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Chemotherapy FAQ

Does ONS have recommendations regarding the administration of vincristine by minibag or IV Push?

We have received a number of clinical inquiries relating to the 2005 JCAHO sentinel alert (which you can view at: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_34.htm) about vincristine, and the statement released by the World Health Organization.

ONS does not currently have a response or position on the administration of vincristine.  The ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (2005), state on page 35 that vincristine is fatal if given intrathecally.  Elsewhere in the guidelines, detailed recommendations regarding prevention of medication error are outlined.

The ONS Chemotherapy and Biotherapy Guidelines have long allowed for both IV push and short term infusion administration of vesicant agents. As there is little evidence that identifies either practice as superior, both methods have been used for many years in different institutions with few complications. 

Many nurses are concerned about the safety of the administration of vincristine, a vesicant, as an infusion rather than administration by IV Push or side-arm technique.  As with any vesicant, the recommendations regarding vesicant administration do apply.  On page 75 of the ONS Chemotherapy and Biotherapy Guidelines, “When administering a vesicant drug by short infusion using a peripheral vein, avoid using an IV pump in order to decrease pressure on the veins; monitor the site for signs of extravasation every 5-10 minutes for infusions less than 30 minutes.”  On page 76, “Use a central venous access catheter or implanted access device to administer any vesicant infusing for longer than 30-60 minutes. If IVP: when administering a vesicant, verify blood return every 2 to 5 ml.”

The guidelines do also acknowledge that some institutions have specific policies regarding some cytotoxic medications that must be delivered by IVP only. Each institution should make the choice as to which works best for each setting and which the nurses administering the drugs are most comfortable with.

Does ONS offer a chemotherapy competency course?
ONS frequently receives questions about chemotherapy certification and who can administer chemotherapy.

ONS has a position statement titled "Education of the Professional RN Who Administers and Cares for the Individual Receiving Chemotherapy and Biotherapy" (read position statement).

ONS asserts that registered nurses responsible for administering chemotherapy should attend an educational course, such as the ONS Chemotherapy and Biotherapy Course, to obtain didactic information necessary to successfully complete a clinical practicum in the administration of chemotherapeutic agents. Click here for information about this course.

Some have confused the ONS Chemotherapy and Biotherapy Course with a certification course. After successful completion of the ONS Chemotherapy and Biotherapy Course, a registered nurse is eligible to receive an ONS Chemotherapy Provider Card. This card indicates he or she has completed the course successfully and has been given the didactic knowledge to care for patients receiving chemotherapy. It is not, however, a competency or certification course. It is the responsibility of the employing agency to determine competency.

Determination of clinical competency is an ongoing process and is the responsibility of the employing agency. The employing agency is responsible for defining clinical competency in chemotherapy administration based on internal policies and their state registered nurses licensing board. In addition, the employer should clearly define the process of determining competency (e.g., the employee must attend a didactic course followed by peer review of a certain number of chemotherapeutic agents and a certain number of vesicants) and how often the competency is required (annually, biannually).

Oncology nurses sometimes confuse chemotherapy certification with the process for becoming an Oncology Certified Nurse (OCN^®). This certification does not offer a hands-on competency for chemotherapy administration. However, it does signify that nurses have met or exceeded rigorous criteria for knowledge and experience and possess a measured competency in a demanding practice area. More information on this certification can be found at www.oncc.org.

How can I find an ONS Chemotherapy and Biotherapy course, and how often are they held?
Specific dates, locations, and fees are set by the individual trainer presenting the course and vary. Click here for a chemotherapy course calendar. ONS offers Chemotherapy and Biotherapy Courses nationally. Click here to view a list of our trainers. Feel free to contact any of them.

Who teaches the ONS Chemotherapy Course?
Nurses who have completed the ONS Chemotherapy and Biotherapy Trainer Course present the ONS Chemotherapy and Biotherapy Course. This ensures that every course participant receives consistent information.

How can I become an trainer for the ONS Chemotherapy and Biotherapy Course?
To become a trainer, a nurse must meet the eligibility requirements, submit an application, and complete the ONS Chemotherapy and Biotherapy Trainer Course. The eligibility requirements are to

• Be a current ONS member
• Be a licensed registered nurse
• Have a minimum of two years experience administering chemotherapy
• Hold a bachelor's degree or higher in a health related field
• Hold a current ONS Cancer Chemotherapy Provider Card (obtained by attending the two-day ONS Chemotherapy and Biotherapy Course).

How can I renew my ONS Cancer Chemotherapy Provider Card?
You can renew online through a new distance-learning program that will fit your busy schedule. Click here to view details about the course and to register.

When will I receive my new card?
Data is processed once a month. If your post-test has been submitted by the due date, you should receive your card and certificate by the end of the next month following expiration of your card.

If my card has expired, can I still renew?
When a renewal request is received up to one month after the expiration of the ONS Chemotherapy Provider Card, a late fee of $25 is required for processing.

When the renewal request is received one month or more after the expiration of the Provider Card, the individual must attend the two-day ONS Chemotherapy and Biotherapy Course to receive a new Provider Card.

Is it safe for nurses to administer chemotherapy if they are pregnant or trying to conceive?
The issue of whether nurses should administer chemotherapy while trying to conceive or during a pregnancy is one of the more controversial topics in chemotherapy administration.

ONS directly addresses this issue in the ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (2005), page 62, as j) "Allow employees who are pregnant, actively trying to conceive, or breast-feeding or who have other medical reasons for not being exposed to hazardous drugs to refrain from preparing or administering those agents or caring for patients during their treatment with them upon request. (No information is available regarding the reproductive risks of workers who use currently recommended precautions [OSHA, 1995; Welch & Silveira, 1997]). Alternate duty that does not include cytotoxic preparation or administration must be made available to both men and women involved in planning a pregnancy when requested."

The American Society of Health-System Pharmacists, (ASHP) "ASHP Guidelines on Handling Hazardous Drugs" states "Because reproductive risks have been associated with exposure to hazardous drugs, alternative duty should be offered to individuals who are pregnant, breast-feeding, or attempting to conceive or father a child. Employees’ physicians should be involved in making these determinations." This report is available on-line at: http://www.ashp.org/s_ashp/bin.asp?CID=6&DID=5420&DOC=FILE.PDF, and the full citation is American Society of Health-System Pharmacists. ASHP guidelines on handling hazardous drugs. American Journal of Health-System Pharmacists. 2006; 63:1172– 93.

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