Safe Use of Chemotherapy

Presenter – Neil Palmer BVsc MRCVS, Abbey House Veterinary Hospital is currently working
towards gaining his Masters degree in clinical oncology

Many moons ago, fresh out of vet school, I remember watching my colleague administer Vincristine to a dog with Lymphoma. They slipped on a pair of latex gloves, drew up the Vincristine in a busy prep area of the hospital and injected Vincristine directly into the cephalic vein straight off the needle. Now please, before judging my colleague too harshly, these were the days when propofol was non-existent, catheterising patients was not common place and maintaining anaesthesia with a syringe of thiopentone was not unusual.

Let’s be honest, the fact that the dog was receiving Vincristine at all was fairly forward thinking. Yet if I saw a chemotherapy agent administered in this way today, I’d probably keel over with shock, which must surely mean that we are moving forward in the field of chemotherapy safety. Who is to say, however, that a new graduate watching me administer Vincristine today would be in equal shock and dismay in twenty years’ time?

Last week’s veterinary webinar organised by The Webinar Vet, discussed the safe handling of chemotherapy agents, and showed me that I still have a lot to learn. Neil Palmer has developed a keen interest in oncology and led the discussion giving advice on best practice for the safe use of chemotherapy within a practice environment.

Chemotherapy safety was discussed from the perspective of the patient, the operator and the client. From the client’s perspective, Neil was keen to point out there have been no studies to indicate the time of excretion for chemotherapy drugs in animals, and clients should be given written advice on taking precautions. Double bagging of waste, the avoidance of being licked and always using gloves when handling drugs are just some pointers indicated by Neil.

Neil also offered great advice on the use of personal protective equipment (PPE) and advised setting up standard operating procedures for the administration of each chemotherapy agent. He advised that latex gloves are just not good enough when performing chemotherapy and currently he uses a long sleeved impervious gown plus a pair of cytoprotective nitrile gloves, along with impervious sleeves and a second pair of nitrile cytoprotective gloves. I guess this could be perceived as ‘over kill’ but with evidence from medicine showing increased levels of drug residues in the urine of operators, it seems the belt and braces approach is more than sensible.

A human study has also shown no increased risk of cancer, reproductive disorders and acute toxicities in trained oncology workers. However, in Neil’s opinion, veterinary staff are more likely to be at greater risk of exposure compared to our human counterparts, having to deal directly with the patient’s urine and faecus. This provides even more reason to minimise any chances of exposure. Needless to say, I have only provided a few snippets from the advice delivered by this veterinary webinar. There is so much more to learn and it is essential viewing which can only help to maintain the safety of yourself, your patient, your clients and your staff.

The Stethoscope MRCVS