what we have learned?? oncology clerkship group b lim kok han
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WHAT WE HAVE LEARNED?? ONCOLOGY CLERKSHIP GROUP B LIM KOK HAN MD HASHIMIE BADDRUDIN BIN MAT HASSAN SURESKUMAR A/L HARISKRISHANAN CHAI YEE YIEN CHUA SUE HOON NABILAH BINTI JAMALUDIN NIK NUR NASEELA FATHIN BINTI NIK MOHD SABRI NUR FADHILAH ARSHAD NUR HAIDAR BT AKBAR TAN SIN YEIN - PowerPoint PPT PresentationTRANSCRIPT
WHAT WE HAVE LEARNED??ONCOLOGY CLERKSHIP
GROUP B LIM KOK HAN MD HASHIMIE BADDRUDIN BIN MAT HASSANSURESKUMAR A/L HARISKRISHANANCHAI YEE YIENCHUA SUE HOONNABILAH BINTI JAMALUDINNIK NUR NASEELA FATHIN BINTI NIK MOHD SABRINUR FADHILAH ARSHADNUR HAIDAR BT AKBARTAN SIN YEINMOHAMAD SYAHIR BIN FADZILMOHD JAUZE BIN KOMA RUDINMUHAMMAD IMADUDDIN BIN CHE MOHD NASIR
LECTURER: Assoc Prof Saad Othman
What I have learned???
By LIM KOK HAN (95298)Group B
ONCOLOGY PHARMACY CLERKSHIP 2010
What I have learned about cleanroom?
• A Cleanroomis "a room in which the concentration of airborne particles is controlled, and which is constructed and used in a manner to minimize the introduction, generation, and retention of particles inside the room and in which other relevant parameters, e.g., temperature, humidity, and pressure, are controlled as necessary.“
• A “Cleanroom” is a controlled environment in which the concentration of airborne particles is controlled to specific limits- so that a desired level of cleanliness can be achieved. The level to which these particles need to be removed depends upon the standards required.
• To control the contamination, the only way is to control the total environment. Air flow rates and direction, pressure, temperature, humidity etc. all need to be controlled carefully. The sources of these particles need to be controlled or eliminated whenever possible. These sources are facilities, people, tool generated, fluids and products generated.
• Cleanrooms are planned and manufactured using strict protocol and methods. Cleanrooms are specifically used in many areas such as electronics, pharmaceutical, biopharmaceutical, medical device industries, operating rooms and other critical manufacturing environments, which need the product to be produced at certain level of “cleanliness”.
Cont…
• Types is based on the airflow pattern, either– Horizontal– Vertical– Mixed
• Classification based on the particles count in the room air
• Clean room have to be evaluated based on some parameters such as air particulate count, air velocity / air changes, temperature, humidity, pressure differences in order to ensure all the controlling parameters are within the normal range.
KEY ELEMENTS OF CLEANROOM1)HEPA FILTERS- These filters are important formaintaining contamination control. They filter particles as
small as 0.3 microns with a % 99.9995 (H14) minimum efficiency. Used with central system or stand alone
2)AIRLOCK- An airlock is a passage which permits the people to pass from non-controlled environment to controlled environment and vice versa.
3)PASSBOX- Passbox is a device which enables objects, parts, tools and other work items to be passed to and from the cleanroom
4)PANEL WALLS, FLOORS, CEILINGS, LIGHTS etc :Made of non contaminant, dust proof materials
MAINTENANCE OF THE CLEANROOM
• Maintenance of the cleanroom involves daily cleaning, weekly cleaning, and monthly cleaning, where all the cleaning work must be done properly based on the established standard cleaning procedure of cleanroom
• Wearing proper equipment while handling the sample that require sterile environment is highly necessary (example: TPN product , cytotoxic drug-PPE must be worn)
Parameters need to be controlled
• For example air particulate count here at clinical lab is done every 6 month & an acceptable result should shows that the Number of particles larger than 0.5 mcm should not be more than 10,000/ft3 or 350/l of air
• The air velocity should be maintained at 0.45 m/sec ±20% Air changes should be more than 20 times/hour.
• Temperature should be maintained at 18oC ± 2oC• Humidity should be maintained at 50% - 60%• Pressure differences should be maintained at 15 pascal
or more
What I had learned at HPP?
