Community Nursing Resource page

Peter MacCallum Cancer Centre (Peter Mac) partners with community providers to deliver specialist cancer nursing care in the home, for Peter Mac patients living in regional and rural areas of Victoria

This dedicated webpage resource provides information to assist community nursing partners in the delivery of care for Peter Mac patients in the community, as well as serving as a resource for nurses seeking information about cancer nursing care in the community

Our Community Liaison Nurses (CLN) coordinates all contracts with community providers and ensure adherence to the contractual agreement. 

Here you will find: 

  • Information that assists community nurse partners in the delivery of care for our patients in the community 
  • Resource for nurses seeking information about cancer nursing care in the community

This webpage includes information on: 

  • CVAD management and principals of care 
  • Assessment and management of a neutropenic patient 
  • Managing administration of Intravenous medications  
  • Pleurx management  
  • Vac management 
  • Drain tube management  
  • Pigtail flushing 
  • Nephrostomy management  
  • Reaction area care dressing regime and grading 
  • Frequently asked questions on community nursing care for patients receiving cancer treatment 

Central Venous Access Device (CVAD) Management 

Our patients require a range of central venous access devices (CVAD’s) for systemic anticancer therapy, supportive therapy, and medication administration. Devices that we can insert at our campuses include: 

  • Implanted Ports 
  • Peripherally inserted central venous catheters (PICCs)
  • Tunnelled devices (Hickmans and Permacaths) 

If we have outsourced the patient from Peter Mac @ Home, the partner community nursing provider will discharge them with: 

  • Written information regarding the type of CVAD inserted  
  • Dressing change date 
  • Adequate PPE if cytotoxic and sharps or equipment for disposal 
  • Adequate equipment for CVAD care 
  • Assessment requirements due on dressing care or CVAD care 
  • Troubleshooting 
  • How to contact Peter Mac @ Home or after hours 

Considerations when choosing the type of CVAD include, but are not limited to: 

  • Patient diagnosis 
  • Treatment requirements 
  • Patient physical assessment 
  • Previous CVAD history 
  • Duration and type of therapy 
  • Where the therapy is administered 
  • Patient preferences, lifestyle, and level of support

The Central Venous Access Device CVAD Principles of Management clinical guideline provides information on all aspects of CVAD assessment and management. 

Peripherally Inserted Central Venous Catheter (PICC) Management 

We usually insert a catheter percutaneously into the basilic or cephalic vein and thread it up the arm so that the catheter tip is positioned in the superior vena cava (SVC). These devices are used for treatment required for medium term (weeks-months). 

Peter Mac Principles of CVAD Management clinical guideline provides information on PICC management – see pages 5-11. 

This training video demonstrates the PICC dressing procedure. 

Tunnelled Device (Hickman and Permacath) Management 

  • Permacath: These devices are used for long term (months to years) treatment. This type of catheter also has a large lumen width, enabling sufficient venous access for therapeutic apheresis procedures, including collection of haematopoietic progenitor cells, as well as haemodialysis. The tunnel creates distance between the exit site and the puncture entry site, reducing the risk of catheter-related blood stream infections. 
  • Hickman: These devices are used for long term treatment (months to years). The tunnel creates distance between the exit site and the puncture entry site, reducing the risk of catheter-related blood stream infections. 

The Peter Mac CVAD dressing, securement device and cap change clinical procedure provides information on how to complete a Hickman & Permacath dressing in the community. See our Principles of CVAD Management Clinical Guideline outlines Tunnelled device management on pages 9-11. 

Tunnelled Implanted Vascular Access Device (Implanted Port Management

We use this device for administration of fluids, blood products and medications and blood sampling. Implanted ports may be single or double lumen. We can use these devices for long term treatment (months to years). A surgically inserted CVAD consisting of a self-sealing silicone injection housed in a body of inert material, connected to a silicone catheter. We insert the catheter into the venous system, typically placed with the tip positioned in the superior vena cava (SVC) but it can be in the upper arm via the basilic or brachial vein or less commonly, can be implanted in the abdomen. 

