orti
ve c
are
med
icat
ions
use
d to
con
trol
can
cer
and
trea
tmen
t-re
late
d sy
mpt
oms:
X
X
G
row
th f
acto
rs (
drug
s w
hich
sti
mul
ate
the
body
s b
one
mar
row
to
mak
e w
hite
blo
od c
ells
or
red
bloo
d ce
lls).
X
X
D
rugs
tha
t pr
even
t or
con
trol
nau
sea
and
vom
itin
g du
ring
and
aft
er
chem
othe
rapy
. X
X
An
alge
sics
for
pai
n co
ntro
l.
X
X
Info
rmat
ion
abou
t ce
ntra
l ven
ous
acce
ss d
evic
e (C
VAD
) (i
.e.,
an
IV d
evic
e pl
aced
into
larg
e ve
ins
in t
he u
pper
che
st).
X
X
X
Sym
ptom
iden
tifi
cati
on a
nd m
anag
emen
t.
X
X Si
de e
ffec
ts o
f ch
emot
hera
py a
re t
o be
tak
en s
erio
usly
. If
the
y ar
e no
t w
ell m
anag
ed,
pati
ents
may
be
hosp
ital
ized
, tr
eatm
ent
regi
men
s de
laye
d, a
nd li
ves
risk
ed.
The
reg
iste
red
nurs
e m
ust
inte
rpre
t
X
X
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The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
info
rmat
ion
from
pat
ient
s an
d fa
mili
es w
ho r
epor
t un
man
aged
sym
ptom
s an
d en
sure
tha
t pr
oper
car
e is
pro
vide
d.
Inst
ruct
pat
ient
and
fam
ily m
embe
rs o
r ca
regi
vers
and
pro
vide
wri
tten
m
ater
ials
as
need
ed r
egar
ding
:
Fe
ver:
Mon
itor
the
pat
ient
s t
empe
ratu
re.
Eve
n a
slig
ht f
ever
in a
pa
tien
t w
ho h
as r
ecei
ved
chem
othe
rapy
may
indi
cate
an
infe
ctio
n th
at is
life
thr
eate
ning
. R
epor
t a
feve
r im
med
iate
ly t
o he
alth
care
te
am.
Fev
er m
ay r
equi
re f
urth
er a
sses
smen
t (e
.g.,
blo
od o
r ot
her
tiss
ue c
ultu
res,
ant
ibio
tics
).
X
X
Ch
ills:
Mon
itor
for
pre
senc
e of
chi
lls a
nd/o
r sh
akin
g, w
hich
may
be
a si
gn o
f in
fect
ion
or n
euro
logi
c re
acti
on.
Not
ify
the
heal
thca
re t
eam
. X
X
N
ause
a: If
nau
sea
is p
rese
nt,
take
ant
inau
sea
med
icat
ions
as
pres
crib
ed,
and
focu
s on
mul
tipl
e sm
all m
eals
and
col
d fo
ods
wit
hout
ar
omas
.
X
X
Vo
mit
ing:
Res
tric
t in
take
of
food
and
flu
id le
adin
g to
mal
nutr
itio
n an
d se
vere
deh
ydra
tion
, as
wel
l as
elec
trol
yte
imba
lanc
e. I
f on
goin
g de
spit
e pr
escr
ibed
dru
g th
erap
y, b
lood
tes
ts m
ay b
e re
quir
ed t
o as
sess
for
deh
ydra
tion
. A
dif
fere
nt f
orm
of
nutr
itio
nal s
uppo
rt m
ay
be n
eces
sary
. Ca
ll th
e he
alth
care
tea
m if
una
ble
to k
eep
flui
ds o
r fo
od d
own.
Re
port
dur
atio
n of
the
pro
blem
and
the
num
ber
of
vom
itin
g ep
isod
es.
X
X
D
iarr
hea:
Can
lead
to
sign
ific
ant
flui
d lo
ss le
adin
g to
sev
ere
dehy
drat
ion.
Tak
e an
tidi
arrh
ea m
edic
atio
ns a
s pr
escr
ibed
and
dri
nk
flui
ds a
s pr
escr
ibed
. M
onit
or f
requ
ency
of
epis
odes
and
rep
ort
prob
lem
to
heal
thca
re t
eam
if n
onre
spon
sive
to
pres
crib
ed
inte
rven
tion
s. M
ay r
equi
re la
bora
tory
ass
essm
ent
and
furt
her
inte
rven
tion
.
X
X
Co
nsti
pati
on:
Can
lead
to
stra
inin
g, t
raum
a to
rec
tal t
issu
e, r
isk
of
X
X
-
8
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
infe
ctio
n in
the
tra
umat
ized
tis
sues
, an
d fe
cal i
mpa
ctio
n (i
.e.,
in
test
ines
blo
cked
wit
h st
ool)
. T
ake
cons
tipa
tion
med
icat
ions
(e.
g.,
stoo
l sof
tene
rs,
laxa
tive
s) a
s pr
escr
ibed
, dr
ink
plen
ty o
f fl
uids
, ca
refu
lly m
onit
or b
owel
mov
emen
ts,
and
noti
fy t
he h
ealt
hcar
e te
am
if c
onst
ipat
ion
is n
ot r
espo
nsiv
e to
inte
rven
tion
s.
M
outh
ulc
ers:
Wat
ch f
or m
outh
ulc
ers
or in
flam
mat
ion
of t
he o
ral
tiss
ue.
Use
med
icat
ions
to
cont
rol d
isco
mfo
rt a
s pr
escr
ibed
. C
old
food
s an
d ic
y nu
trit
iona
l dri
nks
may
be
easi
er t
o to
lera
te.
