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POGO Satellite Manual

3.1.3 Administration of IV Hazardous Drugs

3.1.4 Administration of Oral Hazardous Drugs

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Examples: Mercaptopurine, Thioguanine

Healthcare personnel should avoid manipulating hazardous drugs (HDs), such as by crushing tablets or opening capsules, if possible. Liquid formulations are preferred if solid oral dosage forms are not appropriate for the patient.

Handling Precautions

  • Transfer oral HDs without touching them (PPE on).
  • If available, all HDs manipulation (opening/cutting/dissolving) should be performed in a biohazard hood.
  • It is preferable to dissolve tablets in water instead of crushing them (see below).
  • Prepare each dose on an absorbent pad on an uncluttered surface.
  • Discard materials that have been in contact with the tablets/capsules (medicine cups, oral syringes, absorbent pads, etc.) as hazardous waste.
  • Wash your hands after preparing medication.

Alternatives to HD Tablets

For children who cannot swallow tablets, methotrexate, mercaptopurine and thioguanine can be dissolved in water according to the following procedure:

  • Manipulate the required number of tablets into a liquid formulation immediately prior to dose time as follows:
    • Remove the plunger of a 10mL oral syringe.
    • Place the required number of tablets into the barrel of the oral syringe.
    • Replace the plunger and draw up 5–7.5–10mL of tap water (not hot water) into syringe.
    • Cap oral syringe with blue syringe tip.
  • Wait 5–15 minutes to allow the tablets to disintegrate (gently rock back and forth; shake syringe occasionally).
  • Give the dose in usual manner.
  • Draw up another 5mL of tap water into oral syringe. Cap syringe and shake well to dislodge any remaining particles. Give dose in usual manner.
  • Rinse the dissolve and dose device after each use.

Alternatives to HD Capsules

 For children who cannot swallow capsules or where the dose is less than one capsule, the contents of the capsule can be emptied into a Dissolve and Dose™ container and made into a solution using the following procedure. This activity should be performed in a biohazard hood if possible. Examples include procarbazine, temozolomide, and hydroxyurea:

  • Knock the powder down into one end of the capsule.
  • Take the top off the capsule and empty the contents into the Dissolve and Dose™ device.
  • Add 10mL of tap water (not hot).
  • Cap the device, shake well and allow to sit for 2 minutes.
  • Measure the appropriate dose using an oral syringe.

For children who cannot swallow capsules where the dose is one or more capsules, the contents of the capsule(s) may be removed and mixed with food or liquid immediately prior to dose time as follows. This activity should be performed in a biohazard hood if possible. Examples include lomustine, temozolomide, hydroxyurea, and procarbazine:

  • Put the food or liquid you will mix the drug with in a small medication cup. Ensure the food or liquid being used is compatible with the drug.
  • Knock the powder down into one end of the capsule.
  • Take the top off the capsule and empty the contents into the medication cup.
  • Mix the powder and the food/liquid that is in the cup.
  • Draw liquid mixed with drug into a syringe.

This guidance document was developed by Mr. Kaniska Young Tai, The Hospital for Sick Children, Toronto and Ms. Sylvie Kozlowskyj, Northeast Cancer Centre, Health Sciences North, Sudbury. Reviewed in consultation with Ms. Janie Lappan, McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, Ms. Mary Jo De Courcy, Children’s Hospital, London Health Sciences Centre, London and Ms. Christina McCauley, POGO/The Hospital for Sick Children, Toronto based on the sources in Sub-Section 3.1.7.

Disclaimer: Source Accuracy

You are welcome to download and save a local copy of this document in the Word and/or PDF formats provided. As the POGO Satellite Manual is subject to ongoing revisions and updates by POGO, we recommend you regularly check the online version posted at https://www.pogo.ca/satellite-manual/ to ensure you have the most up-to-date content. In the event of any inconsistency between the content of a local copy and the online version of the POGO Satellite Manual, the content of the online version shall be considered correct. Please see also the POGO Satellite Manual Disclaimer.

