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Care for cancer patients undergoing chemotherapy

Site: EHC | Egyptian Health Council
Course: Evidence of nursing procedures for the Oncology Department
Book: Care for cancer patients undergoing chemotherapy
Printed by: Guest user
Date: Tuesday, 5 May 2026, 11:39 PM

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"last update: 5 May 2025"                                                                                         تحميل الدليل                          

Table of contents

- Prepared by

Oncology guide

Under supervision

- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council

 Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate

Supervised by

Prof. Dr. Hussein Khaled, former Minister of Higher Education

 

Prepared by 

Title  

Name

NO.

Dean Of Faculty Nursing, Professor of Medical and Surgical Nursing, Tanta University

Dr Afaf Abdel Aziz Abdel Aziz Basal

1

Professor Of Critical Care Nursing

Prof.Dr/Zeinab Hussain Ali

2

Professor And Head of the Department of Medical Surgical Nursing. Faculty-. Benha University

Prof.Dr Amal Said Taha Refaie

3

Supervisor Of the Education Sector at Port Said University

Prof.Dr Amal Ahmed Khalil Morsy

4

Professor Of Medical Surgical Nursing- Faculty of Nursing- Cairo University

Dr. Hanan Ahmed Al Sebaee

5

Head of central administration on secondment at MOHP

Dr Neveen ab drab al0nabi Mohamed

6

Director Of Primary Health Care Nursing Department at MOHP.

Maysa Hosny Ahmed Tammam

7

Supervisor Of Technical Education- EHA 

Nancy Alaa Eldeen Abd-Elbaset Ali

8

Supervisor Of Nursing Services Development- EHA

Sherien Mohamed Saad

9

Assistant Professor of Maternity and Neonatal Health Nursing - Faculty of Nursing- Ain Shams University

Assist.Perof. Dr./Heba Mahmoud Mohammed

10

General manager of general administration of health institutes affairs

Dr Mai Galal Ibrahim Al-Assal

11

- Chemotherapy

Chemotherapy is a medication treatment using powerful chemicals to kill fast-growing cells in the body. It is commonly used to kill cancer cells in cancer patients, as cancer cells grow and multiply much faster than normal cells. Several different chemotherapy drugs are available. Chemotherapy can be used alone or with other drugs to treat various types of cancer.

Although chemotherapy is an effective treatment for many types of cancer, it also carries risks of side effects. Some chemotherapy side effects are mild and treatable, while others can lead to serious complications.

 

- Conditions for Using Chemotherapy for Cancer Patients

  • To treat cancer without other treatments. Chemotherapy can be used as the primary or sole treatment for cancer.
  • After other treatments, to kill hidden cancer cells. Chemotherapy may be used after treatments like surgery to kill any cancer cells that may remain in the body (adjuvant therapy).
  • To prepare for other treatments. Chemotherapy can be used to shrink a tumor to make other treatments, such as radiation therapy and surgery, more effective (neoadjuvant therapy).
  • To alleviate the signs and symptoms of the disease. Chemotherapy is used to relieve signs and symptoms of cancer by killing some cancer cells (palliative chemotherapy).

- Side Effects During Chemotherapy

Common side effects of chemotherapy drugs include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Hair loss
  • Loss of appetite
  • Fatigue
  • Fever
  • Mouth sores
  • Pain
  • Constipation
  • Easy bruising
  • Bleeding

Many of these side effects can be prevented or treated. Most side effects subside after the treatment ends.

Long-Term Side Effects

Chemotherapy drugs may also cause long-term side effects that appear months or years after treatment. The late effects vary depending on the chemotherapy drug, but they may include:

  • Lung tissue damage
  • Heart problems
  • Infertility
  • Kidney problems
  • Nerve damage (neuropathy)
  • Increased risk of another cancer

Chemotherapy Drugs

The type of chemotherapy drug is selected based on several factors, including:

  • Type of cancer
  • Stage of cancer
  • Overall health status
  • Previous cancer treatments
  • Patient goals and preferences

- Precautions for Nurses When Handling Chemotherapy

First: Procedures Before Preparing Chemotherapy:

  1. Know the patient's name.
  2. Know the drug name.
  3. Know the scheduled time for administering the dose.
  4. Know the required chemotherapy dose for the patient.
  5. Be aware of the method of administering chemotherapy.
  6. Know the solution used for chemotherapy dilution.
  7. Be familiar with the drug's brand name.
  8. Know the expiration date of the drug (its color and smell).
  9. Know the chemotherapy cycle number.
  10. Ensure the drug is stored properly.
  11. Confirm the chemotherapy order has been signed.

