The kennel itself should be lined with absorbent padding, ideally one or more incontinence sheets, to absorb any fluids; the waterproof backing of the sheet( s) will protect the bottom of the kennel from cytotoxic waste. The patient ' s bedding can then be placed on top to provide comfort and support. Some patients may be ambulatory, and this needs to be taken into consideration when preparing the environment.
The kennel should always be at floor level [ 2 ] to allow easier cleaning after the CRI has been given. This will mean that any urine and / or faeces that falls from the kennel cannot contaminate a kennel below.
The area in front of the kennel should also be restricted, with the floor outside lined with incontinence sheets held in place by tape. The cytotoxic waste bin should be placed within easy reach.
All PPE should be kept in an adjoining kennel to allow the VN and VS to don appropriate PPE before interacting with the patient. All monitoring equipment, such as a thermometer and stethoscope, must be clearly labelled to ensure they are kept with the patient. been placed. Make sure the IVC is still in place by using saline to flush the connector well( the author recommends using 5 ml).
If, at any point, there is resistance to the flush, the leg above the IVC becomes swollen or any other sign that the IVC is no longer patent, stop and examine the limb. If the IVC has become extravascular, remove it and place another cannula in a different leg vein.
If the IVC is patent, remove the end of the CSTD connector and carefully attach it to the IVC Luer-lock connector. Make sure the Luer-lock connection is complete before starting the CRI.
Top tip
MUO patients can need multiple administrations of cytarabine. Create a calm and caring environment for them from the start, including applying topical local anaesthetic to blood-taking sites and IVC placement sites to help reduce stress.
Top tip
Designate a cupboard for all chemotherapy equipment such as waste collection bins and bags, cytarabine CRI packs and monitoring aids( stethoscope, thermometer). This will help prevent cytotoxic equipment being mixed up with other materials and / or used with other patients.
The area must be clearly labelled with signs stating the name of the cytotoxic drug being administered [ 2 ]. Cytotoxic drugs are defined as hazardous substances under the Control of Substances Hazardous to Health( COSHH) Regulations 2002 [ 18 ]. Risk assessments must be conducted and SOPs established to safeguard individuals at risk and to ensure all staff members are adequately informed about potential hazards.
Staff who are immunocompromised or pregnant should not have contact with patients receiving cytotoxic drugs, owing to the heightened risk associated with exposure [ 18 ]. If staffing allows, consideration can be given to appointing two VNs to nurse the patient throughout its stay, to minimise exposure to the rest of the team [ 2 ].
Once the kennel has been appropriately prepared, the patient can be placed in it and connected to the cytarabine CRI. Full PPE( as described above) must be worn by all staff involved in connecting the CRI.
Place an incontinence sheet underneath the chosen limb of the patient where the‘ clean stick’ IVC has
Once the CRI is being administered( the author advises staying in PPE with the patient for the first minute or so to make sure all is well), remove the incontinence sheet under the patient ' s limb and place it in the cytotoxic waste bin nearby. All PPE can then be removed and also placed in the cytotoxic waste bin before recording the start time of the CRI. Other notes should also be made, for example, how well the IVC flushed and the demeanour of the patient.
Conclusions
Chemotherapy has many roles in veterinary practice, one of which is as a treatment option for MUO. Cytarabine can be administered as a CRI multiple times as part of a treatment plan to help reduce the inflammation of the central nervous system. VNs can play an important role in nursing these patients, from preparing the patient to setting up and administering medication under the guidance of the prescribing VS.
The CRI needs to be prepared extremely carefully, and anyone who takes on this task should have received proper training. The use of a CSTD and full PPE are essential to help protect the staff member from the harmful cytotoxic drug.
Chemotherapy and the use of cytotoxic agents are known to be daunting for many veterinary professionals but, with thorough training and administration carried out safely, it is one of the most rewarding aspects of veterinary nursing.
50 Veterinary Nursing Journal