| Author |
Topic |
|
beanie70
14 Posts |
 Posted - 22 July 2010 : 12:12:21
|
Hello all
Anyone had any dealings with giving methotrexate???? I have noticed I have a patient booked in with me next week. Does anyone have any protocols/procedures/guidelines in giving it. Thankyou. |
|
|
karenH
United Kingdom
189 Posts |
Posted - 22 July 2010 : 13:10:14
|
Hi
this was recently discussed at length on this forum - so just do a search.
Hope this helps - its a minefield.
Karen H |
 |
|
|
beanie70
14 Posts |
Posted - 22 July 2010 : 14:17:12
|
| Thankyou!!! Thats really helpful. |
|
|
|
overcomer
76 Posts |
Posted - 23 July 2010 : 15:09:28
|
Methotrexate is a Cytotoxic drug.See that you wear protection if you have to do the procedure - gloves,mask ? gogles.also you need a cytotoxic sharps bin for desposal,also probably have to do more paper documentation.
hope that helps. |
|
|
|
Adipose
200 Posts |
Posted - 23 July 2010 : 15:57:17
|
| As an chemo nurse this does not sound like safe practice in GP surgery. We had to have loads of training and 10 years on I wouldn't be happy to give now. |
|
|
|
overcomer
76 Posts |
Posted - 23 July 2010 : 16:32:34
|
| wouldn't be happy within a GP surgery either. |
|
|
|
c1are
225 Posts |
Posted - 23 July 2010 : 16:51:56
|
Why would you not be happy to give methotrexate in a GP setting? I have been doing it for years. It comes ready drawn up, all you have to do is pop it in subcut... most pts do their own, we only do the ones who cannot manage to self-administer. You don't even have to buy it from hospital pharmacy any more - comes all packaged up. As long as patient is being monitored regularly and nurse isn't squirting it about everywhere what's the harm?
Is there a difference in administration for different conditions? I have only ever used it IM, then subcut for pts with rheumatoid arthritis. |
|
|
|
Adipose
200 Posts |
Posted - 23 July 2010 : 16:59:37
|
| I used to give chemo through hickman lines and cannulars and have only ever given IV so I suppose I was worried about tissuing of canulars, spillage problems etc. I suppose I would be happier giving it IM but have never been asked to in GP setting. Do you have special sharps bins for disposal ? Do many people do this? |
|
|
|
simples
215 Posts |
Posted - 23 July 2010 : 18:11:16
|
I had one regular lady coming for her IM methotrexate, used to draw it up and administer-some years ago now mind yo.
It is so much easier now that it comes pre-packed.
We do used different coloured lid sharps bins.
Taking the necessary precautions.
|
|
|
|
c1are
225 Posts |
Posted - 23 July 2010 : 18:13:54
|
Very common in primary care. Everywhere I have worked have had a few pts on in weekly injections. (approx 1/1000? few less?)
we have special cytotoxic waste purple lidded sharps bins which are collected separately from rest of sharps. Not sure where it goes from there though! It is no longer given IM very often in primary care as most pts derive equal benefit from subcut administration. Most important thing is to ensure that bloods are being done regularly and that pt is stable. If in doubt, withold and discuss with rheumatology first. And educate pt about symptoms to look out for such as sore throat unexplained bruising etc etc |
|
|
|
corrie01
1025 Posts |
Posted - 23 July 2010 : 22:49:40
|
Administering Methotrexate Beanie as you can see is not so straightforward as you may have thought.
Like Adipose I was a chemo nurse for many years and feel exactly as she does. Our chemo training was in depth and as the old saying goes...knowledge is power, leave it to the experts to administer in the correct environment.
There has been no mention of folic acid. I am assuming that will be prescibed.
Folic acid supplementation is required if you take methotrexate.
Since methotrexate is a folic acid antagonist, it must be replenished by taking oral folic acid supplement. Folic acid supplementation should also minimize side effects associated with taking methotrexate.
|
|
|
|
c1are
225 Posts |
Posted - 23 July 2010 : 23:35:57
|
.
Folic acid supplementation is required if you take methotrexate.