Cal
l the
he
alth
care
tea
m if
foo
d an
d fl
uid
inta
ke is
res
tric
ted,
pai
n do
es n
ot
resp
ond
to p
resc
ribe
d m
edic
atio
ns,
or f
ever
dev
elop
s.
X
X
Bl
eedi
ng o
r br
uisi
ng:
May
be
a si
gn o
f lo
w p
late
let
coun
t (i
.e.,
cel
ls
that
hel
p to
clo
t th
e bl
ood)
. A
void
sha
rp in
stru
men
ts a
nd r
igor
ous
phys
ical
act
ivit
y, a
nd c
all t
he h
ealt
hcar
e te
am if
sig
nifi
cant
inju
ry
occu
rs o
r bl
eedi
ng c
anno
t be
sto
pped
. A
spir
in a
nd o
ther
med
icat
ions
th
at in
terf
ere
wit
h bl
ood
clot
ting
sho
uld
not
be t
aken
unl
ess
the
phys
icia
n ha
s in
dica
ted
they
can
be
take
n. N
otif
y th
e he
alth
care
te
am if
ble
edin
g is
fre
quen
t or
can
not
be s
topp
ed.
X
X
Sh
ortn
ess
of b
reat
h: M
ay in
dica
te r
espi
rato
ry d
istr
ess
resu
ltin
g fr
om
resp
irat
ory
infe
ctio
n, b
lood
clo
ts in
the
lung
, ca
rdia
c co
mpl
icat
ions
, bl
eedi
ng,
seve
re f
atig
ue,
or s
ever
e pa
in.
Cal
l the
hea
lthc
are
team
if
shor
tnes
s of
bre
ath
has
a su
dden
or
unex
pect
ed o
nset
.
X
X
An
orex
ia:
A lo
ss o
f de
sire
to
eat
can
resu
lt in
mal
nutr
itio
n.
Not
ify
the
heal
thca
re t
eam
if t
his
occu
rs.
Mon
itor
wei
ght
loss
. Al
tern
ate
sour
ces
of n
utri
tion
may
be
pres
crib
ed.
Sm
all,
fre
quen
t m
eals
may
hel
p.
X
X
N
euro
toxi
city
: Th
is is
a c
hang
e in
sen
sati
on a
nd/o
r fe
elin
g in
the
ex
trem
itie
s. I
f th
e ha
nds
are
num
b or
sen
sati
on is
cha
ngin
g, a
void
ho
ldin
g ho
t or
ver
y co
ld it
ems
and
typi
cal h
ouse
hold
tas
ks s
uch
as
was
hing
dis
hes
or p
utti
ng it
ems
in a
hot
ove
n.
Not
ify
the
heal
thca
re
team
reg
ardi
ng s
ympt
oms.
X
X
-
9
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Prov
ide
a lis
t of
hea
lthc
are
team
mem
bers
(e.
g.,
phys
icia
ns,
regi
ster
ed
nurs
es,
phar
mac
ists
) an
d th
eir
phon
e nu
mbe
rs t
o co
ntac
t fo
r pr
oble
ms.
Re
info
rce
the
impo
rtan
ce o
f re
port
ing
sym
ptom
s as
pre
viou
sly
desc
ribe
d.
Ther
apy
may
be
inte
rrup
ted
if t
imel
y in
terv
enti
on is
not
pro
vide
d.
X X
X
Rein
forc
e pa
tien
t ed
ucat
ion
from
pre
viou
s vi
sits
and
ens
ure
fam
ily
mem
bers
und
erst
and
the
info
rmat
ion.
Ch
eck
to e
nsur
e th
at w
ritt
en
mat
eria
ls h
ave
been
pro
vide
d to
all
who
will
nee
d th
em.
Em
phas
ize
the
need
to
noti
fy t
he h
ealt
hcar
e te
am if
pro
blem
s ar
ise
betw
een
visi
ts.
X
X
Prep
are
the
room
aft
er c
onfi
rmin
g pa
tien
t id
enti
fica
tion
. G
athe
r an
d pr
epar
e eq
uipm
ent
(e.g
., IV
pol
e, t
able
).
X
X
Prep
are
the
pum
p (i
.e.,
a m
echa
nica
l dev
ice
used
to
regu
late
the
rat
e of
in
fusi
on o
f ch
emot
hera
py d
rugs
) fo
r us
e.
X
X
Eq
uipm
ent
mai
nten
ance
. (
Veri
fy t
hat
equi
pmen
t is
cle
an a
nd
func
tion
al.)
X
X
Pr
ogra
m t
he p
ump.
X
Te
st t
he a
larm
.
X
X
Ev
alua
te t
he e
lect
rica
l saf
ety.
X
X
Gat
her
and
prep
are
IV s
uppl
ies.
Det
erm
ine
the
type
of
IV a
cces
s. (
CVAD
ve
rsus
an
IV li
ne p
lace
d in
to v
eins
of
the
hand
or
low
er a
rm k
now
n as
a
peri
pher
al IV
).
X
X
X
For
a pe
riph
eral
IV s
tart
, as
sem
ble
supp
lies:
X
X
IV
cat
hete
r.
X
X
Appr
opri
ate
occl
usiv
e dr
essi
ng t
hat
cove
rs t
he IV
sit
e.
X
X
Tape
.
X
X
-
10
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
G
love
s.
X
X
Anti
sept
ic w
ipes
.
X
X
Al
coho
l wip
es.