- Procedures During Chemotherapy Preparation

  1. The preparation area for chemotherapy should be separate from other hospital departments to minimize contamination risk, as many chemotherapy drugs are fine particles that can easily be inhaled as aerosol.
  2. If the hospital lacks a chemotherapy preparation unit, a fixed, suitable area should be designated for preparation.
  3. A cytotoxic drugs spill kit must be available in chemotherapy rooms to handle any breakage or spillage of chemotherapy drugs. This kit should include: plastic gloves, a medical coat, safety glasses, absorbent cloths, cleaning solution, purple plastic bags, and shoe covers.
  4. Wash hands.
  5. Wear personal protective equipment, including:
    • Long-sleeve gloves.
    • Impermeable, long-sleeve protective gown.
    • Protective glasses, face mask.
    • Single-use shoes, head cover.
  6. Chemotherapy should be mixed in a Biological Safety Cabinet.
  7. The ampoule should be broken away from the face and covered with gauze or cotton.
  8. The diluting solution should be slowly introduced along the side of the ampoule or vial, ensuring that all powder dissolves before withdrawal.
  9. Prevent high pressure inside the vial when starting the mixing and adding the solution.
  10. Air should be purged from the syringe used for injection on a gauze piece, not into the air.
  11. Purge excess drug from the syringe by removing the needle and placing a sterile cotton piece to prevent aerosol spread.
  12. Do not refrigerate the prepared drug; it should be used as soon as possible. The stability period usually lasts 24 hours at temperatures between 2°C to 8°C.
  13. Return any unused doses or expired drugs to the pharmacy for proper disposal.
  14. The syringes, tubes, and IV devices used should be of the Leur-lock type.
  15. Write the patient's name and dose on the solution bag.
  16. Cover the solution before transporting it to the patient.

- Procedures During Chemotherapy Administration

  1. Wash hands.
  2. Wear personal protective equipment.
  3. The nurse should change gloves after touching chemotherapy drugs or the patient.
  4. Place the IV solution device on the holder.
  5. Place a plastic absorbent cloth under the cannula to absorb any chemotherapy leakage during administration.
  6. Open the cannula and flush it with saline, not chemotherapy.
  7. Purge air from the IV device on a gauze piece, not into the air.
  8. Connect the IV solution device to the cannula and its port.
  9. Monitor the patient during chemotherapy administration.

- Procedures after Chemotherapy Administration

  1. Wash hands.
  2. Wear personal protective equipment.
  3. Close the IV solution device and disconnect it from the cannula.
  4. Close the cannula and remove the plastic absorbent cloth, placing it in the designated bin.
  5. The nurse should not dispose of used materials or leftover chemotherapy drugs near the patient.
  6. Properly dispose of all used waste.
  7. Return any leftover chemotherapy drugs to the pharmacy.
  8. Remove protective equipment and wash hands.
  9. Record the drugs administered to the patient.

- Procedures in Case of Chemotherapy Spillage Outside Patient's Vessels (Subcutaneous)

  1. Stop the IV solution device.
  2. Disconnect the IV solution device from the patient.
  3. Attempt to withdraw the spilled drug from the cannula using a syringe.
  4. Notify the doctor.
  5. Apply cold compresses to the spill site.
  6. Administer appropriate antidote to the patient.

After the spill, the following measures should be taken:

  1. Document the spill site and repeat the documentation weekly if necessary.
  2. Advise the patient to rest and elevate the affected area for 48 hours.
  3. Provide written instructions to the patient on symptoms to watch for and report immediately.
  4. Schedule another visit.
  5. Refer to a plastic surgeon if necessary.
  6. Record the incident and the actions taken.

  

- Procedures for Spills on the Ground-skin-eye-patient's bed

  1. Mark the spill location.
  2. Wear personal protective equipment.
  3. Use tweezers to pick up glass shards and place them in a break-resistant, puncture-resistant container.
  4. Place the container in a double-sealed bag and label it as "Hazardous Waste."
  5. Place an absorbent cloth on the ground to absorb the spilled chemotherapy drug, then clean the area with water and soap.
  6. Remove personal protective equipment and dispose of it in a sealed bag labeled as "Hazardous Waste."
  7. Place all items in a break-resistant, puncture-resistant container.
  8. Document the incident and actions taken.

For spills on the skin, follow these instructions:

  1. Warn others and call for help if needed.
  2. Remove gloves or contaminated clothing.
  3. Rinse the skin with a 3% sodium bicarbonate solution.
  4. Wash the skin with large amounts of water.
  5. Disinfect the skin with 70% alcohol.
  6. Rinse the skin with a phosphate-buffered solution.

For spills on the eye, follow these instructions:

  1. Call loudly for assistance.
  2. Rinse the eyes with large amounts of water for 10 minutes.
  3. Rinse the eyes with a phosphate-buffered solution.
  4. Consult an ophthalmologist if necessary.