Record of Updates
Version NumberDate of EffectSummary of Revisions
16/28/2021Original version posted.
3.1.5 Disposal of Equipment/Personal Protective Equipment used to Administer Hazardous Drugs
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In this Section

  • 1.1 History and Overview
  • 1.2 Acknowledgements
  • 1.3 Committees and Working Groups
  • 1.4 POGO Satellite Manual Disclaimer
  • 2.1 Principles of POGO Satellite Clinic Care
  • 2.2 Eligible Patients
    • 2.2.1 Children Eligible for Chemotherapy Administration in a POGO Satellite Clinic
    • 2.2.2 Children Eligible for the Management of Complications in a POGO Satellite Clinic
    • 2.2.3 Children Eligible for Supportive Care in a POGO Satellite Clinic
  • 2.3 Scope of POGO Satellite Clinic Practice
  • 2.4 Expanded POGO Satellite Clinic Practice
  • 3.1 Safe Handling, Administration and Disposal of Chemotherapy Agents
    • 3.1.1 Personal Protective Equipment
    • 3.1.2 Preparation, Transport and Storage
    • 3.1.3 Administration of IV Hazardous Drugs
    • 3.1.4 Administration of Oral Hazardous Drugs
    • 3.1.5 Disposal of Equipment/Personal Protective Equipment used to Administer Hazardous Drugs
    • 3.1.6 Safe Handling for Pharmacy
    • 3.1.7 References
  • 3.2 Accidental Exposure/Spills
  • 3.3 Extravasation Management
    • 3.3.1 Prevention and Management of Extravasations
    • 3.3.2 Antidotes and Treatments for Extravasation
    • 3.3.3 Sample Extravasation Documenting Tool
    • 3.3.4 References
  • 3.4 Injecting SC Medication Via an Insuflon
  • 3.5 Chemotherapy Administration Reference List
  • 3.6 Central Venous Catheter Care
  • 3.7 Chemotherapy Quick Reference
    • 3.7.1 Rapid Hydration
    • 3.7.2 Provider Guide: Prevention and Management of Irinotecan-Induced Diarrhea
    • 3.7.3 Capizzi Methotrexate
    • 3.7.4 Erwinia Asparaginase
  • 4.1 Management of Fever and Neutropenia
    • 4.1.1 Routine Order Sample Sheet
    • 4.1.2 Sample Fever Cards
    • 4.1.3 Criteria for low-risk designation. Risk categorization refers to risk of bacteremia and serious complications, including mortality.
  • 4.2 Pentamidine Administration
    • 4.2.1 Inhaled Pentamidine
    • 4.2.2 Intravenous Pentamidine
  • 4.3 Antiemetics
  • 4.4 Treatment of Varicella-Zoster Infections
  • 4.5 Immunization of Children with Cancer
  • 4.6 Transfusion
  • 4.7 Clinical Circumstances that Warrant Consultation with the Specialized Childhood Cancer Program
  • 5.1 Palliative Care Overview
  • 5.2 Communication
  • 5.3 Settings of Care
  • 5.4 Symptom Management
  • 5.5 End of Life
  • 5.6 When a Child Dies at the POGO Satellite Clinic
  • 5.7 Appendix: Sample Bereavement Materials
    • 5.7.1 Reconciling Your Grief
    • 5.7.2 Funeral Arrangement Checklist
    • 5.7.3 Helping Children Who Grieve
    • 5.7.4 Coping with the Holidays
    • 5.7.5 The Grief Experience
  • 5.8 References
  • 6.1 Goals and Objectives
  • 6.2 Participant Site Selection
    • 6.2.1 Tertiary Hospital Site Selection
    • 6.2.2 Community Hospital Site Selection
  • 6.3 POGO’s Roles
    • 6.3.1 PHIPA, Privacy and Research
  • 6.4 Funding
    • 6.4.1 Funding Support for Tertiary Hospital Activity
    • 6.4.2 Funding Support for Community Hospital Activity
  • 6.5 Infrastructure and Formal Requirements
    • 6.5.1 Specialized Childhood Cancer Program Partners’ Role in the POGO Satellite Program
    • 6.5.2 POGO Satellite Clinic Partners’ Role in the POGO Satellite Program
  • 7.1 Preamble
  • 7.2 Investigator Responsibilities
  • 7.3 Training Requirements
    • 7.3.1 General Training for Conduct of Research
    • 7.3.2 Protocol-Specific Training
  • 7.4 Research Activities That May Be Completed in POGO Satellite Clinics Under Supervision of DSI
  • 7.5 Research Activities to be Completed in Specialized Childhood Cancer Programs Only
  • 7.6 Recognition and Reporting of Adverse Events (AEs)
  • 7.7 Data Transfer
  • 7.8 Pharmacy Drug Accountability
  • 7.9 Site Inspections and Quality Assurance
  • 8.1 Pediatric Oncology Shared Care Initial Data Transfer Sheet
  • 9.1 POGO Satellite Clinic Preparedness Checklist
  • 9.2 POGO Satellite Clinic Quality Assurance Checklist
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