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.
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 be discharged into your service requiring Intravenous medications at home. Peter Mac @ home ensures all supplies are provided upon discharge. Some medications are administered using elastomeric baxter bottles containing Intravenous antimicrobials. The antimicrobials we administer at home are highlighted on pages 12 to 14 of the Referral to Peter Mac @ Home clinical procedure.
These patients require close monitoring and follow-up through our infectious disease team at Peter Mac. Typically, this involves face-to-face review once a week.
If you are experiencing a shortage of Baxter bottles or have an issue with how the baxter bottle is infusing, please contact Peter Mac @ Home on (03) 8559 6800 between 7am - 6pm for troubleshooting. If afterhours, 6pm - 7am, please contact City Hub on 0428 095 891.
Systemic Anti-Cancer Treatment (SACT) via an elastomeric Baxter device
Patients would be discharged to your service with an elastomeric Baxter delivering Systemic Anti-Cancer therapy (SACT) over 24, 46 or 96 hours. Your service will only disconnect the chemotherapy and will not attach it to the patient’s CVAD device.
All patients should be educated on the Baxter elastomeric device and treatment related side effects, as well as cytotoxic precautions, and spills management. The educating nurse will provide the patient with the eviQ patient handout on elastomeric infusion on connection at Peter Mac.
Please refer to pages 6-8 of the Management of Systemic Anti-Cancer Therapy via and elastomeric device clinical procedure for the steps on disconnecting.
Patient receiving any Intravenous systemic anti-cancer medications can be at risk of extravasation. If any concerns the medication has been incorrectly infusing or concerns the medication has leaked from the device, please follow our steps on the Management of Anti-Cancer Drug Extravasation guideline on pages 7-9.
The only drug we outsource is 5FU (Fluorouracil), which falls under the irritant drug classification. Please refer to pages 28-30 of our Management of Anti-Cancer Drug Extravasation clinical guideline for the management of irritant extravasation.
Troubleshooting with Systemic anti-cancer treatment administered via a Baxter device
- Do not disconnect
- Ensure the line is not clamped, check the flow restrictor has been taped to the skin
- If it looks like it’s infusing, contact Peter Mac @ Home (03) 8559 6800, 7 days per week between 8:00am-5:00pm, to reschedule another visit
- Outside of these hours, please call the afterhours hospital coordinator (03) 8559 5000.
- Contact Peter Mac @ Home on (03) 8559 5007, between 8am–5pm, 7 days a week
- Discuss booking the patient into our Chemotherapy Day Unit (CDU) for a medical review or hospital afterhours coordinator if on a weekend.
Refer to the Baxter Device Volume Guide to estimate the infusion time remaining.
Educate the patient regarding the importance of receiving the full dose and arrange for disconnection at completion time.
Clamp the line and see the EviQ hazardous drug spill management clinical guideline for directions on appropriate PPE (Personal Protective Equipment) and spill management.
If a patient has an implanted port, they must visit either Peter Mac or their local emergency department to have the gripper needle replaced and flushed with (X2 10mls NACL 0.9%).
For outsourced patients with PORT/TIVAD, an urgent medical review is required if SACT drug has been incorrectly infusing. If the infusion is administered via a PICC or a tunnelled CVAD, the site will need to be assessed by the visiting nurse for signs of extravasation and infection. Take a photo of the CVAD site with patient consent and perform a comprehensive skin assessment to ensure chemotherapy has not leaked all over the skin. If evidence of redness marks the area, contact Peter Mac @ Home and wait for a medical plan. Ensure the patient takes a shower immediately and thoroughly washes the affected area.
If the patient meets are acutely unwell and meets sepsis criteria, call 000. Follow the clinical deteriorating pathway in the community.
Determine the approximate volume remaining if the device becomes disconnected. The patient may require an additional dose and may need to visit the Day Therapy unit at Parkville campus. Peter Mac @ Home may require a photo of the Baxter for the medical team and pharmacy records.
Please call Peter Mac @ Home on (03) 8559 6800 between 8am-5pm, 7 days a week, to advise, discuss further action required, and document thoroughly.
The minimum education requirement for nurses administering cytotoxic drugs includes the 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.
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.
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