The Petermac Tunnelled Implanted Vascular access device (TIVAD) Management (Implanted PORT) clinical procedure provides information on implanted port accessing and deaccessing. Our Principles of CVAD Management Clinical Guideline outlines Implanted Port principles for management on pages 3-8. 

Management of the deteriorating patient in the community 

Our patients may become unwell due to their disease or treatment while in the community. Without urgent assessment and intervention this can be life threatening. 

Patients may be immunocompromised and may not display the typical signs and symptoms of infection, therefore thorough assessment is critical.  

You should manage all patients presenting with fever following recent anti-cancer treatment as if they have neutropenic fever and receive empiric antibiotics without waiting for laboratory confirmation of neutrophil count. 

Neutropenic fever is defined as a temperature of greater than 38.0*c and neutrophil count (ANC) of less than 1.0 x 10(9) cells/L. 

Any delay in the commencement of antibiotics may cause increased morbidity and mortality. 

The  Clinical Deterioration in the Community escalation flowchart outlines the immediate management for unwell patients in their home. 

Also, our Febrile Neutropenia clinical guideline provides evidence-based guidance on hospital-based management of neutropenic fever.  

Managing administration of Intravenous medications at home 

Patients may discharge into your service requiring Intravenous medications at home. Petermac @home would ensure all supplies are given on discharge. Some are given via elastomeric baxter bottles containing Intravenous antimicrobials.  Some of the antimicrobials we administer at home are highlighted on pages 9-11 of the Referral to Peter Mac @ Home clinical procedure 

We require these patients to have close monitoring and follow up through our infectious disease team at Petermac normally 1-2 weekly face to face review. 

If you are running out of Baxter bottles or have an issue with how the baxter bottle is infusing, we would ask you call PM@H, 080-1700 for troubleshooting.  

PleurX™ drain management 

The PleurX™system allows patients with conditions such as recurrent pleural effusions (thoracic) and malignant ascites (abdominal) to receive treatment at home. Our staff provide education to patients and their families on how to manage their drain tube at home, to improve symptom control and comfort. The PleurX™ system is indicated for the palliation of symptoms and is intended for management in the outpatient setting. 

Our Management of PleurX Drainage Catheter System clinical procedure provides guidance on management of PleurX™ drainage systems.  

The following information is contained within the clinical procedure: 

  • Equipment Requirements (Page 2) 
  • Draining the PleurX™ catheter (Page 3-4) 
  • Application of Dressing (Page 5) 
  • PleurX™  Recommended Drainage amounts (Page 4)

If you only have two kits left, please contact the Peter Mac @ Home admin team on: 

Phone: (03) 8559 6800 
7 days a week between 8am-5pm 

The Peter Mac @ Home staff will advise on how to procure more supplies 

BD PleurX Drain Video 

A visual education resource to assist you in caring for patients with a pleurX drain 

Frequently Asked Questions 

How to access more equipment supplies from Peter Mac 

If the patient is scheduled to come to one of our campuses for an appointment, we can arrange on the day of the appointment for supplies to be sent home with the patient. If the patient is at home, call the Community Liaison Nurse on (03) 8559 5007 when equipment supplies are running low, to ensure sufficient time for delivery by express post. 

Antineoplastic drug administered via a Baxter device has not finished at the expected time 

  1. Do not disconnect
  2. Ensure the line is not clamped
  3. If it looks like it’s infusing, contact PM@H on (03) 8559 5007 7 days per week 8:00am -5:00pm to reschedule another visit 
  4. Out with this time If after hours please call the After Hours hospital coordinator (03) 8559 5000  

Patients will be provided with the Going home with a slow chemotherapy infusion pump (24 hr) or Going home with a slow chemotherapy Infusion pump (46 hr) information resource outlining practical information regarding their infusion. 

If it does not appear to be infusing: 

  1. Contact PM@H on (03) 8559 5007 8am –5pm, 7 days a week 
  2. Discuss booking the patient into our Chemotherapy Day Unit (CDU) for a medical review

Refer to the Baxter Device Volume Guide to estimate the infusion time remaining

Antineoplastic drug administered via a Baxter device has not finished at the expected time, but the patient requests the device be removed 

Educate the patient regarding the importance of receiving the full dose and arrange for disconnection at completion time. 

