CHEM3 Administer intrathecal chemotherapy


This standard covers the administration of chemotherapy treatment intrathecally to adult patients.  It includes the assessment of the patient’s fitness for treatment, the checking of the treatment drugs against the prescription and patient information, the delivery of treatment and the education of the patient with regard to side effects and lifestyle.

Users of this standard will need to ensure that practice reflects up to date information and policies.

Version No 1

Knowledge and Understanding

You will need to know and understand:

  1. national and local chemotherapy guidelines and their application in chemotherapy and the appropriate regimen
  2. national and local guidelines for the administration of intrathecal chemotherapy and lumbar puncture procedure
  3. local infection control guidelines and their application in chemotherapy and the appropriate regimen
  4. the COSHH guidelines and their application in chemotherapy
  5. the Guidelines on the Administration of Medicines
  6. the local guidelines for waste and sharps handling and disposal
  7. the national and local guidelines for consent to chemotherapy, including clinical trials
  8. the local guidelines for patient identification
  9. the local guidelines for patient records, their storage and confidentiality of information
  10. the range of information which should be made available to the patient
  11. the local guidelines for risk management and adverse incidents
  12. the correct route of the administration of cytotoxic agents and the risks, signs and symptoms associated with inappropriate administration
  13. the drugs suitable for use and those fatal if administered by intrathecal route
  14. the symptoms associated with malignant disease and its progression
  15. the treatment of malignant disease
  16. the safe handling, storage and administration of cytotoxic and intrathecal chemotherapy drugs
  17. hypersensitivity, how to recognise, respond, manage and prevent if possible
  18. the anatomy and physiology of the spinal column
  19. the appropriate sites for spinal injections
  20. good practice in using spinal needles and their attachments
  21. the signs and symptoms of the patient’s physical and emotional status
  22. the medical terminology relevant to the treatment
  23. the normal parameters for routine investigations
  24. the correct management of patients post lumbar puncture
  25. the psycho-sexual and body image issues associated with cytotoxic chemotherapy treatment
  26. the side effects of cytotoxic chemotherapy drugs, how to recognise them and the appropriate treatment regimens
  27. the mode of action and side effects of the cytotoxic chemotherapy regimen
  28. the safe operation of equipment used to administer chemotherapy
  29. the importance of timely equipment fault recognition and the local procedures for dealing with these
  30. equipment limitations and routine maintenance
  31. the roles and responsibilities of other team members, associated professionals and agencies
  32. the limits of one’s own knowledge and experience and the importance of not operating beyond these
  33. the importance of clear communications

Performance Criteria

You must be able to do the following:

  1. ensure the treatment room is a designated area in line with national and local guidelines for this procedure
  2. check the environment and equipment to ensure that everything is properly prepared for the procedure, including the availability of emergency kits
  3. ensure that the appropriate consent procedure has been completed
  4. ensure that the required personnel are present for the procedure in line with national guidelines
  5. ensure that you and the required personnel are on the intrathecal register before you proceed
  6. read the patient’s notes, prescription and relevant regimen protocol and identify any special instructions, investigations, (including abnormal blood test results) or issues for which you need to seek advice
  7. check the patient’s platelet count and respond accordingly
  8. provide evidence for pharmacy personnel that the pre-requisite, prescribed intravenous drugs have already been administered as directed by national guidelines
  9. greet and accurately identify the patient
  10. introduce yourself and any colleagues involved in the procedure to the patient and/or carer
  11. review the patient’s history since their last attendance
  12. assess the patient’s physical condition and their fitness for treatment and seek advice from an appropriate team member if required
  13. assess the patient’s psychological and emotional state and respond appropriately including referrals to appropriate agencies and personnel
  14. explain the treatment and potential side effects and their management to the patient and/or carer and accurately answer any questions at a level and pace that is appropriate to:
    1. their level of understanding
    2. their culture and background
    3. their preferred ways of communicating
    4. their needs
  15. check that the patient and/or carer understands the treatment to be given and any potential side effects together with their management
  16. determine whether or not the patient is willing to proceed
  17. obtain the prescribed medication from pharmacy, or designated area, in accordance with national and local guidelines
  18. check the intrathecal treatment drugs in accordance with intrathecal chemotherapy guidelines (with an appropriate second checker who is on the register and the patient or nominated other) against the treatment plan, protocol, regimen, prescription and patient information  with regard to:
    1. patient’s identification on prescription chart and on labelled drugs
    2. critical test results (including blood results)
    3. regimen and individual drug identification
    4. names of drugs
    5. the drugs’ fitness for administration (assessed by appearance and condition)
    6. diluents and dilution volumes
    7. that supportive drugs have been given as per the prescription
    8. dose
    9. administration route
    10. cycle number
    11. the administration as per the schedule within the cycle
    12. expiry date/time of the drugs
    13. the date the drugs are due to be administered
  19. undertake the procedure according to local cytotoxic guidelines, local control of   infection and COSHH guidelines
  20. position the patient correctly for the procedure, respecting their dignity and ensuring their comfort within the constraints of the procedure
  21. administer local anaesthetic into the subcutaneous tissue surrounding the spinal needle insertion area and set aside the syringe and local anaesthetic to avoid inadvertent use
  22. undertake a final check of the treatment drugs against the prescription and the patient’s identity before administration
  23. identify the location for the spinal needle insertion and ensure that the needle is correctly located within the spinal fluid
  24. administer the intrathecal drugs as a bolus injection
  25. during the treatment monitor the patient for indications of discomfort or any allergic or hypersensitive reactions and act appropriately
  26. maintain communications with the patient and/or carer during the treatment and respond to any questions
  27. remove the spinal needle on completion of the treatment according to local guidelines
  28. assess the patient’s condition (both physical and emotional) at the conclusion of the treatment and take appropriate action
  29. dispose of contaminated waste and sharps according to local guidelines
  30. return any unused intrathecal drugs to the pharmacy according to local guidelines
  31. record the details of the treatment in the patient’s notes, in the prescription chart and in the patient held records, as appropriate, according to local guidelines, ensuring that all required signatures are completed
  32. communicate with appropriate professional colleagues as required by local guidelines
  33. recognise when you need help and/or advice and seek this from appropriate sources

Additional Information

This National Occupational Standard was developed by Skills for Health.

This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004):

Dimension: HWB7 Interventions and treatments
CHEM3 Administer intrathecal chemotherapy
Final version approved June 2010 © copyright Skills For Health
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