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IP CAGT AUTOLOGOUS SCT IV CARMUSTINE / THIOTEPA (MATRIX)	

Types:      ONCOLOGY TREATMENT
Synonyms:  THIOTEPA, TEPADINA, CARMUSTINE, BICNU, MATRIX, BMT, CAGT, AUTOLOGOUS, SCT

Transplant	Repeat 1 time	Cycle length: 90 days	Day -6 through -1	Perform every 1 day x1		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexamethasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	every 24 hours over 10 Minutes for 4 doses	Start: S			Instructions:	Administer 30 minutes prior to treatment on Days -6, -5, -4, -3.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to treatment on Day -6.		  	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	every 24 hours for 2 doses	Start: S+4			Instructions:	Administer 30 minutes prior to treatment on Days -2, -1.			Supportive Care
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	daily					  	fluconazole (DIFLUCAN) tablet 200 mg	Dose: 200 mg	Route: oral	daily	Start: S				  	levoFLOXacin (LEVAQUIN) tablet 500 mg	Dose: 500 mg	Route: oral	daily at 0600 (TIME CRITICAL)						Antiemetics
  	promethazine (PHENERGAN) injection 25 mg	Dose: 25 mg	Route: intravenous	every 4 hours PRN	Start: S					Chemotherapy
  	carmustine (BiCNU) 400 mg/m2 in dextrose (NON-PVC) 5% 500 mL chemo IVPB	Dose: 400 mg/m2	Route: intravenous	once over 2 Hours for 1 dose	Start: S	End: S		Instructions:	Start on Day -6. Protect from light.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CARMUSTINE 100 MG INTRAVENOUS SOLUTION	Medications	400 mg/m2	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) IV SOLP (EXCEL; NON-PVC)	QS Base	500 mL	Yes	Yes			  	thiotepa (PF) 5 mg/kg in sodium chloride 0.9% 500 mL chemo IVPB	Dose: 5 mg/kg	Route: intravenous	every 12 hours over 2 Hours for 4 doses	Start: S+1			Instructions:	Start on Days -5, -4. 
Infuse with 0.22 micron filter. Patients should shower twice daily while receiving thiotepa and for 48 hours after completion.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	THIOTEPA 15 MG/1.5 ML SOLUTION FOR INJECTION (RECONSTITUTED VIAL)	Medications	5 mg/kg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	500 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 11	Interval: Until discontinued	Occurrences: --	Comments:	Thiotepa Skin Care Instructions 
1.  Please have patient shower twice daily starting on first day of thiotepa (Day -5) and continue until 48 hours after completion of therapy (Day -2). 
2.  First shower should be 3-4 hours after first dose of thiotepa. 
3.  Patient should shower using only water or non-soap cleanser to wash the skin. 
4.  After each shower, have patient put on clean undergarmets and loose fitting clothing. 
5.  Patient should not apply lotion, cream, deoderant, perfume, or any other occlusive skin care product until 48 hours after last thiotepa dose.
		  	ONC NURSING COMMUNICATION 12	Interval: Until discontinued	Occurrences: --	Comments:	Central Line Dressing Instructions 
1.  Use a gauze type dressing with minimal tape and change it daily on the days receiving thiotepa and for 48 hours after the last dose of thiotepa. 
2.  Do not place an occlusive dressing over the central venous catheter on the days receiving thiotepa and for 48 hours after the last dose of thiotepa.
			Day of Rest
  	ONC NURSING COMMUNICATION 106	Interval: Until discontinued	Occurrences: --	Comments:	No chemotherapy scheduled for Days -3, -2, -1.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN							Day 0	Perform every 1 day x1		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	once for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once for 1 dose				Instructions:	Premed for TRANSPLANT			Transplant Orders
  	ONC NURSING COMMUNICATION 55	Interval: Once	Occurrences: --	Comments:	-Oxygen at bedside during transplantation
-Anaphylaxis precautions at bedside during transplant:
		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses				Instructions:	Administer every 15 minutes x 3 doses PRN for each episode of rigors (if rigors persist, call MD).		  	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	once PRN	Start: S	End: S+2			  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once PRN	Start: S	End: S+2			  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once PRN							Day 1	Perform every 1 day x1		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Day +1		  	ondansetron ODT (ZOFRAN-ODT) disintegrating tablet 8 mg	Dose: 8 mg	Route: oral	every 8 hours PRN	Start: S+1			Instructions:	Day +2