Start hand hygiene and wear a suitable glove.
Check doctor order and review patient file for allergies.
Check medication compatibilities with current active medications.
Verify rate of administration.
Start preparing the required dose.
Verify correct patient.
Assess IV for signs and symptoms of infiltration or phlebitis (and if present, stop until new IV site is obtained).
Turn off IV by turning off pump and/or clamping the tubing directly above the access port.
Swab access port with alcohol or other antiseptic agent according to institutional policy.
If medication is not compatible with IV solution, flush IV line with 2 to 5 mL of normal saline before administration of medication. If medication is compatible with IV solution, normal saline flush is not necessary; continue to next step.
Connect medication syringe to access port via needleless adaptor.
Pull back on plunger of syringe to observe blood return (which verifies placement of IV in vein).
Gently instill medication over required time frame (typically 2 to 5 minutes).
Assess patient carefully during administration for any adverse reactions.
Disconnect syringe when medication is completed.
Flush IV line with 3 to 5 mL of normal saline, instilling at same rate of medication administration in order to administer the medication left in tubing at proper infusion rate.
Turn IV back on or unclamp tubing, then readjust rate appropriately.
Dispose of syringe in sharps container.
Remove gloves, perform hand hygiene, and document medication administration.
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{My own study points.}
First order is Good, Zero order is BAD.
First order is occurring with most medications.
First order: constant proportion of the drug is eliminated per unit time.
Zero order: constant amount of the drug is eliminated per unit time.
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The communication structure Identify, Situation, Background, Assessment and Recommendation (ISBAR) was created to standardise the effective transfer of information in the US armed forces. ISBAR was adopted by the public health service in the 2000s
ISBAR STRUCTURE | POSSIBILITIES |
---|---|
Identify | Introduction (Hello Dr. my name is)
|
Situation | Situation (What’s this about?)
|
Background | Background (Brief & pertinent info) If it's urgent and/or you are concerned — speak up. Brief and relevant case history Admission diagnosis and date Previous illnesses of significance Relevant problems and treatment/interventions to date Allergies |
Assessment | Assessment (Your analysis and consideration of options)
|
Recommendation | Recommendation (What do you want the physician to do?)
When should I next make contact? When will you be here? Confirm messages and interventions with a closed loop. |
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27 questions added to the Adverse drug reactions MCQs Page.
Test yourself in the link below...
Goodluck.
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Started the uploading process, 27 questions added to the side effect MCQs Page.
Test yourself in the link below...
Goodluck.
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Doxorubicin inhibits DNA and RNA synthesis by intercalation between DNA base pairs by inhibition of topoisomerase II and by steric obstruction. Doxorubicin intercalates at points of local uncoiling of the double helix. Although the exact mechanism is unclear, it appears that direct binding to DNA (intercalation) and inhibition of DNA repair (topoisomerase II inhibition) result in blockade of DNA and RNA synthesis and fragmentation of DNA. Doxorubicin is also a powerful iron chelator; the iron-doxorubicin complex can bind DNA and cell membranes and produce free radicals that immediately cleave the DNA and cell membranes.
For those who prepare chemotherapy, we always need detailed guidelines for the preparation of Doxorubicin, and all the chemo handling and preparing precautions.
Does your preparation depend on the route of administration?
Do we use the beads in all preparations, or only for the chemoembolization?
Do we only need a chemo vertical laminar flow hoods, or the equipment we use should ensure closed system?
Doxorubicin is like any other hazardous drug that requires to be prepared under certain conditions stated in USP 800. You may refer to the latest version online. It should answer all your question regarding the precautions you must follow. Closed system devices are not enough by itself to prepare biohazard meds including chemotherapy without a primary engineering control device.
Doxorubicin is mixed with beads for particular procedure called chemoembolization in hepatocellular carcinoma and its given as intra-arterial injection by a trained provider (usually radiologist). But it is never mixed with beads for other routes.
