Chemo administration question?

Nursing Students Student Assist

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STUDENT HERE: I have noticed many different methods of this and have a few things I hope someone can clarify. A Chemotherapy Pt. is there for infusion. hydration is ordered some pre and some post so a 1000ml Nss running in 500/hr Iv running into central line . As the premeds come they PB them and lower the saline so they run in over 30min. and then just let those gravity in by lifting the line, and restarting the flush ( at 60 not 550) . Then the Abraxane comes(nab-paclitaxel).... its only a 33ml bag so again they lower the saline. AND this 33ml is supposed to run in over 30 min. and the pump was set at 66ml/hr...... well after about 15min the entire bags worth of med is in the tubing/ none left in the hanging bag and its going nowhere. So then you'd have to get the rest from the tubing and into the PT. SO I assumed after watching the first time that you do this by lifting the tubing and use gravity ( holding the line up so it all fills into the pump and into tubing past the pump?? then re start the NSS at the same rate ( 66ml /hr ) until whats basically HALF the DOSE ( like 15ml in tubing right??) goes in at the correct rate ?? and then after its in then back to 550 .. i saw that LAST TIME ... BUT this time I saw different nurse lift the tubing and get all the medication where it needs to be in the tubing .. then start the NSS back up at 550ml/hr..... so the 15ml or more of medication thats supposed to go in slowly over the rest of the 30 min went jamming down the line like a freight train and was in the PT in less than 1 min. IS THIS OK ?? or AM I totally misinterpreting??? they always stress the timing and this particular nurse seemed to be in a a big hurry and had lots of pumps beeping for her and it almost seemed like it was done to save the 15 min wait for the rest going in then having to come back and reset the pump ??? ( oh and How many ml's is in the standard length of IV from pump to patient looked like 4 feet or more ) THANK you for any help.... I was only allowed to observe this time.

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STUDENT HERE: I have noticed many different methods of this and have a few things I hope someone can clarify. A Chemotherapy Pt. is there for infusion. hydration is ordered some pre and some post so a 1000ml Nss running in 500/hr Iv running into central line . As the premeds come they PB them and lower the saline so they run in over 30min. and then just let those gravity in by lifting the line, and restarting the flush ( at 60 not 550) . Then the Abraxane comes(nab-paclitaxel).... its only a 33ml bag so again they lower the saline. AND this 33ml is supposed to run in over 30 min. and the pump was set at 66ml/hr...... well after about 15min the entire bags worth of med is in the tubing/ none left in the hanging bag and its going nowhere. So then you'd have to get the rest from the tubing and into the PT. SO I assumed after watching the first time that you do this by lifting the tubing and use gravity ( holding the line up so it all fills into the pump and into tubing past the pump?? then re start the NSS at the same rate ( 66ml /hr ) until whats basically HALF the DOSE ( like 15ml in tubing right??) goes in at the correct rate ?? and then after its in then back to 550 .. i saw that LAST TIME ... BUT this time I saw different nurse lift the tubing and get all the medication where it needs to be in the tubing .. then start the NSS back up at 550ml/hr..... so the 15ml or more of medication thats supposed to go in slowly over the rest of the 30 min went jamming down the line like a freight train and was in the PT in less than 1 min. IS THIS OK ?? or AM I totally misinterpreting??? they always stress the timing and this particular nurse seemed to be in a a big hurry and had lots of pumps beeping for her and it almost seemed like it was done to save the 15 min wait for the rest going in then having to come back and reset the pump ??? ( oh and How many ml's is in the standard length of IV from pump to patient looked like 4 feet or more ) THANK you for any help.... I was only allowed to observe this time.

????/

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Well while there are recommended times for thee meds....there may be behind the scene discussion about this particular patient. We cannot make judgements as we were not there......nursing school is SELDOM the real world. As a student you do it by the book

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Thank you . Wrote it up as I saw it discussed it with instructor... used it for discussion.... went over and above to contact the company that makes the drug so I can use info for a paper ... its an interesting drug very cool ... got more info from them ........ contacted pharmacy for more info too ..... thanks

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Specializes in Pedi.

This whole scenario doesn't make sense to me. I've never seen 33 mL of medication be sent up from the pharmacy in a bag, it would have been dispensed in a syringe when I worked in the hospital and administered via medfusion/syringe pump. How many lumens did this central line have? Did you ask questions while you were there?

