Care for cancer patients undergoing chemotherapy

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.