Doxorubicin is given intravenously as a push, intermittent infusion, or continue infusion. This is usually decided by the treatment protocol you would use. For example, in AC protocol (doxorubicin and cyclophosphamide) for breast carcinoma, doxorubicin is given as IV push over 10-12 minutes. While in a more complicated protocol such as R-EPOCH, it is combined with other chemotherapy drugs and is infused as a continuous infusion over 24 hours for multiple days.
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Data captured from health devices could provide precious information to provide accurate care to the patients.
As we noticed wearable gadgets are increasing in numbers as well as accuracy.
Allowing the healthcare providers to jump instantly between patients, or view organs, or even project radiology images over the body during operations to reduce mistakes.
Combining live video-streaming with Augmented Reality surgeons carrying out operations are able to consult the other side of the world. Who says that you can’t be in two places at once?
The patient, who can afford it, can always consult with their preferred healthcare providers online and even afford a sort of on-call medical service, other than emergency services.
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Bringing the freedom to focus
innohep®
tinzaparin sodium
Get ready to meet your new friend
“A baby is something you carry inside you for nine months, in your arms for three years, and in your heart until the day you die.”
- Mary Mason -
Antenatal assessment and management (to be assessed at booking and repeated if admitted)
Any previous VTE except a Single event related to major surgery
HIGH RISK
Requires antenatal prophylaxis with LMWH
refer to trust-nominated thrombosis in pregnancy expert/team
Hospital admission
Single previous VTE related to major surgery
High-risk thrombophilia + no VTE
Medical comorbidities e.g. cancer, heart failure, active SLE, IBD or inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with nephropathy, sickle cell disease, current IVDU
Any surgical procedure e.g. appendicectomy
OHSS(first trimester only)
INTERMEDIATE RISK
Consider antenatal prophylaxis with LMWH
Obesity (BMI > 30KG/M2)
Age
Parity ≥ 3
Smoker
Gross varicose veins
Current pre-eclampsia
Immobility, e.g. paraplegia, PGP
Family history of unprovoked or estrogen-provoked VTE in first-degree relative
Low-risk thrombophilia
Multiple pregnancy
IVF/ART
Transient risk factors:
Dehydration/hyperemesis; current systemic infection; long-distance travel
Four or more risk factors:
Prophylaxis from first trimester
Three risk factors:
Prophylaxis from 28 weeks
LOWER RISK
Mobilisation and avoidance of dehydration
Regarding the timing of first antenatal and/or postnatal thromboprophylactic dose; please refer to RCOG Green-Top Guideline No. 37a (thrombosis and Embolism during Pregnancy and the Puerperium, Reducing the risk - Published 13/04/2015)
Postnatal assessment and management (to be assessed on delivery suite)
HIGH RISK
At least 6 weeks, postnatal prophylactic LMWH
caesarean section in labour
BMI ≥ KG/M2
Readmission or prolonged admission (≥3 days) in the puerperium
Any surgical procedure int the puerperium except immediate repair of the perineum
Medical comorbidities e.g. cancer, heart failure, active SLE, IBD or inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with nephropathy, sickle cell disease, current IVDU
INTERMEDIATE RISK
At least 10 days postnatal prophylaxis with LMWH
NB if presisting > 3 risk factors; consider extending thromboprophylaxis with LMWH
LOWER RISK
Mobilisation and avoidance of dehydration
Antenatal and post natal prophylactic dose of LMWH
Weight < 50KG = 20MG enoxaparin / 2500UNITS dalteparin / 3500UNITS tinzaparin daily.
Weight 50-90KG = 40MG enoxaparin / 5000UNITS dalteparin / 4500UNITS tinzaparin daily.
Weight 91-130KG = 60MG enoxaparin / 7500UNITS dalteparin / 7000UNITS tinzaparin daily.
Weight 131-170KG = 80MG enoxaparin / 10000UNITS dalteparin / 9000UNITS tinzaparin daily.
Weight > 170KG = 0.6MG/KG enoxaparin / 75UNITS/KG dalteparin / 75UNITS/KG tinzaparin daily.
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