.. every day but methotrexate day! |
|
|
|
knitnurse
653 Posts |
Posted - 23 July 2010 : 23:57:02
|
I too give methotrexate in primary care having given IV chemo in a former former life - we follow rigorous protocols for safety and liaise with secondary care where necessary - it's really about putting patients first - these patients request to have their ongoing treatment in the community in order to get on with productive lives. I have a very hard working A level student currently who pops in weekly at the end of her long day - saves her taking time off school and a round trip to the hospital and waiting around for her jab.
I'd rather be knitting! |
|
|
|
corrie01
1025 Posts |
Posted - 24 July 2010 : 00:48:14
|
Agree with you entirely Knitnurse, but you have experience in cytotoxic drugs, an established procedure and a safe environment to administer this.
Your patient is very lucky that she has been given this choice.
But Beanie has about a week before she sees her patient, has never given this drug before, and reading a protocol, or the forum, is not enough training to protect her license. 'See one do one' with this drug is not appropriate as I am sure you will agree.
There is a need for formal training in this field for practice nurses (similar to the Ear irrigation Course, mandatory now to reduce litigation.) I have never been asked to do this as all our patients are given this in Rheumatology. |
|
|
|
practicenurse31
103 Posts |
Posted - 24 July 2010 : 07:43:47
|
| If the bloods and management is undertaken by the hospital and we are just administrating s/c using aprons gloves etc, then is this an issue? What aditional training would we need ie if we are not monitoring - A pt we see was supposed to give it herself at home but cannot face giving the injection- so we do- if there is a concern why are pts being given injections to do themselves? |
|
|
|
jongeord
123 Posts |
Posted - 24 July 2010 : 08:57:34
|
I have never been asked to do this but dont think i would have a problem with it if i was. I would obviously get advice on the technicalities involved, but as all our patients self administer or have it given by a relative its not something that would overly concern me.
I have been asked on occasion to flush longlines etc which i am not happy to do,firstly beacuse its about 20 years since i last did it but im not sure the surgery is an ideal enviroment to do it in.
|
|
|
|
mandymandy
United Kingdom
116 Posts |
Posted - 25 July 2010 : 01:39:08
|
We do have a few patients on methotrexate too! We follow all the precautions check patient pre injection sore throats ,rashes, unexplained bruising , bleeding gums etc and check blods up to date also gloves,aprons ,googles for administration and use of black lid sharps bin after. It is a procedure , I am happy to do in my clinic , but if I had a concern about a patient would speak to gp /contact rheumatology. Am not aware of any courses in Primary Care for administration of cytotoxics, but perhaps you could spend some time in Rheumatolgoy getting experience of administering .
Mandy x |
|
|
|
CarolJ
United Kingdom
1296 Posts |
Posted - 25 July 2010 : 09:51:10
|
| Beanie protect yourself tell them you cannot do it till trained and change appointment to doctor to sort out |
|
|
|
knitnurse
653 Posts |
Posted - 25 July 2010 : 12:01:25
|
we also flush long lines in the surgery by arrangement - fortunately we have PCT community IV specialist nurse (who knows how long this role will continue) who trains and supports us and supplies us with the bungs etc
I'd rather be knitting! |
|
|
|
beanie70
14 Posts |
Posted - 26 July 2010 : 08:47:00
|
Thankyou so much for all your replies. I think I have opened a can of worms!
I have contacted the local rhematology dept - who were very helpful. They know the patient well - and without going into details of the patient - she can self adminster via subcut inj,but would be happier to do so here in the surgery. I have the appropriate sharps bin - as per our local guidelines. So I dont think I will be doing much. She is under hospital care re blood tests, folic acid etc.
But a HUGE thanks for all you replies. Dont work to hard. |
|
|
|
Sarah.W
United Kingdom
32 Posts |
Posted - 27 July 2010 : 21:49:29
|
Hi Beanie,
I hadto previously give methotrexate IM to a patient within general practice and had to do a lot of reading beforehand to protect both the nurses and patient. We wrote up protocols and ensured safe transport of the injections, had the appropriate cytoroxic sharps bin in place and protective equipment.
Do let me know if you'd like a copy and I'll e-mail info to you.
Best Wishes |
|
|
|
Topic |
|
methotrexate
