Clinical procedure - frozen gel gloves during administration of docetaxel SUPERSEDED

This clinical resource has been superseded based on feedback from the nursing reference committee for the following reasons:

• limited evidence to support use
• lack of availability of equipment in Australia
• infection control issues.

The reported incidence of nail changes associated with taxanes is up to 44%.^rThese include hyperpigmentation, discolouration, Beau-Reil lines and onycholysis and may be painful.^rrThe severity of symptoms is linked to the cumulative dose and is uncommon during the first cycle.^r The evidence regarding the use of gel gloves to reduce nail toxicity is limited: Scotte et al^r reported that docetaxel-induced nail changes might be reduced by using an elasto-gel frozen glove during docetaxel infusion. 45 patients wore a specially designed frozen glove on the right hand while the left hand remained ungloved for control purposes; Overall occurrence of nail toxicity including onycholysis and cutaneous reactions were reduced in the gloved hand to 11% in comparison to 51% in the control hand. Using the National Cancer Institute Common Toxicity Criteria for Adverse Events, grade 2 nail reactions were 0% in the gloved hand compared with 22% in the control hand and grade 1 reactions were 11% compared with 29%. Ishiguro et al demonstrated almost equal effectiveness to Scotte et al's findings using gloves that had only been frozen to between -10 to -20°C thus allowing the use of a standard freezer and provided improved patient comfort.^r Although both studies demonstrated a reduction in nail toxicity there is no recommendation for the use of gel gloves in the manufacturer's product information for docetaxel.

Onycholysis caused by docetaxelr	Beau's linesr

© Photos from A. M. Minisini, Annals of Oncology 2003^r 

Assess patient hands for:

• presence of pain
• pins and needles
• alteration in colour
• difficulty in movement
• nail changes
• any condition that would preclude the use of a frozen glove such as Raynaud's syndrome, arteriopathy or distal metastases.^r

Report any hand neurovascular abnormalities to a medical officer prior to continuing with this procedure.

Educate the patient about:

• the procedure and reason for wearing frozen gel gloves
• the importance of hand hygiene prior to the application of the frozen gel gloves
• reporting immediately any pain, pins & needles, discomfort, difficulty in movement.

The following is a list of recommended equipment required to undertake this procedure:

• frozen gel gloves which have been frozen to a minimum of -10°C, usually achievable by placing in a freezer for at least 12 hours
• 1 pair of cotton insert gloves
• 1 pair of disposable gloves.

Note: The frozen gel gloves should be applied at least 15 minutes prior to and continue for 15 minutes post the docetaxel infusion. The frozen gel gloves should be replaced by another pair from the freezer every 45 minutes.

1. Explain procedure to the patient.^rr

2. Ensure patient washes and dries hands thoroughly.^r

3. Ensure patient is sitting comfortably.

4. Establish venous access. The cannula should be positioned to ensure the IV cannula site can be visualised and gloves can be fitted appropriately.

5. Place patient’s hands in cotton gloves.

6. Place disposable gloves on top of the cotton gloves.^r

7. Apply frozen gel gloves to both hands, 15 minutes prior to commencement of docetaxel.^rr

8. Continually assess patient's comfort level.

9. Remove frozen gloves immediately if the patient cannot tolerate them.

10. Replace initial frozen gel glove pair after 45 minutes.

11. Leave frozen gel gloves insitu for 15 minutes after completion of docetaxel infusion then remove the frozen gel gloves.^rr

12. Dispose of cotton inserts and disposable gloves in bin.^r

13. Remove the outside cover and wash as per hospital policy.^r

14. Do not get the gel insert wet.^r

15. Store the gel gloves in the freezer until ready for re-use. Frozen gel gloves should be replaced as per manufacturers instructions.

16. Observe patients hands for colour, movement, sensation and any abnormalities

17. Document in the patients medical records: the use of the frozen gel gloves, neurovascular hand observations, any adverse reactions or interventions.^r

18. Patients should be supplied with any printed information currently available.^r

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Version 4

 Previous CI-SCaT ID : 12-1260.1