How do you administer your chemo?

Pediatric Critical Care Columnist · Feb 7, 2018

Our children's hospital eliminated all burettes a little more than a year ago. Depending on the volume, our cytotoxic drugs come from pharmacy in either a syringe with special tamper-proof connectors or in exact-a-mix bags, also with special tamper-proof connectors. Protocols for peds can be quite different from adults, some doses are much higher, some doses are much lower and treatment usually goes far longer for kids. Many of the ALL protocols are 3 to 3 1/2 years long. My son, who had Langerhans cell histiocytosis, was treated with vinblastine and etoposide for nearly 4 years before his liver transplant and subsequent lasting remission.

sergel02, BSN · Feb 8, 2018

Our children's hospital eliminated all burettes a little more than a year ago. Depending on the volume, our cytotoxic drugs come from pharmacy in either a syringe with special tamper-proof connectors or in exact-a-mix bags, also with special tamper-proof connectors. Protocols for peds can be quite different from adults, some doses are much higher, some doses are much lower and treatment usually goes far longer for kids. Many of the ALL protocols are 3 to 3 1/2 years long. My son, who had Langerhans cell histiocytosis, was treated with vinblastine and etoposide for nearly 4 years before his liver transplant and subsequent lasting remission.

Thanks!

Aren't a lot of the ALL protocols for adults at least 2 years as well?

We are using the volutrols hospital wide but I feel like it's not super safe for the chemo. They only hold a finite amount and every couple hours, depending on the rate, you are refilling it. For 24 hour chemo It's a lot of messing with the lines and bags. Do kids have 24 hour chemo as well?

Pediatric Critical Care Columnist · Feb 8, 2018

Do kids have 24-hour infusions of cytotoxics? Yes, they do. Not all the cytotoxic infusions we run are "chemo" in the cancer-treatment category though. We run things like ATGAM, cyclosporine, mycophenolate mofetil, tacrolimus, ganciclovir and valganciclovir for our transplant patients and they're handled the same as cyclophosphamide would be. The two antivirals are intermittent, the others are continuous infusions.

Most of the adults I've known who were treated for cancer had chemo courses of about 6 months.

KelRN215, BSN, RN · Feb 11, 2018

Thanks!
Aren't a lot of the ALL protocols for adults at least 2 years as well?
We are using the volutrols hospital wide but I feel like it's not super safe for the chemo. They only hold a finite amount and every couple hours, depending on the rate, you are refilling it. For 24 hour chemo It's a lot of messing with the lines and bags. Do kids have 24 hour chemo as well?

When I worked in the hospital, we had kids who would get 24 hr infusions of doxorubicin. Kids with ALL also get 24 hr infusions of high dose methotrexate during consolidation 1 chemotherapy. It comes from the pharmacy in a 24 hr bag, spiked and primed with PhaSeal attached.

MyAimIsTrue, BSN · Mar 16, 2018

My son, who had Langerhans cell histiocytosis,

Oh my gosh, my daughter had this! I see you are in CA; so are we. How long ago was your son diagnosed? They don't use etoposide any more, or at least very rarely. My daughter was diagnosed in 2005 and on chemo for almost 4 years. She's 13 now and doing very well!

I am a nursing student and just put in my request for a peds onc preceptorship. :-)

Edited to add that maybe your CA means Canada...mine means California.

Pediatric Critical Care Columnist · Mar 17, 2018

Oh my gosh, my daughter had this! I see you are in CA; so are we. How long ago was your son diagnosed? They don't use etoposide any more, or at least very rarely. My daughter was diagnosed in 2005 and on chemo for almost 4 years. She's 13 now and doing very well!
I am a nursing student and just put in my request for a peds onc preceptorship. :-)
Edited to add that maybe your CA means Canada...mine means California.

Yes, my CA means Canada, not California.

My son was diagnosed with disseminated LCH (known as Letterer-Siwe disease in those days) in 1985 at the age of 26 months. The prognosis we were given at diagnosis was 5% chance of survival at 1 year. His chemo treatments ran 3 1/2 years. Etoposide didn't produce a remission for him; what did it was the liver transplant and the immunosuppression that was necessary after it. Of course, he's still taking one of those drugs all these (29) years later, and his last relapse was in 1992. Just as I was about to start nursing school... Luckily that relapse was localized to his oral cavity and was successfully treated with radiation.

My senior practicum was on a peds medicine floor where the hem-onc patients were admitted.

MyAimIsTrue, BSN · Mar 17, 2018

Such a coincidence to find another LCH mom here. I'm glad your son beat those odds of "5%." That must have been terrifying. When my daughter was diagnosed the internet told me her disease was "rapidly fatal in infants." I'll never forget that.

Pediatric Critical Care Columnist · Mar 17, 2018

I remember that day like it was yesterday. Actually, I have quite a few freeze-frame moments that are crystal-clear in my memory. There's still so much we don't know about the different histiocytoses and how best to treat them. Over the years I've seen several children with hemophagocytic lymphohistiocytosis and in so many cases, it's still a death sentence. Nailing down the diagnosis is so difficult and often by the time it's confirmed, it's too late.

DiscGolfNurse, BSN · Feb 23, 2019

We give ours via baxter sigma IV pumps. We prime a primary line with NS and labeled chemotherapy and then the chemo comes up from pharmacy spiked and primed with NS. We connect it as a secondary above the IV pump and then program the pump as a primary for the chemo and run the chemo out of the secondary line completely. Then when it meets the Y and has all emptied into the primary line we flush the rest of the chemo out of the primary line. Some chemos we administer via syringe pump and same rules apply with flushing the remaining chemo.