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POGO Satellite Manual

3.1.4 Administration of Oral Hazardous Drugs

3.1.5 Disposal of Equipment/Personal Protective Equipment used to Administer Hazardous Drugs

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  • All syringes and needles should be discarded in containers that are puncture-resistant, leak-proof, have a lid that seals securely, and are appropriately labeled.
  • Bags and solution administration sets should be discarded intact in appropriately labeled resealable containers that are both leak-proof and puncture-proof.
  • PPE used during handling and administration should be disposed of in appropriately labeled container.

Nursing Care and Management of Patients Who Have Received Hazardous Drugs

  • Potential duration of excretion of chemotherapy agents and their metabolites are not well defined. While there is some data derived from the adult population, the extent to which this is applicable to children is unclear. Therefore, there is a real potential risk to healthcare professionals and parents who are caring for children following the administration of chemotherapy agents. It is recommended that PPE should be worn up to 48 hours post administration of hazardous drugs (HDs). Hazardous Drugs Precautions PPE Poster
  • Parents must be gloved when handling excreta and diapers up to 2 days post treatment.
  • Gloves should be discarded after each patient use, and when soiled or contaminated with body fluids, in appropriately labeled containers.
  • Gloves and gowns should not be worn outside of the drug administration area.

Flushing of Toilets (*Change in Practice*)

New Association of Pediatric Hematology/Oncology Nurses (APHON) references disagree on double flushing and research no longer supports this practice. In hospital, high-pressure toilets may increase risk of aerosolization; therefore, healthcare personnel are advised to flush once and cover with a plastic-lined, absorbent pad (absorbent side facing down) prior to flushing. These pads should be disposed of in biohazard containers after each use. Flushing twice is recommended in the home if the toilet has low flow pressure.

Disposal of Diapers

Diapers should be disposed of in a biohazard container for up to 2 days after chemotherapy administration.

Disposal of Contaminated Linen

Contaminated, non-disposable linen should be handled with gloves and gowns and should be dealt with in a manner consistent with institutional policies regarding handling and disposal of infectious linens.

Disposal of Biohazardous Contaminated Materials

  • All areas where HDs are handled should have specific disposable containers close at hand for easy and safe disposal.
  • Sharps and breakable items (e.g., vials, ampoules) should be disposed of in leak-proof, puncture-resistant containers with labels indicating hazardous or cytotoxic waste.
  • Non-sharp HD waste (e.g., plastic IV bags and tubing, personal protection equipment) should be sealed in leak-proof, puncture-resistant containers with appropriate labels.
  • These containers should be of a different colour from regular hazardous waste disposal containers.

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.

3.1.6 Safe Handling for Pharmacy
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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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