X
X
Hep
arin
cap
(pl
aced
on
the
end
of a
per
iphe
ral o
r ce
ntra
l lin
e to
m
aint
ain
a cl
osed
, st
erile
sys
tem
).
X
X
H
epar
in f
lush
or
solu
tion
and
tub
ing
to m
aint
ain
IV p
aten
cy (
IV is
ope
n /n
o cl
ots
or s
lugg
ish
flow
and
eas
ily in
fuse
s w
ith
good
blo
od r
etur
n).
X
X
For
CVAD
, as
sem
ble
supp
lies:
Ap
prop
riat
e oc
clus
ive
dres
sing
tha
t co
vers
the
sit
e.
X
X
Tape
.
X
X
G
love
s.
X
X
Mas
k.
X
X
Anti
sept
ic w
ipes
.
X
X
Al
coho
l wip
es.
X
X
Hep
arin
cap
.
X
X
H
epar
in f
lush
or
solu
tion
and
tub
ing
to m
aint
ain
pate
ncy.
X
X
Addi
tion
al s
uppl
ies
and
equi
pmen
t fo
r im
plan
ted
pum
p (i
.e.,
dev
ice
impl
ante
d du
ring
a s
urgi
cal p
roce
dure
to
deliv
er c
onti
nuou
s ch
emot
hera
py t
o a
spec
ific
tum
or s
ite
such
as
the
liver
via
the
hep
atic
ar
tery
).
X
To
pica
l ane
sthe
tic
appl
ied
prio
r to
acc
essi
ng d
evic
e w
ith
port
nee
dle.
X
Ap
prop
riat
e ne
edle
for
impl
ante
d pu
mp.
X
Asse
mbl
e ca
thet
er f
lush
sup
plie
s:
X
-
11
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Fl
ush
solu
tion
(he
pari
n or
sal
ine)
.
X
X
Sy
ring
e.
X
X
Nee
dlel
ess
conn
ecto
r.
X
X
Gat
her
and
use
pers
onal
pro
tect
ive
equi
pmen
t to
pro
tect
clin
ical
sta
ff
(e.g
., r
egis
tere
d nu
rse,
pha
rmac
ist)
fro
m e
xpos
ure
to c
hem
othe
rapy
.
X X
Sp
ecia
l che
mot
hera
py-p
rote
ctiv
e gl
oves
.
X X
Ch
emot
hera
py g
own.
X X
M
ask
(as
need
ed t
o pr
even
t ex
posu
re).
X X
G
oggl
es (
as n
eede
d to
pre
vent
exp
osur
e).
X
X
Chem
othe
rapy
haz
ardo
us w
aste
con
tain
er.
X
X
Prep
are
chem
othe
rapy
. Ve
rify
insu
ranc
e co
vera
ge (
does
not
req
uire
a r
egis
tere
d nu
rse
or
phar
mac
ist
to v
erif
y di
rect
ly w
ith
the
insu
ranc
e co
mpa
ny).
How
ever
, be
fore
pre
pari
ng e
xpen
sive
che
mot
hera
py,
the
regi
ster
ed n
urse
or
phar
mac
ist
mus
t be
cer
tain
the
ver
ific
atio
n w
as m
ade.
X
Obt
ain,
ver
ify,
and
re-
veri
fy p
atie
nt c
onse
nt a
s ne
eded
. X
X X
Prep
arat
ion
of c
hem
othe
rapy
req
uire
s ex
tens
ive
know
ledg
e on
the
par
t of
th
e re
gist
ered
nur
se o
r on
colo
gy-s
peci
aliz
ed p
harm
acis
t to
saf
ely
inte
rpre
t ch
emot
hera
py o
rder
s an
d co
rrec
tly
perf
orm
the
ver
ific
atio
n of
:
X
X
X
D
rug
dosa
ges
(che
mot
hera
py d
rugs
hav
e va
ryin
g do
ses
base
d on
the
ac
tual
the
rapy
or
prot
ocol
).
X
X
X
Ad
min
istr
atio
n ro
ute
for
each
che
mot
hera
py d
rug.
(Ad
min
iste
ring
ch
emot
hera
py v
ia t
he in
corr
ect
rout
e ca
n be
har
mfu
l and
eve
n re
sult
in
dea
th.)
X
X
X
-
12
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
D
rug
com
pati
bilit
y an
d/or
inte
ract
ions
. X
X X
D
rugs
ord
ered
(m
ust
be a
ppro
ved
for
the
diag
nosi
s, w
hich
req
uire
s aw
aren
ess
of U
.S.
Food
and
Dru
g Ad
min
istr
atio
n-ap
prov
ed in
dica
tion
s as
wel
l as
appr
oved
of
f-la
bel
use
).
X
X
X
In
fusi
on t
ime.
(In
appr
opri
ate
infu
sion
tim
es s
uch
as IV
pus
h in
stea
d of
sev
eral
-hou
r in
fusi
on c
ould
res
ult
in s
erio
us h
arm
and
eve
n de
ath
to t
he p
atie
nt.)
X
X
X
Ph
ysic
ian
orde
rs p
er c
omm
unit
y st
anda
rd o
r re
sear
ch p
roto
col (
i.e.
, a
wri
tten
doc
umen
t th
at in
clud
es s
peci
fic
deta
ils o
f a
rese
arch
pro
ject
, in
clud
ing
drug
info
rmat
ion,
how
to
adm
inis
ter
the
drug
, pa
tien
t el
igib
ility
, et
c.).
X
X
X
Ca
lcul
ated
dos
e.
