bendamustine
Print| Trade Name(s): Belrapzo; Bendamustine Hydrochloride; Bendeka; Treanda; Vivimusta | |
| Group 1: Antineoplastic Hazardous | AHFS Class: Antineoplastic Agents |
| Formweb: bendamustine | |
| Info Links: Chemotherapy Extravasation Policy | |
| Activity | Glove | Gown | Eye | Mask (N95/PAPR) | CSTD |
| Administration |  |  |
If splashing possible |
If inhalation possible |  |
| Waste/Disposal of drug | | |  If splashing possible |
Nursing Antineoplastic Drugs PPE and Work Practices (Link to a file uploaded to Rhazdrugs or to a file on your intranet, or a shared drive.)
Handling of bodily fluids and/or contaminated materials
| Drug Form | Glove | Gown | Eye | Mask (N95/PAPR) | Shoe |
| All forms | | | If splashing possible |
Irritant (usually):
- Symptoms are; tenderness, warmth, or redness along the vein or at the injection site.
- A variation to this is a hypersensitivity "flare reaction" at the injection site.
- Symptoms of this reaction are redness and itching at the injection site.
Vesicant (rare):
- The reaction to vesicants initially looks like an irritation but may worsen, depending on the amount of vesicant that has leaked under the skin.
- Vesicants can cause redness and blistering. Larger amounts of vesicant leakage from the chemotherapy injection can lead to severe skin damage in a matter of days.
- Symptoms from leakage of vesicants may be delayed for up to 6-12 hours after chemotherapy injection.
- Complaints of itching are common in the absence of pain.
- Severity of the injection site reaction depends on the vesicant potential of the drug, the amount and concentration of the drug exposure, and the immediate measures taken once the extravasation occurs.
Bendamustine hydrochloride extravasations have been reported in post-marketing resulting in hospitalizations from erythema, marked swelling, and pain. Assure good venous access prior to starting drug infusion and monitor the intravenous infusion site for redness, swelling, pain, infection, and necrosis during and after administration.
| Vesicant or Irritant | Apply Heat or Cold | Additional treatment/antidote |
| Irritant (usually) Vesicant (rare) | Cold - for 6 to 12 hours | Initiate substance-specific measures per physician orders. |
References: DailyMed, Hemonc.org, Chemocare
| Glove | Gown | Eye | Mask | Shoe | Head Cover | Hood/Cabinet | CSTD | Notes/Instructions |
(outer layer should be sterile) |
(outer layer should be chemo rated) |
|  |  |
| | Any secondary layers of PPE should be removed/discarded prior to exiting the C-PEC |
| Form | Prep Instructions | Pneumatic Tube |
| Intact tablet/capsule from UD package | Sealed plastic bag, single pair of gloves, cautionary labeling |  |
| Non-intact, repackaged tablet or capsule | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Oral liquid drug or feeding tube | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Topical drug | Sealed plastic bag, single pair of gloves, cautionary labeling |  |
| Powder, solution for inhalation | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Vial; ampule; pre-filled syringe | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Intravenous solution | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Irrigation solution | Sealed plastic bag, single pair of gloves, cautionary labeling | |
Group 1 NIOSH - Full USP <800> precautions required - No Assessment of Risk allowed.
| Dosage Form | Risk of Exposure | Packaging | Pharmacy Manipulation | Nurse Manipulation |
| Injectable | May occur when compounding and administration | Not eligible for AoR | Not eligible for AoR | Not eligible for AoR |
| |  | |  |  | | |
| Chemotherapy rated/tested (tested to ASTM D6978-05 (2013), Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs) | Disposable
| Should be worn in situations where eye, mouth, or nasal splashing is possible (i.e., during a bladder instillation of a hazardous drug) | Goggles protect the eyes, but not the face, against spraying. | Certified N95 | Powered air purifying respirator | required for compounding sterile and nonsterile hazardous drugs | required for compounding sterile and nonsterile hazardous drugs |
| Powder-free | Shown to resist permeation by hazardous drugs
| N95 offers no protection against gases and vapors. | For events such as large spills when an IV bag breaks or a line disconnects and leaks, or where there is known or suspected airborne exposure to vapors or gases | Double booties required for HD preparation areas, top layer is doffed before exiting the HD buffer room. | |||
| Inspect for visible defects | Must close in the back (no open front) | Surgical masks do NOT provide respiratory protection from drug exposure | Hazardous drugs with potential to vaporize at room temperature: • Carmustine • Cisplatin •Cyclophosphamide • Etoposide • 5-Fluorouracil • lfosfamide • Thiotepa | ||||
| Double gloving is recommended for all activities involving hazardous drugs except for handling intact, unit-dose oral agents, when one pair of chemotherapy-tested gloves is acceptable | Long sleeves with closed cuffs that are elastic or knit | ||||||
| When wearing double gloves, tuck the cuff of the inner glove under the gown sleeve and the cuff of the outer glove over the gown sleeve. | No seams or closures that could allow hazardous drugs to pass through | ||||||
| During medication manipulation/compounding the outer layer should be sterile | In preparation areas gowns should be changed every 2-3 hours or immediately after a spill or splash | ||||||
Change gloves every 30 minutes unless permeation testing has noted shorter time limits
| Gowns worn in hazardous drug handling areas must NOT be worn to other areas |
Sequence for Donning & Doffing PPE
References: Oncology Nursing Society, NIOSH
Bendamustine is a bifunctional mechlorethamine derivative capable of forming electrophilic alkyl groups that covalently bond to other molecules. Through this function as an alkylating agent, bendamustine causes intra- and inter-strand crosslinks between DNA bases resulting in cell death. It is active against both active and quiescent cells, although the exact mechanism of action is unknown.
Reference: Drug Bank
- Toxic if swallowed.
- Suspected of causing cancer.
- May damage fertility or the unborn child.
Reference: SDS - Cayman Chemical
NIOSH 2020: Cytotoxic; Developmental toxicity
