IV filters with Chemo???

Specialties Oncology

Published

Specializes in Pediatrics.

Okay, this is really bugging me. My friend (and coworker) had to give Etoposide the other night. And like a good little doo-bee, she looked up the med on the hospital's computerized drug reference (actually she hadn't given it in a long time, and wanted to refresh her knowledge- nothing wrong with that). And she noticed that it said that it should be administered with a .22 micron filter. It seems that in our institution, we NEVER put filters on chemo lines. Why?? Because we don't. This attitude makes me very angry :angryfire . This is one of my pet peeves, when you are told to do something, with no rationale. So when she started asking the other staff members, they all emphatically stated "Oh no!! We NEVER put a filter on any chemo". Meanwhile, the Lexicomp (which we have been told is the exact information from the manufacturer's packeage insert) says you should (at least for this drug). I have also worked in two other places that give chemo- One place does use it (I distinctly remember reading it in the protocol). At the other place, I honestly cannot remember what we did.

I'd like to hear what other people do, or if anyone knows of any documented ratioale that states why you should? And no, I can't refer to the hospital policy, as we do not have ones for specific chemo meds. Also, we prime or own lines (I know some place do not, so they hang their lines as they receive them from pharmacy) so we need to prepare them properly.

My friend and I are not cool with the response of 'this is how we've always done it'.

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My friend and I are not cool with the response of 'this is how we've always done it'.

Best advice I have for you is to call Pharmacy. Do you have clinical pharmacists there? The guys that are on the floors? If so they are a wealth of information.

When I was in college I worked as a pharmacy tech and I've taught CPhT classes as of a couple of years ago. I explain this because often times the pharmacy will filter it before it ever gets to you. If it needs a specific filter they should be sending it with the bag. Verify this.

If something happens and you have to defend your actions will you be able to defend your actions by claiming it was hospital policy even though you know what the manufacturer suggests? If you go as far as looking up this specific data and then you don't follow it, how will you explain this to the board? Or their lawyer?

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Specializes in MS Home Health.

I agree with previous posts. Call pharmacy document. Call your super document and last but not least sit on the hospital policy and procedure committee to help be an agent of change.

renerian

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Specializes in Pediatrics.
i agree with previous posts. call pharmacy document.
she actually called pharmacy- i don't remember what their response was (but i know it wasn't good enough). it may have been something like "the chemo pharmacist would know, and he/she is not here at night".
call your super document and last but not least sit on the hospital policy and procedure committee to help be an agent of change.

:chuckle :chuckle :chuckle :chuckle our nurse manager (a former staff member) will undoubetly give the same answer as the senior staff (and sadly, has a lot more 'important' things to do, so she would tell us to call the pharmacy or look it up). as for the p&p committee, it's a longshot, as they will turn to the educator (we don't have a heme/onc educator) who knows squat about this, or to the 'expert' nurses on the unit, who refuse to believe that we should (or need) to use a filter.

i'm not trying to be a smarty-pants. i wasn't really looking for advice, but more like information. i know what channels i need to take. if my institution were a little more competent, we could try to solve this problem internally. i was wondering what experiences anyone had with this situation, and knew of any documented info to support their actions.

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i also work in bone marrow transplant. we give etoposide all the time and have never used a filter with it. we do use filters when administering taxol. off-hand that's the only chemo that we administer that needs a filter used with it. now, you've got me wondering about the etoposide. i'll have to look into that one!!

our pharmacy or nursing supervisor wouldn't know the answer to that question. we're better off finding out on our own!!

she actually called pharmacy- i don't remember what their response was (but i know it wasn't good enough). it may have been something like "the chemo pharmacist would know, and he/she is not here at night". :chuckle :chuckle :chuckle :chuckle our nurse manager (a former staff member) will undoubetly give the same answer as the senior staff (and sadly, has a lot more 'important' things to do, so she would tell us to call the pharmacy or look it up). as for the p&p committee, it's a longshot, as they will turn to the educator (we don't have a heme/onc educator) who knows squat about this, or to the 'expert' nurses on the unit, who refuse to believe that we should (or need) to use a filter.

i'm not trying to be a smarty-pants. i wasn't really looking for advice, but more like information. i know what channels i need to take. if my institution were a little more competent, we could try to solve this problem internally. i was wondering what experiences anyone had with this situation, and knew of any documented info to support their actions.