For spills on the patient's bed:

  1. Wash hands.
  2. Wear personal protective equipment.
  3. Remove the contaminated bed linen and place it in special, sealed bags.
  4. Label the bags.
  5. Remove the contaminated protective equipment and wash hands.
  6. Wear new personal protective equipment.
  7. Use a new bed linen and set it up.
  8. Remove the protective equipment and wash hands.
  9. Document the incident and actions taken.
  10. Contaminated bedding should be placed in special bags and washed separately at least once before mixing with other laundry. Laundry staff should exercise caution when handling it.

- Chemotherapy Administration via Urinary Catheter

Chemotherapy through a urinary catheter is a procedure used to treat certain types of cancer, such as bladder cancer. The chemotherapy drugs are directly delivered into the bladder through a urinary catheter.

Tools Required:

  1. Sterile catheter (14-16 French for adults).
  2. Chemotherapy drug prepared according to the prescribed dosage.
  3. Sterile gloves.
  4. Sterile water or saline solution for washing.
  5. Sterile gel.
  6. Urine collection bag.
  7. Personal protective equipment (protective gown, mask, and eye protection).
  8. Hazardous waste disposal bag.

Confirming Patient Identity: Verify the patient's identity by name and date of birth, and ensure the correct procedure and treatment plan are being followed.

Patient Assessment:

  • Review the patient's medical history, including allergies and previous reactions to chemotherapy.
  • Assess for any contraindications, such as active urinary tract infections. Check recent blood tests and kidney functions (creatinine and glomerular filtration rate).
  • Ensure the patient has emptied their bladder.

Environment Preparation:

  • Provide adequate lighting.
  • Ensure proper ventilation.
  • Maintain privacy.

Preparing the Patient:

  • Introduce yourself to the patient.
  • Explain the procedure to the patient.
  • Obtain the patient’s consent for the procedure.
  • Assess the patient's general condition.
  • Cleanse the genital area thoroughly using sterile materials.
  • A local anesthetic may be applied to minimize discomfort.

Nursing Steps:

  • Position the patient comfortably in a reclining position with legs slightly apart. Cover the patient to maintain their privacy.
  • Wear personal protective equipment:
    • Long neck gloves.
    • Long-sleeved protective gown.
    • Protective glasses and face mask.
    • Disposable shoes and head cover.

Administering Chemotherapy:

  • Prepare the chemotherapy drug according to the prescribed dosage.
  • Follow sterile techniques when preparing the medication.
  • Double-check the medication name and dosage to prevent errors.
  • Connect the chemotherapy syringe to the catheter and slowly administer the drug into the catheter.
  • After administration, close the catheter to prevent the drug from leaking outside the bladder.
  • The drug should remain in the bladder for 1-2 hours based on the treatment protocol.
  • After the specified time, open the catheter to empty the bladder.
  • Introduce saline to ensure the drug is flushed out of the bladder.

Monitoring the Patient Post-Administration:

  • Monitor the patient immediately after administering the drug for any abnormal reactions.
  • Watch for side effects such as discomfort, bleeding, or signs of infection.
  • Instruct the patient on the importance of keeping the drug in the bladder for the specified duration and avoiding urination.

Catheter Removal:

  • Remove the catheter if no further medical procedure is required.
  • Open the catheter and allow the bladder to empty.
  • Remove the catheter carefully and dispose of it in a kidney basin.
  • Advise the patient to increase fluid intake and monitor for any signs or symptoms of infection.

Documentation:

  • Record all nursing interventions provided to the patient in their medical file, including the medication name, dosage, time of administration, and any abnormal reactions observed.

Nursing Actions Post-Chemotherapy Administration:

  • Dispose of all used waste properly.
  • Remove personal protective equipment and wash hands.

Health Education for the Patient:

  • Provide guidance on what to expect after chemotherapy administration, such as discomfort or burning sensations in the bladder.
  • Advise the patient to seek help if they experience signs of infection, severe pain, or bleeding.

Follow-up:

  • Set up a follow-up schedule to monitor the effect of the drug on the bladder or the occurrence of side effects.
  • Answer any questions the patient may have regarding the treatment.
  • Monitor the patient for complications such as infections or allergic reactions.

- Port-a-Cath Placement for Chemotherapy Injection

Nursing Steps for Port-a-Cath Placement:

Evaluation:

  1. Review the patient's file, including their name, age, diagnosis, and current medications (including anticoagulants).
  2. Take the medical history, including blood disorders and coagulation tests.
  3. Check for allergies to any medications.
  4. Assess the patient’s awareness level and anxiety level.
  5. Evaluate the patient’s skin for swelling or redness.
  6. Assess the patient’s pain level.