CYTOTOXIC DRUG REQUEST FORM(HPP)
Example of real cytotoxic drug request
* This is meant for educational purposes only…
Request form for cytotoxic drug reconstitution
• Requested by the physician/doctor via a form(as shown) and to be sent to the CDR unit for screening and cytotoxic drug preparation
• Pharmacist at CDR unit will do prescription screening from left right style.
• In the request form, the physician(prescriber) has to fill up some of the details required, which includes:1)General information on patient demographic
data2)Information about the requested drug(s)
1)General information on patient demographic data that need to be filled by prescriber:
• Chemo administration date:• Ward& Bed. No :• Patient’s Name & I/C:• Gender• Age• Weight(kg)• Height(cm)• BSA(m2)-to be calculated by the pharmacist based on patient’s weight and height• Diagnosis• Chemotherapy Protocol/Regimen• Interval: Days or Week• Cycle Number• Case : Old or New
• *BSA formula used : (Body weight(kg) x height(cm)/ 3600)^0.5
•
2) Information about the requested drug(s) need to be filled by prescriber based on the selected protocol
• Name of the drug• Dosage & Frequency• Chemo Day• Route IVI/IVB• Diluent Final Volume• Duration(hrs)
**At the bottom of this form, the prescriber must hand down their signature, name, chop(if any) and date the request has made
Particulars to be filled by the pharmacist in this form include
1) Reconstitution information-product batch no-no of ampoules/vial & strenght-reconstitution solution used & volume for cytotoxic
drug that is available in powder form such cyclophosphamide
-final volume of drug added-infusion solution used & volume : 2 types : 0.9% NS or
D5W solution-expired date of final product
Cont..things to be filled by pharmacist
2) product information• -trade name/manufacturer• -batch no.• -expiry date
Once the screening and all the particulars need to be calculated and written by the pharmacist have been completed, the pharmacist in-charge for processing this request need to hand down his/her signature, name and date it was done
If there is any drug-related problem(s) detected in the cytotoxic request form, the pharmacist needed to contact the prescriber(the physician that make the order), inform them about the potential problems and recommend the intervention to be done. All form of communication between pharmacist and the physician regarding any changes to the prescription must be written in a box provided.
….• Thus in regard to this request form, the pharmacist at Cytotoxic Drug
Reconstitution(CDR) unit must provide the best pharmaceutical care to the patient which include the through screening on the prescription and check for any errors/discrepancies/doubtful
• Thus, here screening process is still a part of the functions that pharmacist working at CDR unit .
• To ascertain certain information and to clarify the values written, this prescription will be needed to be prepared by another pharmacist
• Since this issue has involved pharmacokinetic formulas, thus as pharmacist we have to make sure that error is at minimal level while deliver the most effective drugs to the patient at safe recommended drug level.
THANK YOU…• Prepared by LIM KOK HAN• ( 95298)
• ONCOLOGY PHARMACY CLERKSHIP 2010• GROUP B
CDR CALCULATION
18MOHAMAD SYAHIR BIN
FADZIL (UF 070007)
Patient’s Profile
1)Name : ABC2)I/C : 07-55103)Gender : Male4)Weight: 63 kg5)Height : 123cm6) BSA :1.47m2
7)Diagnosis : Breast Cancer8) Protocol/Regime :FEC 9)Chemo Administration Date : 29/9/201010)Ward & Bed No : C19 (In Patient)
19MOHAMAD SYAHIR BIN FADZIL (UF 070007)
FEC RegimensCytotoxic Drug Dose (mg/m2) Prepared in Duration
5FU 600 500mL NS Over 1 hour
Epirubicin 75 500mL NS Over 1 hour
Cyclophosphamide 600 500mL NS Over 1 hour
All day 1 only Recycle 3 weekly
20MOHAMAD SYAHIR BIN FADZIL (UF 070007)
Drug available in Penang GH.Cytotoxic Drug Strength
5 FU 1g/20mL
Epirubicin 50mg/25mL , 10mg/5mL
Cyclophosphamide 1g/50mL , 200mg/10mL
21MOHAMAD SYAHIR BIN FADZIL (UF 070007)
Final Volume of Drug Needed
I. 5FUAmount required in mg600 mg/m2 x 1.47m2 = 882mg ≈ 880mg
Volume need to withdrawn from vial stock solution= 880mg 1000mg
= 17.6 mL≈ 17.5 mL
X 20mL
22MOHAMAD SYAHIR BIN FADZIL (UF 070007)
II. Epirubicin Amount required in mg= 75 mg/m2 x 1.47m2 = 110.25mg ≈ 110 mg
Volume needed to withdrawn from vial stock solution is 55 mL as shown in table below.