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Specializes in Pediatrics.
Now, you've got me wondering about the Etoposide. I'll have to look into that one!!

Let me know what you find out!!

Our pharmacy or nursing supervisor wouldn't know the answer to that question. We're better off finding out on our own!!

I hear ya!! I'm glad it's not just me.

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Let me know what you find out!!

I hear ya!! I'm glad it's not just me.

I just looked it up quickly and you are supposed to use a filter with Etoposide.

http://www.cancercare.on.ca/pdfdrugs/Etoposi.pdf#search='etoposide%20and%20filter'

YIKES! I've been hanging it for years and NEVER used a filter. :uhoh3:

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Specializes in Pediatrics.
I just looked it up quickly and you are supposed to use a filter with Etoposide.

http://www.cancercare.on.ca/pdfdrugs/Etoposi.pdf#search='etoposide%20and%20filter'

YIKES! I've been hanging it for years and NEVER used a filter. :uhoh3:

:bow: :bow: Thank you so much!!! Still doesn't say why, but at least we have more literature.

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Hey guys!!

I am peds HemOnc RN and have given Etop alot, we never use a filter. This is really strange. I am wondering though, is the filter requirements for mixing in pharmacy or during administration. I know I have ran into questions about filtering before (with other drugs) and when pharmacy investigated... it was for mixing purposes. I wonder if the Etop was or is pre-filtered? Very interesting. Let me know what you think, or what you find out. I will be contacting our chemo pharmacist tomorrow and see what he thinks.

Thanks for the info!!

:uhoh3:

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I took a peek at our lexi-comp as well as our chemo standards and neither mentions anything about using a filter. However, a recent change in protocol on our unit has us using low-sorbing tubing (also known as cyclosporin tubing) with VP-16, but this isn't indicated in lexi-comp or the chemo standards either. The more I think about this, though, I wonder if it's not something about mixing the chemo as opposed to administering it. Just a thought.

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HI -

Back in nursing after 6 years out. I think some books are outdated. I'm not sure. I wasn't satisfied with the answers from my "newbie pharacist", he gave me to the more experienced pharmacist which I appreciated.

Re: Gangcyclovir: The phcst. told me that I did not need to administer it with a filter. He also said that it's not really a chemo drug and that only older pharmacists put the "CHEMO" sticker on it. He said to wear gloves because if it got on your skin it it as irritant. This, of course, did not match my 2003 Davis Drug Guide. I have a new Nursing Drug Guide 2005, out in the car?, somewhere? What is your experience with Gangcyclovir? In this case, it was being used on a pt. who was s/p respirator arrest, +VRE, +MRSA, +C-diff. What a mess, eh? Yes, there was a rectal tube in place already, thank heavans. I believe it was for CMV, Epstein Barr, or prevention of infection by a virus due to immunosuppression. The guy's foot started bleeding after administration, in the area of a dry gangrenous toe that vascular surgery was monitoring to see if reperfusion would occur. I did mention this to the intern thank goodness. The guy had also had an alveolar hemorhage which had given him a pneumonia, he was status/post respiratory arrest w/ intubation and then BOOP, which, I think is the newest named pneumonia 2ndary to being on a ventilator. Needless to say, the pt. had a very involved differential diagnostics going on and he was on our tele floor 2ndary to Atrial fibrillation. Arrhythmias are listed as a side effect of Gangcyclovir. Do you see this occur with use of this drug?

Please - all you hem/onc nurses out there, I'm very interested in your input and comments. What a case study, eh?

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I work in peds Onco. We use cyclosporin tubing (low sorbing) to give Etoposide.

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