(Mos
t ch
emot
hera
py d
rugs
are
dos
ed a
ccor
ding
to
pati
ent
s bo
dy s
urfa
ce a
rea
[BSA
], w
hich
is a
for
mul
a ba
sed
on h
eigh
t an
d w
eigh
t th
at is
use
d in
det
erm
inin
g ap
prop
riat
e ch
emot
hera
py
drug
dos
es.)
X
X
X
M
axim
um d
ose
of d
rug.
(Pa
rtic
ular
che
mot
hera
py d
rugs
hav
e a
max
imum
dos
age
that
can
be
give
n. T
his
shou
ld b
e ca
lcul
ated
and
m
onit
ored
to
ensu
re t
hat
the
dosa
ge is
not
exc
eede
d re
gard
less
of
the
pati
ent
s BS
A. F
or e
xam
ple,
dox
orub
icin
is u
sed
for
man
y tu
mor
s an
d ha
s a
max
imum
dos
age
set
to r
educ
e th
e po
tent
ial f
or c
ardi
ac
dam
age.
)
X
X
X
Asse
mbl
e su
pplie
s fo
r dr
ug p
repa
rati
on:
X
X
IV f
luid
s.
X
X
Anti
emet
ic a
gent
s (i
n vi
als
from
man
ufac
ture
r).
X
X
Chem
othe
rapy
age
nts
(in
vial
s fr
om m
anuf
actu
rer)
.
X X
Tu
bing
: Ce
rtai
n ch
emot
hera
py a
gent
s re
quir
e sp
ecia
l IV
tubi
ng a
nd/
X
X
-
13
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
or t
he u
se o
f an
in-l
ine
IV f
ilter
to
elim
inat
e un
dilu
ted
part
icle
s.
Sy
ring
es,
alco
hol p
reps
, an
d ne
edle
s fo
r re
mov
ing
solu
tion
fro
m v
ials
an
d pl
acin
g in
eit
her
a sy
ring
e fo
r in
ject
ion
or IV
flu
id f
or in
fusi
on.
X
X
Asse
ss t
he p
atie
nt a
nd d
rug
for
prop
er s
olut
ion.
In
man
y in
stan
ces,
the
vo
lum
e an
d ty
pe o
f IV
flu
id t
hat
a ch
emot
hera
py a
gent
is d
ilute
d in
may
be
det
erm
ined
by
the
indi
vidu
al p
atie
nts
nee
d fo
r IV
flu
ids.
For
ex
ampl
e, p
atie
nts
wit
h di
abet
es n
eed
to r
ecei
ve c
hem
othe
rapy
dru
gs
dilu
ted
in n
orm
al s
alin
e (r
athe
r th
an d
extr
ose)
if t
he s
peci
fic
drug
and
fl
uid
are
com
pati
ble.
X
X
X
Asse
ss d
rug
stab
ility
. T
he r
egis
tere
d nu
rse
or p
harm
acis
t ne
eds
to k
now
ho
w lo
ng d
rugs
are
sta
ble
in s
olut
ion
so t
hat
they
are
pre
pare
d in
the
co
rrec
t ti
me
fram
e, s
tore
d in
the
cor
rect
env
iron
men
t to
mai
ntai
n dr
ug
pote
ncy
and
stab
ility
, an
d de
liver
ed in
a s
afe
and
tim
ely
fash
ion.
X
X
X
Prep
are
the
labe
l for
all
IV f
luid
s (f
or in
ject
ion
or in
fusi
on).
X X
Doc
umen
t th
e lo
t nu
mbe
r of
che
mot
hera
py d
rugs
. T
his
allo
ws
for
trac
king
of
each
dru
g th
at is
adm
inis
tere
d.
X
X
Doc
umen
t ex
pira
tion
dat
es o
f ch
emot
hera
py d
rugs
.
X X
Use
the
Cer
tifi
ed B
iolo
gica
l Saf
ety
Cabi
net
(nee
ded
to s
afel
y pr
epar
e dr
ugs
and
prev
ent
expo
sure
of
phar
mac
y or
nur
sing
sta
ff t
o ae
roso
lizat
ion
of c
hem
othe
rapy
age
nts)
. P
repa
rati
on a
nd m
aint
enan
ce in
clud
e:
X
X X
X
Cl
eani
ng t
he c
abin
et e
ach
day
prio
r to
use
, w
hene
ver
a sp
ill o
ccur
s,
and
at t
he e
nd o
f ea
ch w
orkd
ay.
X
D
econ
tam
inat
ing
the
cabi
net
wee
kly,
whe
neve
r a
spill
occ
urs,
or
whe
n th
e ho
od is
ser
vice
d or
mov
ed.
X
O
pera
ting
the
hoo
d co
ntin
uous
ly (
i.e.
, 24
hou
rs p
er d
ay).
X
In
spec
ting
and
cer
tify
ing
the
cabi
net
ever
y si
x m
onth
s.
X
-
14
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Prep
are
supp
orti
ve c
are
agen
ts.
X
X
Anti
emet
ic a
gent
s fo
r th
e pr
even
tion
of
naus
ea a
nd/o
r vo
mit
ing.
X
X
G
row
th f
acto
rs f
or lo
w r
ed b
lood
cel
l or
whi
te b
lood
cel
l cou
nts:
Co
nfer
wit
h th
e ph
ysic
ian
if la
bora
tory
dat
a in
dica
te t
he n
eed
for
incr
ease
d re
d or
whi
te b
lood
cel
ls t
hat
can
be m
anag
ed w
ith
grow
th
fact
ors.