Vial strength No. of vial used Amount (mg) Volume (mL)
50mg/25mL 2 100 5010mg/5mL 1 10 5
110 55
23MOHAMAD SYAHIR BIN FADZIL (UF 070007)
III. Cyclophosphamide
Amount required in mg
= 600mg/m2 X 1.47m2
= 882mg≈ 880mg
Volume needed to withdrawn from the vial stock solution
X 50mL= 880mg 1000mg
= 44mL
24MOHAMAD SYAHIR BIN FADZIL (UF 070007)
Medical apparatus/devices used in the reconstitution of cytotoxic drugs
Below are some of common apparatus used: Syringe Syringe filters/ Injection filter Filter Straw Vial’s spike/Vial’s adapter/ Reconstitution device Needle Vials Ampoules Bottle of infusion liquid such as normal saline, dextrose 5% etc
PREPARED BY: NABILAH JAMALUDIN
PREPARED BY: NABILAH JAMALUDIN
Syringe• It is a medical instrument used to inject or withdraw fluids
• Types of syringes used in cytotoxic reconstitution: Disposible syringes (three parts) luer slip Disposible syringes (three parts) luer lock Disposible syringes (two parts)
• Packaging details: The syringes are packed individually in poly bag or blister package
• Individual package is more easier to be handled as the syringe is sterilized.
• The syringe that has been shown to us during clerkship is disposable syringes luer lock of 10 ml and 50 ml
PREPARED BY: NABILAH JAMALUDIN
Types of syringes Available size
Disposible syringes (three parts) luer slip
1 ml, 2 ml, 3 ml, 5 ml, 10 ml, 20 ml, 30 ml, 50 ml, 60 ml, 100 ml
Available Size of Syringes
Luer slip connector
PREPARED BY: NABILAH JAMALUDIN
Types of syringes Available SizeDisposible syringes (three parts) luer lock
2 ml, 3 ml, 5 ml, 10 ml, 20 ml, 30 ml, 50 ml, 60 ml
Luer lock
PREPARED BY: NABILAH JAMALUDIN
Types of syringes Available size
Disposible syringes (two parts) 1 ml, 2 ml, 3 ml, 5 ml, 10 ml, 20 ml, 30 ml.
PREPARED BY: NABILAH JAMALUDIN
Parts of syringe
PREPARED BY: NABILAH JAMALUDIN
Needle• In cytotoxics reconstitution, needles is used to withdraw drug
liquid from the vial• During clerkship, we have been shown the needles that been
packed individually.
Needle cap
Luer connector
PREPARED BY: NABILAH JAMALUDIN
• Needle gauge: Indicates the diameter of the needle.
• Various needle lengths are available for any given gauge
• Available needle gauge: Range from 7 G (largest in diameter) to 34 G (smallest in diameter) needles
PREPARED BY: NABILAH JAMALUDIN
Syringe Filter/Injection filter
• Use: To filter the solution or liquids from particles
• There are also available type that use to filter gases, and remove bacteria.
• It needs to be attached at the end of a syringe for use.
• The liquid is filtered by drawing it out from the syringe through the filter into vials, bottles, etc
• Most common sizes available: 0.2 or 0.22 µm and 0.45 µm pores. Membrane diameters of 10 mm, 13 mm, 25 mm are common as well.
PREPARED BY: NABILAH JAMALUDIN
• It may have luer lock fittings at one side to fit into the luer lock syringe. It consists of a plastic housing with a membrane which serves as a filter.
Luer lock connector
PREPARED BY: NABILAH JAMALUDIN
Using filter syringes
Step Diagram Explanation
1 Draw a small amount of air (about 1 ml) into the syringe. This air is used to purge the filter ensuring maximum sample throughput.
