Giving chemotherapy safely: hazardous-drug handling, extravasation, spills and waste
- Safe practice
Chemotherapy drugs can harm staff and tissue: the nurse wears the right protection, watches the vein closely and knows the spill and extravasation steps.
What it is
Many cancer drugs are hazardous drugs: they can harm the people who handle them, through the skin, by breathing them in, by hand-to-mouth transfer or by a needlestick. The nurse who gives them protects herself or himself, colleagues and the family with the right gloves and gown, careful handling of the patient's body fluids and correct disposal of everything that touched the drug. At the same time the nurse protects the patient's tissue: some drugs (vesicants) can blister and destroy tissue if they leak out of the vein, so the line is checked before and during the infusion and leakage is acted on at once. Peripheral-line problems in general are on the IV complications page; this page adds what is specific to chemotherapy.
What it requires
- A written institutional procedure for hazardous drugs, with training before anyone handles them.
- Personal protective equipment chosen for the task: gloves, gown, and eye and face protection when a splash is possible.
- A spill kit within reach wherever these drugs are given, and staff who know how to use it.
- A vein or central line checked for blood return before a vesicant, and a site kept visible during the infusion.
- Waste separated as the institution's waste-management plan sets out.
How it is applied (and why)
- Check the order, the patient, the drug and the route with the double check your institution requires — chemotherapy is a high-alert medicine.
- Put on two pairs of chemotherapy gloves (inner under the gown cuff, outer over it) and a closed gown — absorbent fabrics hold the drug against the skin.
- Add goggles and a face shield when a splash is possible — many of these drugs irritate the eyes and are absorbed through mucous membranes.
- Before a vesicant, confirm blood return and a free flow, and avoid joints, flexion areas and limbs with poor circulation or lymphoedema — this lowers leak risk.
- Give vesicants by gravity or slow push as the protocol says, not by pump, and keep the site in view — a pump keeps pushing drug into tissue.
- Ask the patient to report pain, burning, stinging or swelling at once — the patient often notices extravasation first.
- If a leak is suspected: stop, leave the cannula in, aspirate, raise the limb and follow the protocol for packs and antidote — the response depends on the drug.
- Handle urine, vomit, stool and soiled linen with double gloves and a gown, and close the toilet lid before flushing — excreta can carry the drug.
- For a spill, use the spill kit with full protection, contain and clean as the procedure says and report it — spill response needs training and equipment.
- Discard gloves, gown and tubing in the labelled hazardous-drug container and wash your hands with soap and water — all used protection counts as contaminated.
In nursing practice
- Signs of extravasation: swelling, redness, burning or stinging, resistance when pushing, a sluggish infusion or no blood return.
- Document any extravasation, with a photograph if the protocol asks for one, and check the site again over the following days and weeks for pain, ulceration or necrosis.
- Staff who are pregnant, breastfeeding or trying to conceive should know which drugs are reproductive hazards; protection applies to all staff, not only to them.
- Change gloves when they are torn or touched by the drug, and do not wear the gown outside the administration area.
- Respiratory protection (a fit-tested N95 respirator or better) is needed only in specific situations, such as some spills or aerosolised drugs, as the institution decides.
Common mistakes
- Wearing a cloth gown or scrubs, which soak up the drug instead of stopping it.
- Priming the line with the drug at the bedside.
- Using a pump for a peripheral vesicant and leaving the site covered and unchecked.
- Pulling the cannula out at once after a suspected extravasation, before aspirating.
- Cleaning a spill with ordinary gloves and throwing the waste in the general bin.
Test yourself
Think of the answer, then tap the question to see it.
Which gloves are used to give IV chemotherapy?
Two pairs of chemotherapy-rated, powder-free, non-latex gloves: the inner one under the gown cuff and the outer one over it.
What are the first steps when extravasation of a vesicant is suspected?
Stop the infusion, leave the cannula in place, aspirate as much drug as possible and follow the institutional protocol for the antidote, elevation and cold or warm packs.
Why should the nurse not prime chemotherapy tubing with the drug at the bedside?
Because drug escapes into the air and onto surfaces; tubing is primed in the ventilated cabinet or with a solution that contains no drug.
How are hands cleaned after removing gloves used with hazardous drugs?
With soap and water; alcohol-based hand gel is not recommended for this.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Managing Hazardous Drug Exposures: Information for Healthcare Settings (Publication 2023-130) (National Institute for Occupational Safety and Health (NIOSH), CDC, 2023); Hazardous Drugs Exposures in Healthcare (National Institute for Occupational Safety and Health (NIOSH), CDC, 2024); Extravasation of Antineoplastic Agents: Prevention and Treatments (Boschi R, Rostagno E; Pediatric Reports) (PubMed Central (open access), 2012); The Role of Nursing in the Management of Chemotherapy Extravasation: A Systematic Review (Antúnez-Blancat A et al.; Healthcare) (PubMed Central (open access), 2024).
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Representative model, for educational purposes only.