X
X
Bi
spho
spho
nate
s to
low
er b
lood
cal
cium
leve
ls:
Som
e tu
mor
s an
d/or
ca
ncer
the
rapi
es c
an d
estr
oy b
one
mas
s, c
ausi
ng e
leva
ted
seru
m
calc
ium
. Th
is c
an le
ad t
o co
nfus
ion,
sei
zure
s, a
nd/o
r de
ath.
X
X
An
tibi
otic
s: O
ncol
ogy
prac
tice
s of
ten
adm
inis
ter
IV a
ntib
ioti
cs t
o pa
tien
ts w
ho h
ave
infe
ctio
ns in
an
effo
rt t
o av
oid
hosp
ital
izat
ion.
X
X
IV
flu
ids:
Pat
ient
s m
ay n
eed
to r
ecei
ve IV
hyd
rati
on b
ecau
se o
f ch
emot
hera
py-i
nduc
ed d
iarr
hea
or s
ever
e na
usea
and
vom
itin
g in
an
effo
rt t
o av
oid
hosp
ital
izat
ion.
Th
is a
lso
redu
ces
the
risk
of
blee
ding
(h
emor
rhag
e) in
the
bla
dder
.
X
X
Mix
che
mot
hera
py a
gent
s in
bio
logi
c sa
fety
cab
inet
. A
reg
iste
red
nurs
e,
phar
mac
ist,
or
phar
mac
y te
chni
cian
und
er t
he s
uper
visi
on o
f a
phar
mac
ist
mus
t m
ix t
he c
hem
othe
rapy
. S
ome
stat
es d
o no
t al
low
ph
arm
acy
tech
nici
ans
to p
repa
re c
hem
othe
rapy
. C
hem
othe
rapy
dru
gs
are
carc
inog
enic
(i.
e.,
can
caus
e ca
ncer
) an
d ne
ed t
o be
pre
pare
d un
der
circ
umst
ance
s th
at m
inim
ize
expo
sure
to
the
pers
on p
repa
ring
the
ch
emot
hera
py a
nd t
o th
e en
viro
nmen
t.
X
X X
X X
D
on c
hem
othe
rapy
gow
n an
d gl
oves
, as
wel
l as
a m
ask
and
gogg
les
if
appr
opri
ate.
X X
X X
X
Pl
ace
a pl
asti
c-ba
cked
pap
er d
rape
on
the
coun
ter
surf
ace
of t
he
biol
ogic
saf
ety
cabi
net.
X X
X X
X
Ve
rify
tha
t th
e gl
ass
shie
ld o
n th
e bi
olog
ic s
afet
y ca
bine
t is
onl
y op
en
X
X X
X X
-
15
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
8" t
o pr
even
t ex
posu
re t
o ch
emot
hera
py a
gent
s.
If
wit
hdra
win
g fr
om a
via
l, r
emov
e th
e du
st c
over
and
cle
an t
he
rubb
er d
iaph
ragm
.
X X
X X
X
At
tach
the
nee
dle
(or
need
lele
ss s
yste
m)
to t
he s
yrin
ge.
X
X X
X X
Inse
rt t
he n
eedl
e co
rrec
tly
into
the
via
l to
prev
ent
cori
ng.
X
X X
X X
Usi
ng a
sept
ic t
echn
ique
, w
ithd
raw
med
icat
ion
from
the
via
l tak
ing
care
not
to
touc
h an
y in
tern
al p
art
of t
he p
lung
er w
hen
pulli
ng b
ack.
X X
X X
X
Cl
ear
all l
iqui
d fr
om n
eedl
e or
hub
pri
or t
o re
mov
ing
the
need
le f
rom
th
e cl
osed
via
l.
X
X X
X X
W
ithd
raw
the
nee
dle
or s
yrin
ge f
rom
the
via
l wit
hout
spi
lling
con
tent
s in
the
Bio
logi
cal S
afet
y Ca
bine
t.
X
X X
X X
If
rec
onst
itut
ing
a po
wde
r, d
raw
up
corr
ect
amou
nt o
f di
luen
t.
X
X X
X X
Inje
ct d
iluen
t in
to v
ial.
X X
X X
X
M
ix c
onte
nts
of v
ial,
dilu
ent,
and
pow
der
(wit
h ne
edle
rem
aini
ng in
vi
al).
X X
X X
X
Fo
r in
fusi
on,
inje
ct t
he c
hem
othe
rapy
dos
e in
to t
he s
olut
ion.
X X
X
X
Cl
ean
the
addi
tive
por
t on
the
sol
utio
n co
ntai
ner
prio
r to
and
aft
er
inje
ctin
g ch
emot
hera
py.
X
X
X X
Pr
oper
ly m
ix c
onte
nts
and
perf
orm
a f
inal
insp
ecti
on.
X
X
X X
Plac
e a
tam
per-
proo
f se
al o
n ad
diti
ve p
ort.
X X
X
X
Pl
ace
a ca
p on
the
end
of
the
tubi
ng t
o m
aint
ain
ster
ility
, m
aint
ain
stab
ility
of
prod
uct,
and
pre
vent
leak
age.
X X
X
X
W
ipe
the
bag
wit
h an
alc
ohol
pre
p to
rem
ove
any
poss
ible
ch
emot
hera
py c
onta
min
atio
n.
X
X
X X
-
16
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Fo
r an
IV p
ush,
pla
ce t
he c
ap o
n th
e en
d of
the
syr
inge
to
mai
ntai
n st
erili
ty,
mai
ntai
n st
abili
ty o
f pr
oduc
t, a
nd p
reve
nt le
akag
e.
X
X X
X
Pr
int
and
appl
y th
e dr
ug la
bel t
o th
e m
ixtu
re.