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It was a bard power port on her chest not a picc, it was accessed like usual,( Huber needle y site) one more access in the tubing too (http://www.bardaccess.com/powerportadvantage/assets/pdfs/MC-0475-01_PowerPort_Nursing_Guide_web.pdf) and then the nurse started the 1000ml of saline , 500ml pre 500ml post and they stop the saline and PB the premeds and the chemo Abraxane..... so its the 500 saline running then they stop that and start PB the premeds first( over 30 min) and then PB the abraxane then after the other 500 ml of saline goes in ...ABRAXANE chemo .... you have to reconstitute it from a cake (Pharmacy does that ) .. I saw it 12 times there on 12 different days .. ALWAYS in a bag there ( the video to reconstitute it also mentions bag or syringe) .... its ordered by weight/body surface area and I read and re read the insert info available online and was able to ask the pharmacist on one occasion .... they reconstitute it there and do not add extra saline etc etc ... apparently its incredibly expensive 19 k per dose and 33ml was what she got because of her weight and m2 ... checked her dose 100mg/m2 using (Medscape: Medscape Access) then I did it with Mosteller formula as well ... then I watched this Youtube video regarding reconstitution of the drug I think the video is for pharmacists... https://www.youtube.com/watch?v=niWyYTD29r0....... her weekly doses were 33ml in the bag .... the orders staated for it to be given over 30 min at 66ml/hr ..... inside the baglooked milky but couldnt be frothy and since the bag had so little in it about half went in her in 15 min or so and then the rest would be hung up in the line from gravity ... the first nurse week 1 first set the bag ( when it arrived 33ml ) at 66ml/hr and 15min later the pump beeped so she came back and lowered the abraxane bag and let it flow into the line thru the pump til the upper line had no medications in it it had all flowed into the lower part of the line between the pump and the patient then reset the pump to let the saline flow in behond it at 66ml per hout for 15 more minutes to make sure all 33 got in there at the right rate ..... that way seemed exactly correct and right to the letter of the orders thru EPIC from the doctor ....... THe next time and a few other times it was not done this way and so I have questions... Noting the fact to the instructor that each time the way it was given here was not consistent... when I asked questions I basically was told each nurse does it differently and I thought lack of continuity can lead to more mistakes ... but ... oh here's the info I got ABRAXANE Recommended Dose and Schedule for Non-Small Cell Lung Cancer (NSCLC) Patients and http://www.abraxane.com/downloads/Abraxane_PrescribingInformation.pdf BUT WHAT I WANTED TO KNOW and its my BIG QUESTION::::: Was it not good ALLOWING almost 20ml in the line to be administered in less than 1 minute ??because instead of resetting the saline ( bag of fluids ordered 500 pre and 500 post ) to 66ml/hr for the next 15 min or so to let the remainder of the medication flush thru the line at the proper rate like the first nurse I saw do it did ... ...this one nurse and two other nurses on a diff occasion instead of letting the saline flush what was left in the line after the first 15 min when gravity hung it up instead of restarting the saline at 66ml to clear the line of the rest of the meds, instead they just set the saline back to 500ml/hr BUT doing that pushed the thick liquid that was sitting in the line because of gravity ( about 20ml) thru at 500ml/hr.. I WATCHED IT FLY IN and I ASKED QUESTIONS LIKE MAD ( her response was something I dont wish to post but I will if you ask .. SO I have the question I am asking because after reading the orders on Epic that the entire amount of medication 33ml has to go in at 66 not 500 and seeing on the bag that this medication all 33ml should go in over 30 min at 66ml/ hr .. and NOT FASTER ..... it UPSET ME ..... I assumed any Taxane had to be given at the rate ordered even if it meant coming back again and again like after 15min to then reset the saline when the abraxane got hung up due to gravity to 66ml/hr for 15 more min until the line would look clear again .... I thought Taxanes ( any paclitaxil --nab or not ) caused bad heart problems if given too fast ....

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PS Also a question about stage 4 ulcers.... and a rapid response question but I can ask separately

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I still am not clear what you are asking. I think you need to discuss this with your instructor. I was not there I cannot say what is right or wrong based on random information. It sounds like you have done your homework on this matter and I think you can draw your own conclusion.

In the real world some nurses may not follow proper procedure. When this occurs it needs to be addressed immediately and not on an anonymous internet board. I can't say whether this nurses was right or wrong based on your reported observations. That would be negligent of me.

What are your other questions.

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And please, please, please learn to use paragraphs. And punctuation. And English words. And avoid abbreviations you don't define. I had an incredibly hard time figuring out what you were describing/asking.

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