Plus-Hex CLINICAL
Introduction
Cytarabine( also known as cytosine arabinoside) is a chemotherapeutic drug used as a treatment option for meningoencephalitis of unknown origin( MUO), an immune-mediated neurological disease. Cytarabine is classed as an anti-metabolite, which stops the mechanism of cellular growth and division [ 1 ], therefore preventing the spread of the abnormal cells. have tested their gloves against cytotoxic agents and have claimed they are resistant to cytotoxic drugs [ 5, 6 ], although the NHS states that no glove is completely chemotherapy resistant [ 7 ]. Double gloving is a good way to increase protection. It also facilitates an important step later in the setting up of the CRI, when the outer gloves can be removed( see page 48).
Cytarabine can be administered as a constant-rate infusion( CRI) or subcutaneously. In veterinary practice it is used to treat dogs and cats. Veterinary nurses( VNs) can play an important role in the preparation and administration of the CRI. Thorough training and complete standard operating procedures( SOPs) must be provided to all staff before they prepare and administer a cytarabine CRI.
This article explores the safety of preparing cytarabine as a CRI and the setting up of the patient ' s environment.
Learning outcomes
• Evaluate cytarabine as an option for patients in general practice
• Identify the procedure for safe preparation and administration of a cytarabine CRI
• Understand the importance of comfort and safety in patients ' environment, for them and their caregivers
Figure 1. Chemotherapy-resistant double gloves fitted over the cuff of an impermeable gown.
Personal protective equipment
As with any cytotoxic drug, the preparation and administration of the cytarabine CRI needs to be carried out extremely carefully. Cytotoxic drugs are harmful to humans; they can have substantial, acute and chronic, health effects on the handler [ 2 ]. The need to wear correct personal protective equipment( PPE) cannot be overemphasised.
Cytotoxic drugs can be transferred through skin contact, in the case of a spill or needle injury, and through inhalation and ingestion [ 2, 3 ] as well as in patient urine, faeces and saliva [ 3 ], which is why PPE and a safe set-up are needed for the preparation and administration of the CRI.
To help prevent skin contact, chemotherapy-resistant gloves and gowns must be worn. Gloves are made from nitrile or neoprene material, which provide increased protection and longer breakthrough time compared with standard latex-free examination gloves. Ideally, they should be long in the wrist( extended cuff) in order to cover the cuff of the gown [ 4 ]( Figure 1). This will prevent any absorbent material or skin coming into contact with the chemotherapy agent. Some manufacturers
The gown worn when handling chemotherapy drugs must be impermeable( waterproof) to protect the body from direct contact with the cytotoxic drug [ 3 ]. Back closure of the gown is also recommended to prevent gaps allowing exposure to the drug during preparation.
Both gloves and gowns are to be single-use and must be disposed of as cytotoxic waste once used.
The use of a face guard and goggles is also strongly recommended during the preparation and administration of chemotherapy [ 3, 4 ], especially when there is no laminar flow cabinet available. Although the use of a laminar flow cabinet and / or a closed system transfer device( CSTD) decreases the risk of aerosol and splash contact, it does not eliminate the risk, so it is always advisable to wear PPE to protect the eyes and face.
Patient preparation
Before the administration of cytarabine, the patient ' s blood test results should be evaluated by the veterinary surgeon( VS). Haematology is essential to assess the patient ' s neutrophil count, as well as the overall white blood cell count and packed cell volume. Cytarabine is
Volume 40( 4) • August 2025
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