X
X X
X X
Dis
pose
of
cont
amin
ated
equ
ipm
ent
in a
n ap
prop
riat
e ha
zard
ous
drug
-dis
posa
l con
tain
er p
er f
eder
al r
egul
atio
ns.
X
X X
X X
Prep
are
syri
nges
wit
h no
rmal
sal
ine
to f
lush
IV li
ne b
etw
een
adm
inis
trat
ion
of e
ach
agen
t.
X
X X
X X
Dou
ble
chec
k:
Ori
gina
l che
mot
hera
py o
rder
. X
X X
X X
X
D
rug
bein
g pr
epar
ed.
(Lo
ok a
t th
e or
igin
al v
ial
to v
erif
y co
rrec
t dr
ug
is b
eing
adm
ixed
.)
X X
X X
X X
Vi
al s
izes
. (
Use
a c
ombi
nati
on o
f vi
al s
izes
tha
t co
mes
clo
sest
to
the
pres
crib
ed d
ose
to r
educ
e w
aste
and
dec
reas
e co
st.)
X
X X
X X
X
Am
ount
of
drug
to
be in
still
ed in
to s
olut
ion
for
infu
sion
. X
X X
X X
X
D
ose
calc
ulat
ions
. X
X X
X X
X
Prep
are
IV c
hem
othe
rapy
. F
ill IV
tub
ing
wit
h a
nonc
hem
othe
rapy
IV f
luid
(s
uch
as n
orm
al s
alin
e).
X
X X
X X
Inve
ntor
y m
anag
emen
t:
Reor
der
drug
s.
X
X
X
Rest
ock
drug
s. (
Mus
t w
ear
pers
onal
pro
tect
ive
equi
pmen
t).
X
X
X
Obt
ain
vita
l sig
ns.
Obt
ain
vita
l si
gns.
(F
indi
ngs
may
sig
nal b
ody
syst
em a
bnor
mal
itie
s ne
cess
itat
ing
post
pone
men
t of
tre
atm
ent.
)
X X
X
Bl
ood
pres
sure
.
X X
X
-
17
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn OO
nnee ::
PPrr ee
tt rree aa
tt mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Pu
lse
and
resp
irat
ory
rate
.
X X
X
Te
mpe
ratu
re.
X
X
X
Obt
ain
heig
ht.
X
O
btai
n w
eigh
t.
X
X
X
Calc
ulat
e th
e ap
prop
riat
e ch
emot
hera
py d
osag
e. A
n in
accu
rate
ch
emot
hera
py o
r bi
othe
rapy
dos
age
coul
d re
sult
in o
ver-
or
unde
rdos
ing
of a
gent
s.
Veri
fy d
osin
g ba
sed
on:
X X
X
X
BS
A (f
orm
ula
usin
g he
ight
and
wei
ght)
OR
X
X X
Ar
ea u
nder
the
cur
ve (
AUC)
. X
X X
Ve
rify
BSA
or
AUC
wit
h or
ders
and
dos
e re
com
men
dati
ons.
Ina
ccur
ate
calc
ulat
ions
of
BSA
have
res
ulte
d in
18%
of
the
seri
ous
prev
enta
ble
adve
rse
drug
eve
nts
whe
n pr
acti
tion
ers
have
insu
ffic
ient
info
rmat
ion
abou
t th
e pa
tien
t.
X
X
X
-
18
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn TT
wwoo ::
TT
rr eeaa tt
mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Adm
inis
trat
ion
of c
hem
othe
rapy
. D
efin
itio
ns.
Chem
othe
rapy
and
sup
port
ive
care
med
icat
ions
are
adm
inis
tere
d in
a v
arie
ty o
f w
ays.
Met
hods
of
adm
inis
trat
ion
incl
ude
the
follo
win
g.
Pe
riph
eral
IV m
etho
ds:
IV p
iggy
back
: A
prim
ary
(mai
n) b
ag o
f IV
flu
ids,
usu
ally
sal
ine
solu
tion
, is
hun
g an
d th
e ch
emot
hera
py s
olut
ion
is c
onne
cted
(p
iggy
back
ed)
into
a s
ide
port
of
the
tubi
ng o
f th
e pr
imar
y fl
uid.
Th
is t
echn
ique
fur
ther
dilu
tes
the
med
icat
ion
as it
ent
ers
the
pati
ent
s ve
nous
sys
tem
.
IV p
ush:
A p
rim
ary
bag
of IV
flu
ids
is h
ung
and
slow
ly d
rips
into
the
pat
ient
s v
ein.
Th
e re
gist
ered
nur
se s
low
ly p
ushe
s th
e ch
emot
hera
py a
gent
into
a s
ide
port
of
the
prim
ary
bag
s IV
tub
ing.
Ch
emot
hera
py a
gent
s kn
own
as v
esic
ants
mus
t be
ad
min
iste
red
in t
his
man
ner.
Bec
ause
the
ves
ican
t dr
ug h
as t
he p
oten
tial
to
caus
e se
vere
dam
age,
incl
udin
g ti
ssue
dea
th,
if
any
of t
he m
edic
atio
n is
allo
wed
to
leak
into
the
tis
sues
aro
und
the
vein
, th
e re
gist
ered
nur
se m
ust
cons
tant
ly m
onit
or t
he
rate
of
deliv
ery
and
the
cond
itio
n of
the
sit
e w
here
the
IV is
pla
ced.
Ce
ntra
l ven
ous
acce
ss m
etho
ds:
Cent
ral v
enou
s ac
cess
req
uire
s th
at a
n IV
dev
ice
is p
lace
d in
to a
larg
e ve
in in
the
upp
er c
hest
(C
VAD
).
