HSR in Outpatient Chemo Infusion Qs

[mackyclaire]

Hi all, I am an experienced nurse, but new to chemo infusion and I have two practice questions for those with ore experience.

 1.When a patient is having a true hypersensitivity reaction, obviously I stop the chemo immediately, but when I clamp that off and open the line with NS, it’s still pushing some of the chemo in first. Do any of you keep a separate primed NS bag as a backup and if they react just disconnect the chemo set and attach the pure NS line instead? I’ve gotten so many different answers from co-workers and observed varying practices so I am curious as to what you all do.

2. Prior to giving a chemo prone to HSR, many of the nurses who have precepted me will make the rate 999 for 20-40cc to get it closer to the patient before starting. I do this with blood but it makes me nervous bc I can't really tell where the chemo starts (even though it's obviously around 20-40cc for the remainder of the line). Is this common practice?

 TIA!

[DavidFR, BSN, MSN, RN]

1) Always have a proximal 3 way tap so that if you need to you can aspirate 20cc and flush immediately with a bolus of saline. You will have aspirated what little bit of chemo you had in the line proximallly to the end of your port-a-cath or catheter or whatever.

2) Never done this and share your worries about it. Pose your chemo, set your rate. It will get there.

Some of our chemo régimes have pre-meds of solumedrol or dexamethasone, or some products always have concomitant products infused to avoid side effects (for example Ifosamide (Holoxan) is never given on its own, always with Mesna (Uromexitan) to protect the bladder.

[RachRn]

1. We disconnect the line that contains the drug the patient is reacting to, and connect NS with a new primary. 
 

2. Some nurses do use a rate of 999 ml/hr to get the med to the patient. There are certain instances where this makes sense. For instance a blood product that is monitored for the first 15 minutes at a slower rate and then increased. Or for other titrated drugs. You’re supposed to titrate them up after infusing the blood or drug for a specified amount of time. Some of these initial rates are so slow that unless you get the product to the patient first, the only thing you’re doing is observing your patient while nothing but saline is infusing. That being said, I NEVER bolus more than 12ml to get it to the patient. Our packaging on our tubing says they hold 18 ml, but when I do this with blood my eyes can clearly see the blood getting close approaching my patient at 12 ml. I err on the side of caution when doing this. For drugs with a flat rate, I really don’t see any reason to do this. 

[mackyclaire]

Thanks! 

1. So do you have them just ready in the room primed and then waste it if not needed or just unprimed and quickly prime if they react? 

2. This makes sense. Thanks!!

DavidFR - Thanks as well!