Reply To: Home Cytarabine Administration

  • Kimberly Diniz

    Member
    May 25, 2022 at 4:15 pm

    At my current institution, we do SQ Ara-C injections and educate parents how to do it at home. We work with the hospital’s home infusion pharmacy since most home infusion pharmacies don’t prepare chemotherapy. We do not give the choice to families. It is presented to the patient as our institution’s standard of care.  The only time we do SQ Ara-C in clinic is for families that cannot utilize home health or families that refuse despite the education. If families opt for the clinic, we still do SQ instead of IV to reduce infection risk and to keep our care consistent regardless of situation.

    It’s been helpful to explain to parents that doing the injections at home reduce clinic visits. That motivates a lot of my families to want to do it at home. For our adolescent population, they are given the option to learn and give the injection themselves. We do not utilize home health nursing at all in this process. 

    For the patient’s first SQ dose, RN navigator provides instructions of what to do before Ara-C (i.e. Zofran and emla) and how to give Ara-C step-by-step in clinic. I created our SQ Ara-C teaching sheet that is specific instructions related to chemotherapy. RN navigator will verbalize it to the family and then demonstrate on medical doll. Family will then do teach back with the doll. After they complete this step, they will give the first dose of SQ Ara-C in the cycle to the patient in clinic. This allows for medical staff to be by the parents’ side to coach and encourage them as needed. This dose is prepared by clinic pharmacy. Home health’s order will only request 3 home doses for that first week in the cycle.

    Example:

    Treated as per AALL1731-SR 

    Delayed Intensification

    Day 29-32, 36-39 SQ Ara-C

                Day 29 SQ Ara-C prepared by clinic & parents give after education

    D30-32 SQ Ara-C prepared by home health and delivered to clinic for parents to give at home

                D36-39 SQ Ara-C prepared by home health and delivered to clinic

    We utilize home health to prepare the Ara-C doses and deliver them to clinic. We only have home health prepare max 4 doses at a time. The home health box includes: alcohol swabs, needles, hazardous sharps box, PPE, gloves, chemo spill kit, and flyer with numbers to call for assistance.  Families bring hazardous sharps box back to clinic after all Ara-C is completed in a cycle and we dispose of the hazardous box.

    Though it feels traumatic to families at first, they respond well to having to give SQ chemo at home. Happy to answer any other questions you have !

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    Kimberly Diniz, MSN RN CPN
    Nurse Navigator-Leukemia & Lymphoma Team
    Levine Children’s Cancer & Blood Disorders 
    Charlotte, NC 
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    Original Message:
    Sent: 05-24-2022 12:00 PM
    From: Anne Joseph
    Subject: Home Cytarabine Administration

    Hello!

    I am looking for information from institutions that have the parents/caregivers administer SQ Cytarabine at home.  Currently, our patients either receive their Ara-C via Home Health Care (their choice of SQ or IV), or they come to receive it in our Day Hospital if they do not have HHC coverage.  We are experiencing difficulties with the Home Health agencies having nursing availability.  We would like to consider teaching some of the parents how to do home administration of SQ Ara-C.

    I am looking for resources that we would use for educating the families.  We have a subcutaneous injection teaching sheet, but we would want to have something more comprehensive that takes into consideration the chemo precautions/safety.

    Can you please answer the following questions:

    • What educational resources do you have for the families?
    • Are families given the choice if they would like to learn how to do it at home?  Or is everyone automatically expected to do it?
    • Do they administer the first dose in your facility with one of your nurses?  If yes, is that chemo supplied by your hospital pharmacy or the same pharmacy that will be providing the home doses?
    • How are families provided with a spill kit, chemo sharps container, etc?  
    • Any other tips we need to consider?

    Thanks in advance for any input you can give me!

    Anne

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    Anne Joseph, BSN,CPHON,RN
    Milwaukee, WI
    United States
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