[das]

Has any one out there had phlebitis problems with Ellence???
We have had 3 FEC( 5FU, Ellence and Cytoxan) patients develope phlebitis even up to several weeks post treatment. We have not had a problem with our ACs or FACs. These are all periperal lines and we follow all the recommendatins by the company and OCN, Y-site, free flowing IV, lots of flush, SLLLLLLOOOOOOOWWWWW pushes. DIfferent nurses have given the meds, we have had 6-7 FEC patients and the phlebitis have occured after the 4th to 6th treatment. Thanks, deb, RN

[jemb]

I haven't seen phlebitis with our FEC patients, but we don't use that regimen much.

You said that you use a y-site. Do you infuse the epirubicin into a high side port of the free flowing NS so that the med well diluted by the time it hits the vein? Or do you infuse the epirubicin into a free flowing line that is attached to the y-site of another line? I wasn't sure how you meant you use the y-site. Injecting into a y-site close to the venipuncture site could contribute to phlebitis.

Also, the drug should be given in 3-5 minutes so it does not stay in contact with the vein for a longer period. Sclerosing of smaller veins can be a problem with slower infusions.

5FU and epirubicin are not compatible, so you need free-flowing NS between them also, but I can't imagine that you would not already be doing that.

Have you let the drug company that you are having a problem in spite of doing everything according to their recommendations? Maybe they can give you more info.

[das]

We have only recently started using the Ellence. Our MDs are at odds if the Ellence is any better than Adria. Up to that point we have always used Ardia and have not had any problems. We inject the Ellence into the y-port closest to the patient through a free flowing IV (as recommended by the Company) and we have taken up to 20-25 min to push the Ellence re:vein size, location and free flow of the IV. We flush well between drugs.

We have talked to the Drug rep and they stated they are not aware of any problems. One of our MDs recommended administration by drip, but with an extravasator we don't feel comfortable doing it that way. If the patient mentioned tenderness or pain we would not use the vein that was tender or painful. We did receive a booklet entitled "A Comprehensive Guide for Nurses" and did not gleen any new info from it.

Thanks for your help. deb, RN

Side note. We have one patient that received Gemzar peripherally and developed micro-clots in her fingers and hands. She got a port and we never had any more problems.

[caroladybelle]

I would prefer a central access for epirubicin (as with any vesicant)

[das]

A port or VAD would always be our preference, but not always an option. If we see a problem early in the treatment phase we ask for a VAD, but if it is the 5th or 6th of 6 treatments it is not an option.

[caroladybelle]

Your MDs may want to start planning ahead if this becomes a regular occurrance (PICC lines are an easy option if ports/Hickmans/Groshongs are not).