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POGO Satellite Manual

3.5 Chemotherapy Administration Reference List

3.6 Central Venous Catheter Care

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The information provided in the following sections is intended to guide safe practice in the POGO Satellite Program. It is not intended to replace your institutional policies and procedures. Please ensure all staff are aware of their own institutional policies and procedures and refer to them as their primary source.

Central Venous Catheter Care in the POGO Satellite Program

Variations in practice related to Central Venous Catheter (CVC) care exist across the five specialized childhood cancer programs in Ontario. Each tertiary hospital that refers patients to the POGO Satellite Program is committed to ensuring the initial and ongoing education of the nursing staff caring for their patients. CVC care is a controlled act authorized to Nursing.

Consistency of CVC care received in both the POGO Satellite Clinic and the specialized childhood cancer program is important in developing and maintaining the confidence of patients and families as they move between shared care partners. However, the most important determinant in CVC care is that best practice standards are being followed and that the POGO Satellite Clinic nurses are both skilled and competent in providing care for patients with a CVC.

Refer to your institutional policy for central line care. Contact your patient’s specialized childhood cancer program (tertiary centre) primary nurse, nurse educator or vascular access resource nurse with questions or concerns.

The following are general guiding principles for managing CVCs and Port-a-caths in the POGO Satellite Program:

  • For all catheter repairs, contact your patient’s tertiary hospital primary nurse or nurse educator.
  • Current evidence contradicts using vacutainers or syringes < 10 ml to draw lab work directly from pediatric CVCs because they can create pressure that can damage CVCs.
  • Coagulation blood work cannot be drawn from a heparinized CVC.
  • All CVCs/Port-a-caths should have a needle-less inject cap in place.
  • If a CVC/Port-a-cath is not heplocked, it must be infusing on an infusion pump at all times.
  • If using a gauze-type dressing, palpate the site each 8-hour shift. If patient complains of pain or tenderness, remove the dressing and visually assess the site.
  • When infusing IV fluids via a Port-a-cath, best practice recommendation is that the entry site be viewed hourly, if use of transparent dressing makes this possible.
  • Use a transparent dressing over the needle site, especially when administering chemotherapy. Transparent dressing should be changed weekly and PRN.
  • Change the Port-a-cath needle weekly and PRN.

Note: Copies of the complete set of policies and procedures for CVC care for each of the specialized childhood cancer programs which refer patients to a POGO Satellite Clinic should be made available at the POGO Satellite Clinic in the clinic, on the ward and in the emergency department, if appropriate.

This guidance document was developed by Mr. Kaniska Young Tai, The Hospital for Sick Children, Ms. Patti Bambury and Ms. Cristina Peter, Grand River Hospital, Ms. Kirsty Morelli, Scarborough Health Network, Centenary Hospital, and Mr. Graham Robinson, CHEO. Reviewed in consultation with Ms. Lindsay Lauer and Mr. Jose Oliveria, Trillium Health Partners, Credit Valley Hospital, Ms. Christina McCauley, Pediatric Oncology Group of Ontario/The Hospital for Sick Children and Ms. Mary Jo De Courcy, Children’s Hospital, London Health Sciences Centre, 2021, based on the sources below.

References

  1. Registered Nurses Association of Ontario (2021). Best Practice Guideline: Vascular Access, Second Edition. Retrieved August 12, 2021 from https://rnao.ca/sites/rnao-ca/files/bpg/Vascular_Access_June_2021.pdf.
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.
3.7 Chemotherapy Quick Reference
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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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