2 Load the sample into the syringe. Note the visible air pocket ready to purge the filter.
PREPARED BY: NABILAH JAMALUDIN
Step Diagram Explanation
3 Attach the filter to the syringe at the luer lock connector.
4 Hold the assembled syringe and filter vertically to wet the membrane. This prevents air blocks and promotes high flow rates.
PREPARED BY: NABILAH JAMALUDIN
Step Diagram Explanation
5 Press the syringe plunger gently. If possible, discard the first 0.25-0.5ml of sample. If the back pressure ever increases significantly, change the filter as it may have plugged. Avoid pressing excessively as this could cause the filter housing to burst.
6 Push the air through the filter to purge the housing and recover any remaining sample.
PREPARED BY: NABILAH JAMALUDIN
Filter Straw Use: To withdraw and filter fluids from the
ampoules
Only be used to withdraw not to inject out the liquid
It enhance patient safety by reducing the potential for glass particle injection
It is a flexible straw, which can be angled for easy use, is needle-free and latex free promoting personnel safety
PREPARED BY: NABILAH JAMALUDIN
Size of the Filter strawSize: 5 µm, 4.5 cmShort filter straw for withdrawal and filtration of fluids from small ampoules 4.5 cm filter straw 5 µm filter hub attached Blunt plastic straw
Size: 5 µm, 10 cmLong filter straw for withdrawal and filtration of fluids from large ampoules 10 cm filter straw 5 µm filter hub attached Blunt plastic straw
Filter hub
Long Filter straw
Short Filter straw
PREPARED BY: NABILAH JAMALUDIN
Vials• Varies types of vials, such as screwed
neck vials, vials with snap cap, crimp neck vials etc with or without rubber septa for the closure.
• Available size/volume for injection vials (crimp neck vials) to store the cytotoxics: 2 ml, 4 ml, 5 ml, 10ml, 25 ml and 50 ml
• The vials can be used to store liquids or soluble powders like cyclophosphamide.
PREPARED BY: NABILAH JAMALUDIN
Vial’s spike/Vial’s adapter/ Reconstitution device
• Used for withdrawal or addition of drug’s fluid from or into the vials in the reconstitution process.
PREPARED BY: NABILAH JAMALUDIN
Ampoules
• Ampoules are made of glass (clear or amber) or plastic.
• An ampoules may comes with a break point or a circular line around the neck for the ease of breaking it (the weakest point).
• Available sizes: Ranges from 1 ml to 25 ml.
Break point
Break line
PREPARED BY: NABILAH JAMALUDIN
Bottle of infusion liquid• For IV infusion administration, the
cytotoxics is directly injected into the bottle of infusion liquid such as normal saline or dextrose 5% for reconstitution
• This IV infusion bottle already equipped with the hook at the bottom for hanging purposes
• Usually, the bottle contains 500 ml of infusion liquid.
Roles of oncology Pharmacist
In Hospital Pulau Pinang, oncology
pharmacy service is divided into two
subunit:
Cytotoxic Drug Unit ( CDR unit )
Clinical Unit
by CHUA SUE HOON
Roles in CDR unit:• Receive prescription• Screening prescription• Calculation• Drug reconstitution• Labelling• Teaching – mostly the undergraduated nurses or
pharmacy students from the college and university.
• Provide information to the ward• Monitor stock level• Provide safety talk to the personnel
In Clinical part, most of the oncology pharmacist involved in:
• Monitoring, mainly sign and symptom of the patient.
• Ward round• Counselling - providing information, advice and assistance to
help patient for better adherence towards their treatment
• Give suggestion to the doctor
In general, oncology pharmacist play a
significant roles in cancer treatment patient.
They not just dispensing the drugs but also
valuable information throughout the therapy;
including counseling of
side-effect and management
of proper handling technique.
Cytotoxic Drugs• Cytotoxic drugs has a toxic effect on cells. It is
often used in the chemotherapy and
management of cancer patient.
• It may also produce unpleasant side effects
such as nausea, vomiting, hair loss and
suppression of bone marrow function.
Colour of Cytotoxic Drugs
During the clerkship, we have been exposed to few
of the chemotherapy drugs. The preceptor
emphasizes us on the importance of knowing the
color of chemotherapy drugs.
