Which chemo drugs do you use?

Re: Which chemo drugs do you use?

Laurence Webb — Thu, 29 Jul 2010 19:00:37 GMT

Sounds like I need more chemo weapons to my armoury then! Thanks for the replies. I'll have a look at the Phaseal products as handling safety is my main concern.

Re: Which chemo drugs do you use?

Rob Reid — Thu, 29 Jul 2010 18:14:54 GMT

Yeah they ask that all the soft waste goes in as well - they are very strict on using bags etc. Our 11 litre bins won't 'half-close' but as they get practically full each time anyway it kind of renders the issue academic I guess.

[quote user="robloxley"]our waste disposal people didn't get my concern about trying to stuff gowns into sharps bins that HAVE SHARPS IN THEM! [/quote]

Haha you're not wrong there Pain in the backside if you ask me.

Re: Which chemo drugs do you use?

Rob Loxley — Thu, 29 Jul 2010 17:40:07 GMT

[quote user="Rob Reid"]Our waste disposal people ask that the bin is closed after every chemotherapy session so hence we end up using one each time. I have to confess that I am unsure as to the exact H&S regulations surrounding this anyone care to expand on this further?[/quote]

Does your waste disposal company require that all soft waste goes in a sharps bin - ours does - whereas some allow double bagging in cytotoxic labelled bags. We therefore generally have 2 bins on the go - 1 for sharps/vials and 1 for 'soft waste' (gloves, gowns). It means you can stuff the soft one full without worrying about a needlestick injury - our waste disposal people didn't get my concern about trying to stuff gowns into sharps bins that HAVE SHARPS IN THEM! Bins get half-closed between use and fully closed when full - they are designed to do this.

Re: Which chemo drugs do you use?

Rob Reid — Thu, 29 Jul 2010 17:03:19 GMT

Our waste disposal people ask that the bin is closed after every chemotherapy session so hence we end up using one each time. I have to confess that I am unsure as to the exact H&S regulations surrounding this anyone care to expand on this further?

We use an 11 litre bin and everything goes in there including all the gloves, aprons, masks, giving sets etc - and to be fair once all that is in there it tends to be full anyway. We are charged approx £50 per 11 litre bin disposal, but we mark up to £63 to cover all the other sundries (gloves, aprons, masks etc) and the hassle surrounding it on the day.

Re: Which chemo drugs do you use?

Martin Atkinson — Thu, 29 Jul 2010 16:38:08 GMT

[quote user="Rob Reid"]

The main issue from my point of view is more the disposal as this massively adds to the cost of the case - for example a Mastiff I am treating for lyphoma at the moment, it is £63 per week just to dispose of the cytotoxic bin!

[/quote]

Am I being naive here - why do you have to charge to dispose of the bin every week, is there some regulation I've missed out on that prevents you waiting until its full like with the pharmaceutical waste? We only have a collection from DOOP every blue moon anyway.

Re: Which chemo drugs do you use?

Rob Loxley — Thu, 29 Jul 2010 15:17:56 GMT

[quote user="Rob Reid"]a Mastiff I am treating for lyphoma at the moment, it is £63 per week just to dispose of the cytotoxic bin[/quote]

Yikes that sounds a lot; how does that break down? I think we charge clients about £20 for each 5l cytotoxic bin, as we hold onto all the items that need the extra expensive collection costs until we've got a lot then send them all at once.

We have used vincristine, vinblastine, doxorubicin, chlorambucil, cyclophosphamide, l-asparaginase all relatively recently.

Would recommend the disposable vinyl gowns with thumbloops (from JAK) over a plastic apron as much better protection; some practices make use of used disposable surgical gowns for chemo then throw them, but we are still on reusable gowns for surgery. Proper FFP3 face masks and close fitting goggles are easily available from builder's suppliers.

Re: Which chemo drugs do you use?

Rob Reid — Thu, 29 Jul 2010 14:25:47 GMT

Obviously case dependent, but I am happy doing COAP protocols in our practice for example and have used a fair number of other chemo drugs in the past without problems. Similar to Martin I am the only one who handles the drugs and everyone involved gloves, aprons, masks and goggles up just in case.

Re: Which chemo drugs do you use?

Mark Holmes — Thu, 29 Jul 2010 13:26:55 GMT

Phaseal do a range of products that makes handling chemo drugs much easier and eliminates the requirement for a fume cupboard. Google phaseal if interested, They are not overly priced, cheaper than traveling some distance for treatment, for cop they added about £12.00 per admin of vincristine (with 50% mark up), the last time I checked.

Re: Which chemo drugs do you use?

Martin Atkinson — Thu, 29 Jul 2010 12:57:03 GMT

I've never had a problem with this and have become very experienced over the years. We've used doxorubicin. asparaginase, cisplatin, carboplatin, cytosine arabinose, cytarabine, vincristine, vinblastin....indeed anything. However, I'm the only one who handles the products, I reconstitute where appropropriate and draw up into syringes over a tub table (how many vets have a fume cupboard)? Everyone involved wears impervious gloves, face masks and goggles and observes barrier nursing techniques where appropriate. Doses and routes of administration are double checked and triple checked and agents drawn up at the last moment to avoid mistakes. Hopefully with the development of tyrosine kinase inhibitors and similar designer drugs use of such evil products will become a thing of the past but with common sense there is little to fear.