Chem
othe
rapy
can
be
very
cau
stic
to
the
vein
s, a
nd r
epea
ted
expo
sure
to
chem
othe
rapy
can
scl
eros
e (h
arde
n) v
eins
or
cau
se t
hem
to
be v
ery
frag
ile,
thus
mak
ing
a pe
riph
eral
IV d
iffi
cult
to
inse
rt.
Fra
gile
vei
ns c
an e
asily
be
punc
ture
d du
ring
in
sert
ion
of t
he p
erip
hera
l IV,
thu
s ne
cess
itat
ing
mul
tipl
e at
tem
pts
at p
laci
ng t
he IV
. In
the
se in
stan
ces,
an
impl
ante
d de
vice
ca
lled
a po
rt c
an b
e su
rgic
ally
pla
ced
unde
r th
e pa
tien
ts
skin
. A
sm
all t
ube
that
is c
onne
cted
to
the
port
is t
hrea
ded
into
the
la
rge
vein
in t
he c
hest
cav
ity.
Th
e po
rt h
as a
res
ervo
ir m
ade
of t
itan
ium
wit
h a
self
-sea
ling
acce
ss p
orti
on t
hat
allo
ws
a ne
edle
to
be p
lace
d th
roug
h th
e po
rt t
o re
mov
e bl
ood
for
sam
plin
g or
del
iver
a v
arie
ty o
f m
edic
atio
ns (
incl
udin
g ch
emot
hera
py)
and
flui
ds in
to t
he p
atie
nts
blo
odst
ream
. E
xter
nal
cath
eter
s al
so c
an b
e pl
aced
in t
he la
rge
vein
in t
he c
hest
ca
vity
. T
hese
cat
hete
rs a
re p
arti
ally
ext
erna
l and
gen
eral
ly h
eld
in p
lace
wit
h st
itch
es in
the
ski
n.
Im
plan
ted
pum
ps:
Arte
rial
acc
ess
devi
ce:
This
impl
ante
d de
vice
res
embl
es a
por
t bu
t ha
ve a
mec
hani
sm t
hat
deliv
ers
chem
othe
rapy
into
the
he
pati
c (l
iver
) ar
tery
. T
he d
evic
e al
low
s fo
r th
e de
liver
y of
che
mot
hera
py in
to a
spe
cifi
c re
gion
of
the
body
thu
s pr
ovid
ing
a hi
gher
con
cent
rati
on o
f ch
emot
hera
py a
t th
e tu
mor
sit
e.
-
19
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn TT
wwoo ::
TT
rr eeaa tt
mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Intr
aven
tric
ular
(om
may
a) a
cces
s de
vice
: Th
is is
a d
ome-
shap
ed,
self
-sea
ling
silic
one
rese
rvoi
r at
tach
ed t
o a
cath
eter
. T
he
devi
ce is
impl
ante
d un
der
the
scal
p ab
ove
the
fron
tal l
obe
and
allo
ws
for
deliv
ery
of c
hem
othe
rapy
into
the
cer
ebra
l spi
nal
flui
d to
tre
at c
ance
r ce
lls p
rese
nt in
tha
t fl
uid.
Epid
ural
and
intr
athe
cal a
cces
s de
vice
s: T
hese
cat
hete
rs a
re in
sert
ed in
to t
he e
pidu
ral s
pace
(be
twee
n th
e bo
ny p
rom
inen
ces
of t
he s
pina
l col
umn)
and
allo
w f
or t
he d
eliv
ery
of c
hem
othe
rapy
, op
ioid
s, a
nd a
nest
heti
c m
edic
atio
n fo
r ch
roni
c in
trac
tabl
e pa
in.
Man
y pa
tien
ts a
re s
ent
hom
e w
ith
chem
othe
rapy
del
iver
ed b
y a
devi
ce t
hat
pum
ps d
rugs
into
the
ir b
odie
s 24
hou
rs a
day
. T
he
regi
ster
ed n
urse
in t
he o
ffic
e is
on
call
for
thes
e pa
tien
ts in
the
eve
nt o
f pu
mp
prob
lem
s, in
clud
ing
disl
odgi
ng a
nee
dle
from
th
e po
rt,
an a
larm
war
ning
of
occl
usio
n (p
ossi
bly
rela
ted
to b
lood
tha
t ha
s co
ngea
led
and
form
ed a
clo
t in
the
cat
hete
r),
the
acci
dent
al c
utti
ng o
f th
e tu
bing
, or
a d
ead
batt
ery.
Pr
oble
ms
can
lead
to
rapi
d or
inad
equa
te in
fusi
on o
f th
e ch
emot
hera
py,
infe
ctio
n, a
nd/o
r th
e fo
rmat
ion
of a
clo
t in
the
cat
hete
r or
a b
lood
ves
sel b
ecau
se o
f in
adeq
uate
flu
id f
low
.
Chem
othe
rapy
tre
atm
ent
plan
s or
ord
ers
are
clea
rly
and
conc
isel
y w
ritt
en a
nd v
erif
ied
befo
re a
dmin
istr
atio
n.
Dou
ble-
chec
k th
e do
se c
alcu
lati
on f
or e
ach
chem
othe
rapy
age
nt p
rior
to
adm
inis
teri
ng.