Most of the chemotherapy dugs are colorless.
There are only few drugs that have special
characteristic that oncology pharmacist should
take note of.
Anthracyclines group such as doxorubicin, epirubicin have red color of solution. Besides, idarubicin have a slightly red-orange colors of solution.
Idarubicin
Methotrexate, an antimetabolites cytotoxic drug have yellow color of solution.
Mitoxantrone, an anthracenedione has a blue color of solution.
By having knowledge in term of colors of each cytotoxic drusg, we can reduce the wrong drug error by identified the colors. Thus, can reduce the unnecessary wastage as cytototoxic drugs usually are expensive.
By: Chua Sue Hoon
ONCOLOGY CLERKSHIP INDIVIDUAL REPORT
NAME: MD HASHIMIE BADDRUDIN BIN MAT HASSANM/N: 95304
How to Break an Ampoule
What types of standard ampoules
• Ampoules can be:• self breakable (type of opening) – OPC –„one point cut“, with a cut at the
place of breakage– CBR – „color break“ with colored ring at
the breakage point
• with code rings (CR) for easier identification
• with screen print
Breaking procedures
You suppose to wrap the ampoule cap with gauze or tissue in order to avoid injuring during opening the ampoule.
Topic:isolator
• By Chai Yee Yian
Isolator in HPP
•A closed system•Not necessary put in cleanroom•Everything bring into pass box need swab with alcohol
Air flow after pass thru HEPA filter
Pass box with 2 side doors (inner and outer)
Gloves
Barometer, temperature, & humidity meter
Switch open pass box doors by step on it
Light to show pass-box’s inner door can open or not
air recirculated
Image of general isolater used, similar with isolator in HPP
Reconstitution Solvent
• Sodium Chloride (normal saline)• Dextrose solution (dextrose 5% water, D5W)
Cytotoxic Waste Management
Prepared by: NUR HAIDAR BINTI AKBARGROUP B
Cytotoxic waste includes: Expired drugs and aborted dosages
unused cytotoxic pharmaceuticals
sharps and syringe
intravenous infusion sets and containers
ampoules and vials
personal protective equipment and clothing
dressings and bandages
Caps, gloves, swabs
Adequate, leak-proof waste disposal containers:• sharps and solids containers• distinctive plastic waste bags
must be available in every area where cytotoxic drugs are prepared, administered or stored, and all cytotoxic drug-related waste must be placed into these containers or bags.
Any excreta from a patient being treated with cytotoxic drugs that is handled by a worker must be treated as cytotoxic drug-related waste
Items to be placed in shape container:• Needles• syringes and breakable items• glass vialsbefore they are stored in the waste bag
Waste Storage
• Storage of cytotoxic waste in should be in a dedicated, and secure area which can also be easily cleaned and maintained.
• Waste bins should be sealable.
Waste Disposal• Incineration is the only acceptable technology for
treating cytotoxic waste
• The waste are burn at 1000-1100 ⁰C
• Patient waste such as urine, faeces, vomitus and
the contents of colostomy and urostomy bags
may be disposed of in the normal sewage system
STORAGE OF CYTOTOXIC DRUG
Prepared by:NUR HAIDAR BINTI AKBAR
GROUP B
• In a locked refrigerator that must be at 4 ⁰C OR
• At room temperature ( below 30 ⁰C) must be
stored in locked cupboard in an appropriate
room for the storage of medicines
Cytotoxic drugs are required to be stored:
CYTOTOXIC DRUG STORAGEFridge items(4⁰C) Non-fridge items(<30⁰C)
Docetaxel Carbopletin
Paclitaxel Cytarebine
Doxarubicin Etoporoside
epirubicin Irinofecam
dacarbazine Oxaciplastin
vincristine Ifosfomide
Venorelbine Daunorubicin
Docetaxel Bleomycin
Gemcitabine
5-Fluorouracil
Methotrexate
TEMPER EVIDENT CAP LOCK SYRINGE
Ref: http://www.freepatentsonline.com/6585691.html
Prepared by Nik Nur Naseela Fathin binti Nik Mohd Sabri
• A temper evident cap lock syringe in cytotoxic drug unit is used to prevent any mishandle by health practitioner.
• Once the cap has been locked into the nozzle of the syringe, the cap will keep rotating at the same direction and will not responsive to counter rotation.