Antineoplastic drugs administered via a Baxter device has become disconnected from the patient 

Clamp the line and see the EviQ hazardous drug spill management clinical guideline for direction on appropriate PPE (Personal Protective Equipment) and spill management.  

If a patient has an implanted port, they will need to attend either Peter Mac or their local emergency department to have the gripper needle replaced, and a heparin lock administered. 

If the infusion is administered via a PICC or a tunneled CVAD, the site will need to be assessed by the visiting nurse for signs of infection. 

Ascertain approximate volume left when the device became disconnected. The patient may require a further dose and will need to come into one of our campuses to do so.  

Please call PM@H (03) 8559 6800 8am-5pm, 7 days a week to advise, discuss further action required, and document thoroughly. 

What education/training do Peter Mac nurses require to manage patients receiving antineoplastic drugs? 

The minimum education requirement for nurses administering cytotoxic drugs is completion of the Peter Mac Chemotherapy Module One or an equivalent program, in addition to completion of our Cytotoxic Chemotherapy Competency Assessment Tool. 

Your organisation may have an in-house education program or alternatively utilise resources available from EdCaN or eviQ

Speak with your manager regarding your organisations' requirements. 

What personal protective equipment should I wear if my patient has received antineoplastic agents within the last seven days? 

The Peter Mac Safe Handling of Cytotoxic, Monoclonal Antibody and Hazardous Non-Cytotoxic drugs clinical procedure provides directions on safe handling practices. 

How do I manage a cytotoxic spill in a patients’ home? 

A cytotoxic spill refers to both a liquid or powder spill of a cytotoxic drug and/or the bodily fluids of the patient within seven days of administration of a cytotoxic drug. Equipment used in this situation can be disposed of in a sealed cytotoxic waste bag (purple) and placed in a cytotoxic bin (purple).  

The Peter Mac Management of a Cytotoxic and Hazardous Non-Cytotoxic Spill Clinical procedure  provides direction to all staff involved in the safe management of a cytotoxic or hazardous non-cytotoxic drugs spill. 

The KCI vacuum wound therapy machine is alarming with a leak or blockage. 

See ActiVAC Alarm Trouble Shooting Guide

Alternatively, KCI Customer Service Call Centre professionals are available 24/7: 

  • Phone: 1300 KCI VAC (1300 524 822)  
  • Fax: 1800 KCI VAC (1800 524 822)  
  • Email: This email address is being protected from spambots. You need JavaScript enabled to view it.  

Drain Tube Management 

Our patients may have a drain tube in situ on discharge. We use the following drain tubes:  

  • Exudrain 
  • Bellovac 
  • Surimex 
  • Jackson Pratt 
  • Pigtail

We will discharge all our patients with a relevant written drain tube removal order, care and requirements. 

For more information on the management of these devices, please refer to The Peter Mac Wound Drain Tube Management clinical procedure. 

Some drains may require flushing more so our Pigtail drains. We highlight this information on page 9-10 on the Wound Drain Tube management procedure  

Removing a drain is highlighted on page 6 of Wound Drain Tube Management clinical procedure 

Nephrostomy Management  

Our patients may be discharged with a nephrostomy requiring care in the community. 

We would ask that you follow our Petermac Care of Nephrostomy catheters clinical guideline for weekly care. The steps on how to change a nephrostomy bag is on page 3-4 

 If a Nephrostomy is to be flushed, then orders and equipment would be sent home with the patient these steps are highlighted on pages 4-5 of the Nephrostomy catheter clinical guideline 

Radiotherapy dressing management  

Many of our patients may be discharged to your service requiring daily dressing care.  

We would supply adequate equipment for managing the reaction area care. 

More information on grading the radiotherapy indued skin reaction we follow the CTCAE system which is highlight in eviQ on the radiation-induced dermatitis  

If any patient requires wound re-assessment we would ask you contact PM@H to organise a review with the radiotherapy nurses and treating team. 

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