X
X
X
Ch
eck
the
phys
icia
n or
der
for
the
curr
ent
date
, da
ys o
f ad
min
istr
atio
n fo
r th
e th
erap
y, p
atie
nt a
llerg
ies,
and
phy
sici
an s
igna
ture
. X
X X
Ve
rify
cal
cula
tion
s pe
rfor
med
by
the
phys
icia
n, s
uch
as t
he d
rug
dosa
ge o
f th
e dr
ug (
e.g.
, m
illig
ram
s or
dere
d m
ulti
plie
d by
the
pa
tien
ts
BSA)
.
X
X
X
U
sing
app
ropr
iate
ref
eren
ce,
chec
k to
ens
ure
that
the
dos
age
falls
w
ithi
n th
e pr
escr
ibed
saf
e ra
nge.
X
X X
Chec
k fo
r co
ntra
indi
cati
ons
(e.g
., a
bnor
mal
labo
rato
ry r
esul
ts,
seri
ous
side
ef
fect
s fr
om p
revi
ous
trea
tmen
ts)
befo
re a
dmin
istr
atio
n.
X X
X
Com
plic
atio
ns o
f ve
nous
acc
ess
are
prev
ente
d or
red
uced
wit
h ap
prop
riat
e ca
re.
Che
mot
hera
py a
nd t
hera
peut
ic
agen
ts a
re a
dmin
iste
red
safe
ly.
The
regi
ster
ed n
urse
mus
t be
kno
wle
dgea
ble
rega
rdin
g in
dica
tion
s fo
r th
erap
y, s
ide
effe
cts
and
pote
ntia
l adv
erse
rea
ctio
ns,
and
appr
opri
ate
X
X
X
-
20
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn TT
wwoo ::
TT
rr eeaa tt
mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
inte
rven
tion
s.
Init
iate
per
iphe
ral I
V ac
cess
: X
X X
As
sess
for
app
ropr
iate
vei
n se
lect
ion.
Rev
iew
pri
or s
ites
of
acce
ss a
nd
look
for
dam
age
to p
revi
ousl
y us
ed v
eins
. X
X X
Th
orou
ghly
cle
anse
ski
n at
acc
ess
site
to
redu
ce t
he p
oten
tial
for
in
fect
ion.
X
X X
Ro
utin
ely
begi
n IV
acc
ess
in a
reas
bel
ow t
he e
lbow
. X
X X
Su
bseq
uent
sit
es s
houl
d be
init
iate
d ab
ove
the
prev
ious
IV s
ite.
X
X X
Init
iate
CVA
D a
cces
s:
X X
X
Use
a n
onco
ring
nee
dle
for
port
s to
min
imiz
e da
mag
e to
the
sep
tum
. X
X X
Pr
even
t le
akag
e of
che
mot
hera
py f
rom
the
por
t se
ptum
. X
X X
Han
g pr
imar
y IV
flu
ids.
Th
is k
eeps
the
vei
n op
en,
dilu
tes
chem
othe
rapy
ag
ents
, an
d m
aint
ains
IV a
cces
s fo
r th
erap
euti
c an
d po
tent
ial e
mer
genc
y si
tuat
ions
.
X X
X
Veri
fy t
hat
the
IV is
fun
ctio
ning
cor
rect
ly:
X
X
X
Chec
k th
e si
te f
or a
ny s
igns
of
leak
age
into
the
ski
n.
X
X
X
Chec
k fo
r bl
ood
retu
rn.
Som
e ch
emot
hera
py a
gent
s ca
n da
mag
e th
e ti
ssue
sur
roun
ding
the
vei
n if
leak
s oc
cur.
Blo
od r
etur
n is
ver
ifie
d to
co
nfir
m t
he IV
line
rem
ains
in a
sta
ble
posi
tion
in t
he v
ein.
X
X
X
Ensu
re t
he
five
rig
hts
of
med
icat
ion
adm
inis
trat
ion
prio
r to
ad
min
iste
ring
any
med
icat
ion
to p
reve
nt e
rror
s:
X
X
X
Ri
ght
pati
ent.
X
X X
Ri
ght
tim
e.
X
X
X
Righ
t dr
ug.
X
X
X
-
21
The Role of the Oncology Registered NurseIn Outpatient Medical Oncology
SS eecc tt
ii oonn TT
wwoo ::
TT
rr eeaa tt
mmee nn
tt
Requires Registered
Nurse
First Visit
Each Visit
Each IV Push
Each Infusion
Each Cycle
As Needed
Ri
ght
dose
. X
X X
Ri
ght
rout
e of
adm
inis
trat
ion.
X
X X
Adm
inis
ter
prem
edic
atio
ns (
e.g.
, an
tiem
etic
s an
d/or
ste
roid
s to
pre
vent
na
usea
and
vom
itin
g).
X
X
X
Dou
ble-
chec
k th
e pa
tien
ts
iden
tity
. (
Ask
the
pati
ent
to s
tate
his
or
her
nam
e, d
ate
of b
irth
, ad
dres
s, o
r ot
her
iden
tifi
er t
o pr
even
t ac
cide
ntal
de
liver
y of
med
icat
ion
to w
rong
pat
ient
.)
X X
X
Begi
n th
e IV
infu
sion
: X
X X
G
athe
r an
d us
e pr
otec
tive
equ
ipm
ent
(i.e
., a
gow
n m
ade
of lo
w-
perm
eabi
lity
fabr
ic,
chem
othe
rapy
glo
ves,
and
gog
gles
if t
he p
oten
tial
fo
r ey
e co
ntam
inat
ion
exis
ts).
X X
X
Co
mpa
re t
he d
rug
in IV
bag
wit
h th
e ph
ysic
ian
orde
r.
X X
X
X
Secu
re a
noth
er r
egis
tere
d