• It has its own method to use by which a sound will be produced once it is opened.
• If the lock is already tampered, it means that someone have utilized it.
• Thus, it is safe and effective to be applied to special drugs like cytotoxic drugs which can be administered by specialized people only.
Protocol/Regime in Chemotherapy
What is Chemotherapy regime/protocol?
The chemotherapy protocol describes in detail the aim, the modalities, the
complications and the expected results of the medical treatment which is going to
be prescribed. It is used as a reference throughout the prescription.
What it is used for?
It is used for calculation of the dose need to be given to cancer patient. The amount of needed drugs times with the body surface area (BSA) gives the recommended dose for the patient.
Prepared by MUHAMMAD IMADUDDIN BIN CHE MOHD NASIR
Protocol/Regime in Chemotherapy
Example of regime/protocol
FEC – consists of Fluorouracil (5-FU), epirubicin, cyclophosphamide
FEC regime is usually prescribed for treatment of breast cancer.
Information given on each protocol’s page:
1) The amount of drug e.g; 10 mg2) Infusion and reconstitution solution e.g; Normal Saline3) Day(s)4) Cycle Number
Spillage Management
Mohd Jauze bin KomarudinUF070008
840622015795
Cytotoxic Spill Kit
Contents of Cytotoxic Spill Kit• 1 x Goggles• 1 x Heavy Duty gloves• 1 x Vinyl Gloves• 1 x Respiratory Mask• 1 x Biohazard Bag• 3 x Spill Towels• 1 x Plastic Rubbish Bag• 1 x Gown• 1 x Shoe Covering• 1 x Scoop• 1 x Report Card• 2 x Cytotoxic Waste Labels
Spillage Management
Spillage Management: Surface Spills
1. Minimize air flow to area by shutting doors and windows.2. Call for help to get the nearest cytotoxic spill kit3. Open the kit and display the "Cytotoxic spillage" sign near the
spill area4. Put on the following from the kit in this order: a pair of gloves
(inner), mask, goggles (spectacles may not be used instead of goggles), the gown, overshoes, and a pair of blue gloves (outer).
5. For small volume spills (less than 5ml or 5g)i) Cover liquid spill with absorbent towels but avoid splashing.ii) Pick up solids with a moistened absorbent towel (wet with water or sodium chloride 0.9%)
Spillage Management: Surface Spills
6. For large volume spills (more than 5ml or 5g)i) For liquids, cover the spill with chemotherapy absorbent gel pads.ii) For solids, place an absorbent towel moistened with water or sodium chloride 0.9% on top of the cytotoxic material. Then cover with chemotherapy absorbent gel pads. Wait for the pad to be transformed into a gel and scoop up using plastic scoop. Ensure all of the residual gel is removed.
7. Scoop up any sharps using either the plastic scoop or swabs and place in a sharp plastic
8. Work from the outside inwards, clean the spill area with soap and water at least three times. Place all used absorbent towels in one of the yellow bags. Take care to avoid contamination of the bucket of water by only placing new absorbent towels in the water. If contamination does occur rinse the bucket thoroughly.
Spillage Management: Surface Spills
9. Place all contaminated material (including gown, outer gloves, mask, goggles and overshoes) in yellow bag. Then place filled bag and inner gloves in the other yellow bag
10. Wash hands11. Fill in adverse event form, inform Occupational
Health Department and record spill in departmental records. Fill out incident report card in spill kit and return to Oncology Pharmacist
Pulse TechniqueTo maintain negative pressure inside the vial. The purpose on doing this is to avoid the spillage of cytotoxic drug out from the vial.Step :For example the pharmacist need to fill in 10 ml drug into the syringeFirst pull out 10 ml air from the syringe.Then press in 1/3 of the syringe and pull out the plunger to fill in the 1/3 space of the drug.Repeat the above step to fill in 10 ml of the cytotoxic drug.After finish filling all the 10 ml drug. Don’t straight away pull out syringe from the vial. Pull out the plunger with extra air until 18 ml. Then only pull out the syringe.