Preparation:

  1. Gather necessary tools, including:
    • Sterile strips or bandages.
    • Transparent semi-permeable dressing.
    • 2x2 inch gauze.
    • Sterile towel.
    • 2% Chlorhexidine solution.
    • Normal saline solution.
    • Heparin 100 units/ml in a 10 ml syringe or 10 units/ml/kg.
    • Non-hollow needle (appropriate size).
    • Personal protective equipment (face mask, clean gloves, sterile gloves, skin protectant wipes, alcohol wipes, iodine and povidone wipes).
    • IV stabilization device.
    • Cover.
  2. Wash hands.
  3. Wear disposable gloves.
  4. Wear personal protective equipment.
  5. Prepare the environment around the patient by closing doors and windows, pulling curtains, ensuring proper lighting, and adjusting the bed to a comfortable height.
  6. Prepare the patient by confirming their identity, explaining the procedure, and positioning them comfortably for easy access to the IV catheter site.

Procedure:

  1. Needle Insertion:
    • Use a blanket to cover any exposed area besides the insertion site.
    • Wear clean gloves and assess the insertion site, checking for any surgical incisions.
    • Discard the gloves and wear sterile gloves with personal protective equipment.
    • Attach the needle to the extension tube to remove air from the tube.
    • Clean the cap with an alcohol wipe, then insert a syringe with saline to fill the extension tube with saline.
    • Clean the insertion site with chlorhexidine or povidone iodine using a circular motion for at least 30 seconds, covering an area of at least 2-3 inches. Let it dry.
    • Using the non-dominant hand, pull the skin tight and insert the needle at a 90-degree angle into the correct site.
    • Check for blood return to confirm correct placement before administering the medication or solution.
    • Withdraw the syringe slightly to obtain a few milliliters of blood. If blood enters the syringe, remove the syringe, and wash with 3-5 ml saline while observing for leakage.
    • Administer saline solution via the syringe, open the extension tube clamp, and flush with 3-5 ml saline.
    • After flushing, remove the syringe, inject heparin, and maintain the injection for a minute or as per hospital policy.
    • Apply a sterile dressing to the insertion site and allow it to dry.
    • Secure the needle with sterile tape or strips in a star pattern.
    • Place a transparent dressing on the injection site or stabilization device.
    • Label the dressing with the date and time of change and the initials of the person administering the intravenous fluid injection.

Needle Removal:

  1. Wash hands.
  2. Wear gloves.
  3. Secure the needle holder with the non-dominant hand.
  4. Clean the extension tube cap and insert the saline-filled syringe.
  5. Open the clamp and flush with at least 10 ml of saline solution.
  6. Remove the syringe and insert heparin-filled syringe (approximately 5 ml of heparin).
  7. Remove the syringe and secure the extension tube.
  8. Carefully remove the transparent dressing starting from the edges.
  9. Secure the insertion site with fingers on both sides.
  10. Remove the needle smoothly at a 90-degree angle from the skin.
  11. Apply sterile gauze to the insertion site and place an adhesive bandage.
  12. Position the patient comfortably.
  13. Remove gloves.
  14. Wash hands.

Documentation: Record the following:

  • Needle insertion site.
  • Needle size used.
  • Signs or symptoms of infection.
  • Patient’s reaction.
  • Name of medication and dosage used.

- References

1. External beam therapy (EBT). RadiologyInfo.org. https://www.radiologyinfo.org/en/info/ebt. Accessed Jan. 17, 2023.

2. Hall WA, et al. "Magnetic resonance linear accelerator technology and adaptive radiation therapy: An overview for clinicians". CA: A Cancer Journal for Clinicians. 2021; doi:10.3322/caac.21707.

3. Mitin T. "Radiation therapy techniques in cancer treatment". https://www.uptodate.com/contents/search. Accessed Jan. 20, 2023.

4. Nguyen HT. "Allscripts EPSi". Mayo Clinic. May 5, 2022.

5. Radiation therapy and you: Support for people with cancer. National Cancer Institute. https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you. Accessed Jan. 17, 2023.

6. Radiation therapy. RadiologyInfo.org. https://www.radiologyinfo.org/en/info/intro_onco. Accessed Jan. 20, 2023.

7. Tepper JE, et al., eds. Intensity-modulated and image-guided radiotherapy. In: Gunderson & Tepper's Clinical Radiation Oncology. 5th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Sept. 26, 2022.

8. What to expect during treatment. American Society for Radiation Oncology. https://www.rtanswers.org/What-is-Radiation-Therapy/What-to-Expect/During-Treatment. Accessed Jan. 20, 2023.