NIOSH 2014 List of Antineoplastic & Other Hazardous Drugs in Healthcare Settings

This is an updated version of  the National Institute of Occupational Safety and Health (NIOSH) hazardous drugs list. So what’s new in this current update?

The text for the update to the 2014 list was updated and expanded to reflect the complexity of safe handling issues that have arisen over the past few years.  This was driven, in part, by the growing number of oral antineoplastic drugs and the addition of oral non-antineoplastic drugs.  The list was reformatted and some drugs have been deleted.

(a) Based on feedback from multiple sources, it was determined that the universal approach as described in the 2004 Alert on Hazardous Drugs for handling hazardous drugs was no longer feasible.

 (b) The list of hazardous drugs was separated into three categories: (Table 1) Antineoplastic drugs; (Table 2) Non-antineoplastic drugs; (Table 3) Drugs with adverse reproductive effects only; and (Table 4) Deleted drugs.

  (c)  It was noted that the majority of the antineoplastic drugs may have adverse reproductive effects and the drugs in the non-antineoplastic category that had adverse reproductive effects as a secondary reason for their listing was noted.

  (d) New drug listings for 2014 are indicated by red font and drugs in the non-antineoplastic category that also have adverse reproductive effects are indicated by blue font.

 (e) Also added is a matrix of common activities related to hazardous drug handling and recommendations for the use of personal protective equipment and ventilated engineering controls for each activity (Table 5).

 

Hazardous drugs include those used for cancer chemotherapy, antiviral drugs, hormones, some bioengineered drugs, and other miscellaneous drugs.  The NIOSH cautions that the list may not be all inclusive and recommend that each organization should create its own list of drugs considered to be hazardous. This perhaps explains why sometimes I notice a drug not on the hazardous list is considered hazardous by one organization but not by another.  In my experience, many oncology infusion centers follow the precautions recommended for hazardous drugs for all drugs they administer regardless of classification in a effort to standardize handling practices.

When a  drug is hazardous, various precautions should be applied when handling the drug.  Click here for the full publication of the 2014 NIOSH Hazardous Drug List.

NIOSH 2014

Acknowledgement:

Many thanks to Barbara MacKenzie and Thomas H. Connor for the  information and updates.

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Yearly Tribute 9/11

We will always remember…..September 11, 2001.

It was a day no one would ever forget. I remember exactly where I was and what I was doing at the time. I remember feeling lucky that although I was at an airport, I was not on an airplane.

We will always be grateful to the courageous firefighters, rescuers and first responders who risked their lives to save those in the rumbles of this dreadful day.

We will always remember those who died from this tragedy, whose memories we celebrate today.

But as we remember those who are no longer with us in this world, let us not forget those who survived or were left behind…those whose lives were forever changed..those who will always be guilty that they survived.

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FIVE Year Blog Anniversary Gift

To celebrate the “FIVE” year blog anniversary and to thank you for your continued support, I am giving away “FIVE” free registrations to  a web seminar on September 18, 2014 entitled:  A Closer Look at Peripheral IVs

Description
Intravenous therapy via a peripheral IV (PIV) catheter is one of the common IV procedures performed by nurses in hospitals and other healthcare settings, including long-term care, outpatient, and home care.  PIVs are used for medication administration and/or infusion of IV solutions.  Because PIV placement is such a common and simple nursing procedure, nurses may underestimate the risks and the consequences of complications such as phlebitis, infiltration/extravasation, infection, and nerve damage.  In this presentation, the importance of appropriate PIV site selection, techniques to reduce complications, and the importance of monitoring the PIV site will be addressed.

Here’s how to participate:

1. You must reside in the United States and available to attend on Sept 18, 2014 1-2pm ET

2. Send a comment to this post.  The comments must be in response to this particular post in order to be considered an entry. Comments (entry) must include your first and last name, a valid email address, and  the phrase – “Fabulous 5 giveaway”

3. This free offer is valid only for the webinar on Sept 18, 2014. Offer does not apply to any other events.

4. Five entries will be selected. You will be notified by email if you’re one of the five winners. No substitution will be allowed.

5. Offer ends on September 12, 2014 12noon ET.

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The Fabulous Number “FIVE”

The Infusion Nurse Blog is now “FIVE” years old!!! Happy 5 year Blog Anniversary!!!

I am sincerely grateful and humbled as our readers and site numbers continue to grow each year. It is my hope that you will continue to visit, read, post comments, and subscribe to my blog posts. Thank you so much for your support!!

As I always do at each anniversary, here are the top five most read posts this year:

1. “Is there a difference? Osmolarity vs. Osmolality”: second year for this post to take first place so I’m thinking.. now you can tell the difference!!

2. “Calculating and Counting Drops “- many nurses have forgotten how to calculate IV drip rates, hopefully, this post did help!

3. “Infusion by Gravity Drip”:  Yup, it doesn’t hurt to know the formula for drop calculation  even if you are using an infusion pump!!

4. “Nurse, my IV Hurts”: so, you just started a PIV in the patient’s right arm and soon after, the patient complained of sharp pain and ask that the PIV be removed. What would you do?

5.  The Phlebitis Scale does mean something”  you got it! It is about phlebitis and rating severity. I hope y’all are using this one!

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Thank you for taking the survey

My sincerest thanks to everyone who took the survey on the “Use of Unlicensed Healthcare Personnel in the provision of infusion therapy” posted on Aug 8, 2014. You were very gracious in responding and we sincerely appreciate your feedback. The survey is now closed and we will share the results when ready.

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Looking for RNs to take a SURVEY!

If you are a registered nurse currently working with/delegating/supervising “unlicensed healthcare personnel” (UHCP) also known as “unlicensed assistive personnel” (UAP), would you be interested in answering a short survey related to the use of unlicensed healthcare personnel in the provision of infusion therapy?

The survey is open to US registered nurses from all healthcare settings who work with, delegate/and/or supervise UHCP. The survey results will be integrated in a project for the Infusion Nurses Society.

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(Click sign ^^ above to take the survey)

If you have any questions, please use the comment section of this post. Your comment will reach me first and will not be posted publicly. I will reply as soon as possible.

Thank you so much! Your help and willingness is greatly appreciated!

 

 

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Q&A: BP cuff for vein distention

Q: I am a new RN and was always told that I can use a BP cuff to distend the veins for IV starts instead of a tourniquet. Can you tell me how high should I pump the cuff?

A:  BP cuff is one method that can be used for vein distention while assessing veins for venipuncture and during the actual venipuncture. There are various views on what the inflation pressure is best for this purpose  and the consensus opinion appears to indicate  just below diastolic pressure.  Here’s what the following infusion nursing/infusion therapy textbooks indicate:

1. Alexander et al:  Infusion nursing an evidence based approach 3rd edition 2009 states: You can inflate the cuff and release to just below the diastolic pressure.

2. Philips & Gorski Manual of IV Therapeutics 6th edition 2014:  You can apply the BP cuff on the patient’s arm, then slightly pump the cuff to about 30mmHg  The authors added this nursing fast fact: when using a blood pressure cuff, care must be exercised not to start the IV too close to the cuff, which causes excessive back pressure.

3.  Weinstein & Hagle Plumer’s Principles and Practice of Infusion Therapy 9th edition 2014. The patient’s blood pressure cuff may be used to distend the vein; inflate the cuff and then release it until the pressure drops to just below the diastolic pressure.

As an infusion nurse, I’ve only used a BP cuff in lieu of a tourniquet a few times when starting an IV.  I’ve found that inflating and releasing to about 30-40mm Hg provided sufficient distention without increased discomfort to the patient.

Good luck and thank you for your question.

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