TOPIC : PULSE TECHNIQUE & LABELLING by TAN SIN YEIN
LABELLING The label on the drug contains the drug name, drug strength, duration for infusion, patient name, patient registration number, patient identity card number (last 6 digits)The label must be stick on upside down direction of the Normal saline Infusion label
CYTOTOXIC DRUGIntravenous Fluid : Normal Saline/ _______________________Drug(s) added Amount_______________mg _________________________________ml __________________
Final Volume : 1 pint (500 ml)__________________Date and time Prepared: ________________Expires : ________________Duration of Infusion : _________________Name :Ward : R/N:
Labelling for Intravenous Bolus
Drug Route _____________________mg in_______________ml_____________Prepared__________Expired_______
Name_________________Ward___________R/N____________
CYTOTOXIC DRUG Handle with care
The intravenous bolus will fold and stick on the syringe after well prepared the cytotoxic drug to the patient.
What I learn in Oncology clerkship?
Sures kumar a/l Hariskrishanan95369
What is HEPA filter?
• EPA filters are composed of a mat of randomly arranged fibres.
• The fibres are typically composed of fiberglass and possess diameters between 0.5 and 2.0 micrometer.
• Key factors affecting function are fibre diameter, filter thickness, and face velocity. The air space between HEPA filter fibres is much greater than 0.3 μm.
• The common assumption that a HEPA filter acts like a sieve where particles smaller than the largest opening can pass through is incorrect. Unlike membrane filters, where particles as wide as the largest opening or distance between fibres cannot pass in between them at all, HEPA filters are designed to target much smaller pollutants and particles.
These particles are trapped (they stick to a fibre) through a combination of the following three mechanisms:
• Interception, where particles following a line of flow in the air stream come within one radius of a fibre and adhere to it.
• Impaction, where larger particles are unable to avoid fibres by following the curving contours of the air stream and are forced to embed in one of them directly; this effect increases with diminishing fibre separation and higher air flow velocity.
• Diffusion, an enhancing mechanism is a result of the collision with gas molecules by the smallest particles, especially those below 0.1 µm in diameter, which are thereby impeded and delayed in their path through the filter; this behaviour is similar to Brownian motion and raises the probability that a particle will be stopped by either of the two mechanisms above; it becomes dominant at lower air flow velocities.
• Diffusion predominates below the 0.1 μm diameter particle size. Impaction and interception predominate above 0.4 μm. In between, near the Most Penetrating Particle Size (MPPS) 0.3 μm, both diffusion and interception are comparatively inefficient. Therefore, the HEPA specifications use the retention of these particles to define the filter.
My understanding about negative pressure
• Negative Room Pressure to Prevent Cross-Contaminantion A negative pressure room includes a ventilation system designed so that air flows from the corridors, or any adjacent area, into the negative pressure room, ensuring that contaminated air cannot escape from the negative pressure room to other parts of the facility.
• Negative pressure is created by balancing the room’s ventilation system so that more air is mechanically exhausted from a room than is mechanically supplied.
• This creates a ventilation imbalance, which the room ventilation makes up by continually drawing in air from outside the room.
• In a well-designed negative pressure room, this air is pulled in under the door through a gap (typically abot one half-inch high) for that purpose.
• Other than this gap, the room should be as airtight as possible to prevent air from being pulled in through cracks and gaps, such as those around windows, light fixtures, and electrical outlets.
• Leakage from these sources can compromise or eliminate room negative pressure, even if the system is balanced to achieve it.
MEDICAL SURVEILLANCE
• Everyone who works in cytotoxic unit should be monitored in a systemic program of medical surveillance.
• It is to identify the earliest reversible biologic effects so it can be reduced or eliminated before sustains irreversible damage.
• Medical evaluation should be perform before starting job at cytotoxic unit, every 6 months periodically during employment, following acute exposure, transfer to other units and at time of job termination at cytotoxic unit.
PREPARED BY: NUR FADHILAH BINTI ARSHAD•85301•GROUP B
PERSONNEL ACCIDENTAL EXPOSURE
• Contact with cloth – remove any cloth soaked with cytotoxic drug
• For skin contact – wash with soap and plenty of water
• For eye contact – wash with plenty of water or normal saline and immediately see a doctor
• Report the incident and do medical check up
PREPARED BY: NUR FADHILAH BINTI ARSHAD•85301•GROUP B
GROUP B-ONCO CLERKSHIP