A nurse is preparing to administer an intravenous infusion of paclitaxel to a client undergoing chemotherapy. Which of the following actions should the nurse take to ensure safe administration?

Appeared in: NORCET 10 Mains

Explanation

The formulation for paclitaxel contains Cremophor EL, a solvent that can leach a toxic plasticizer, diethylhexyl phthalate (DEHP), from standard polyvinyl chloride (PVC) equipment.
To prevent patient exposure to DEHP, it is mandatory to use special non-PVC infusion bags and administration sets.
An in-line filter with a pore size of 0.22 microns is also required to remove any potential precipitates or microbial contaminants from the solution before it reaches the patient.

Option A: While cardiac events like bradycardia can occur with paclitaxel, continuous cardiac monitoring is not a standard requirement for all patients. It is typically reserved for patients with pre-existing cardiac conditions or those who develop symptoms during the infusion.
Option B: Premedication is absolutely essential before paclitaxel administration, but this option is incomplete. The standard premedication regimen includes a corticosteroid (like dexamethasone), an H1 antagonist (like diphenhydramine), and an H2 antagonist (like cimetidine or ranitidine). While hydrocortisone is a corticosteroid, the equipment requirement in the correct option is a more specific and non-negotiable safety measure related to the drug's formulation.
Option C: Castor oil has no role in premedication for paclitaxel. In fact, the vehicle in paclitaxel (Cremophor EL) that causes hypersensitivity reactions is a derivative of castor oil. Administering castor oil is illogical and would not prevent any adverse effects.

Clinical Relevance

Nursing practice connection: Use the key finding related to Safe Administration of Chemotherapy to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary responsibility in chemotherapy administration is patient safety, which includes verifying drug and equipment compatibility. Using the wrong IV set with paclitaxel can directly expose the patient to a toxic substance (DEHP).
Always perform the 'five rights' of medication administration, and for chemotherapy, add a sixth right: 'the right equipment'.
What if the pharmacy sends a standard PVC IV set by mistake? The nurse is the final safety check. The nurse must identify the error, not use the equipment, and contact the pharmacy immediately to obtain the correct non-PVC set. Proceeding with the wrong equipment would be a serious medication error.

How to Approach the Question

First, identify the key drug in the question: 'paclitaxel'.
Recall the specific and unique safety precautions associated with paclitaxel. This drug is known for two major safety issues: high risk of hypersensitivity reactions and incompatibility with standard PVC equipment.
Evaluate each option based on these known safety requirements.
Option A (cardiac monitoring) is not a universal requirement.
Option C (castor oil) is illogical.
Compare Option B (premedication) and Option D (equipment). Both are important. However, Option D describes a mandatory equipment requirement to prevent direct toxicity from the administration set itself, which is a very specific and critical action. Option B describes premedication, which is also critical, but the option is less complete than the standard three-drug regimen. Therefore, the specific, non-negotiable equipment requirement is the best answer.

Concept Tested & Keywords

Concept Tested: Safe Administration of Chemotherapy
Stem keywords: paclitaxel, intravenous infusion, chemotherapy, safe administration
Lead-in keywords: actions should the nurse take

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E6 Pharmacology Nursing Lilley 11e Part 3 pp. 94-96, 106-108

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