>> Chemo Takedown. This video has been provided by
the Johns Hopkins home care group and
the Johns Hopkins Division of Infectious Diseases.
Thank you in advance for watching this video.
This video will be presented in 11 sections: One, introduction.
Two, how to get started.
Three, hand hygiene.
Four, prepare a clean workspace.
Five, gather supplies.
Six, use your personal protective equipment.
Seven, prepare supplies.
Eight, disconnect and discard.
Nine, scrub the hub.
Ten, pulse flush.
Eleven, de-access the port.
One, introduction.
It is now time to disconnect your chemotherapy,
it is important to pay special attention to safety measures when
disconnecting the chemo to
not contaminate yourself or your surroundings.
We will review how to disconnect from
both an electronic pump as well as an elastomeric infusion.
Please watch this video as many times as you need.
If you have a caregiver who is going
to assist in disconnecting the chemo,
please have them watch the video as well.
Two, how to get started.
Your nurse will tell you at approximately what
time you should be ready to disconnect from your chemo.
You should be monitoring the bag or elastomeric device
during your infusion to be sure it is becoming smaller in size.
If you have a large volume of chemo
left when it is time to disconnect,
please call your infusion provider for direction.
First things first, hand hygiene.
Practice good hand washing.
Washing your hands helps reduce your chance of infection.
Use soap and water at first.
Make it a habit to wet your hands,
apply soap and lather for 20 seconds.
To make sure you are taking 20 seconds,
sing the happy birthday song twice.
You can use hand sanitizer after you've
already washed your hands with soap and water.
If you use hand sanitizer wrap
a dime size amount between your hands until they are dry.
Never wave or blow your hands to speed up drying.
Even if you are using gloves,
you must still wash your hands.
If you are using gloves,
put your gloves on after washing your hands.
Four, prepare a clean workspace.
Before we take down our chemotherapy,
it is important to find and prepare a clean,
dry, hard workspace to set up our supplies.
Clean the workspace with a gentle cleansing solution
such as a disinfectant spray or alcohol.
You can place the provided sash placemat on top of the workspace.
Also clean the sash mat with
a gentle cleaning solution such
as a disinfectant spray or alcohol.
Wash your hands.
Five, gathers supplies.
The next step will be to gather your supplies.
Your home infusion agency will provide you with these supplies.
If you're missing any supplies,
contact your home infusion agency.
You will need two sets of gloves,
one chemotherapy gown if
the caregiver is going to perform the takedown,
one hazard zip bag for gloves and gown post use,
one large hazard bag for long-term storage,
which is reusable,
four alcohol pads to clean your supplies and hub,
one saline syringe to flush
your IV line after the medication has completed,
one chemo sharps container to
dispose off used pump and pump tubing,
one trash bag for garbage, and one red cap.
Place the trash bag close by and
the sharps container within your reach.
Wash your hands one more time.
Six, use your personal protective equipment.
Narrow down the chemo gown first with the opening to the back.
The gown should cover your arms, torso,
and at least your upper legs. Tie the ties.
Next, put on both sets of gloves, one after another.
The first set should fit under the gown's calf.
The second set should fit over the gown's calf.
Seven, prepare supplies.
Place an alcohol pad into one saline syringe on the sash mat.
Pick up your syringe and remove
the protective cap from the syringe.
Place the cap flat side down on your sash mat,
hold the syringe with the end up and the plunger at the bottom.
Pull back on the plunger slightly to break the seal.
You will be able to see the air bubble in the syringe.
Slowly push the plunger up and let the air bubble out.
Once the air is removed,
pick up the cap from the table and put
the cap back on the end of the syringe.
Do not touch the inside of the cap.
Place the syringe back on the sash mat.
Number 8, disconnect and discard.
Now the moment we've been waiting for
, disconnecting and discarding.
First remove the infusion bag or
elastomeric pump from the carry bag.
Sit the bag or device on the work surface.
Inspect to be sure the chemo has infused.
If you can't tell or the chemo hasn't infused,
please call your infusion pharmacy.
If you're using an electronic pump,
the pump will beep when the chemo is complete.
Stop the pump by hitting the Stop/Start button.
Select "Yes", when the infusion is completed.
Power the pump down by pushing and holding in
the gray button on this side until the pump powers off.
Be sure to clamp any clamps on the tubing.
Next, disconnect your medication tubing from your IV line.
Grasp the end cap of your IV line with
one hand while using
your other hand to unscrew the medication tubing.
Do this until the tubing is disconnected from the end cap.
Do not remove the end cap from your IV line.
The end cap protects your IV line from bacteria.
Cover the end of the chemo line with the thin end of the red cap.
If you are using an elastomeric device,
place the entire device into the chemo sharps container.
If you're using an electronic pump,
pull down on the lever on the side of the pump and
cassette to unlatch the cassette from the pump.
Remove the cassette and discard
the cassette tubing and bag in the chemo sharps container.
Nine, scrub the hub.
We will now scrub the hub.
Hold the end cap between your fingers and scrub the hub,
which is the tip of the end cap for
15 seconds with an alcohol pad.
Do not put down the end cap.
Discard the alcohol pad.
Pick up your saline flush syringe.
Ten, pulse flush.
Remove the cap of the syringe,
being careful not to touch
the end cap that was just cleaned with alcohol.
If you do touch or drop the end cap,
scrub the hub again for 15 seconds with a new alcohol pad.
Attach the saline syringe to the center of the hub
and push and turn clockwise until it is attached.
Now push 1-2 mls of fluid at a time until the syringe is empty.
Discard the syringe in the chemo sharps container.
Clamp your IV line.
Eleven, de-access the port.
Remove the dressing from
your skin and the port needle insertion site.
Carefully remove the dressing tape around in over
the port needle by removing the dressing from all sites first.
Then hold the needle down when
removing the dressing from the port needle itself.
Be careful not to pull the needle out during the process.
Now it is time to remove the needle itself.
If the needle has yellow or black plastic wings,
pinch the wings together with one hand
while stabilizing port with the other hand.
This will pop out the needle.
Discard the needle in the white chemo bucket.
If you have a clear or white plastic port needle,
hold the white circle against your skin
and pull the knob away from the chest.
This will remove the needle,
discard the needle in the white chemo bucket.
It is now time to remove your PPE.
First, remove your gown.
As you take the gown off,
fold the outside inward to keep
the inside of the gown on the outside.
Be careful not to ruffle the gown because
this could spread particles into the air.
Place the rolled-up gown inside the clear plastic bag.
Remove each pair of gloves,
one pair at a time.
Turning the gloves inside out as you remove them.
Place the gloves inside the clear hazard bag and close the bag.
Place the close plastic bag into
the larger hazard bag and close it using the zip tie.
Keep the large hazard bag stored in and out of the way area,
a closet, garage, or shade, all work.
Wash your hands one final time.
Congratulations, you have
now completed your chemotherapy takedown.