Line set-up for Chemo

[bonodonnaonaroll]

I am trying to change the way we set up chemo at our hospital. I prefer to have a 250cc bag of NS to straight, non-pump tubing. Luer lock the chemo into most distal connection. Chemo is connected to pump tubing and run through the pump as primary.

Using this method if there is an emergent need can stop chemo and give NS. Will deliver a maximum 0.5cc of drug using this method.

Currently NS is the primary on pump tubing and chemo is run as secondary. Pump tubing connected directly to pt. If emerg arises will give the entire line of chemo (approx 20cc) before NS hits pt.

What I am trying without sucess to find is documentation to support the change. ONS doesn't seem to have a reccomendation that I can find. Any ideas?

Thanks for all of your help in advance.

Julie

[barbshortt]

Julie,

In our setting, we mostly use a primary/secondary set-up for most chemo tx, with the secondary set-up being the chemo. However, for those infusions that often cause reactions (taxol, rituxan, erbitux, herceptin), I run it in on a second primary line, luer-locked into the distal connection(as you describle) so that in the case of a reaction, the tubing isn't full of drug.

There is no policy where I work that determines this - just seems like common sense to me. I am the only one who does it this way, in fact.

I don't think you will be able to find documentation for this, but if you happen, to, I'd love to have a copy. Please PM me with any info you find

Thanks, Barb

[LaurynRN]

I also don't have an answer for you as far as evidenced based practice goes. At my hospital everyone seems to do it differently. I hang chemo as primary with NSS on stand by (hanging but not connected). When we have ill effects whether it be a reaction or something like an infiltrate we don't flush with NSS...we withdrawl from the catheter.

Good luck on your search and if you do find anything please let us know.

[animalfriend]

I also don't have an answer for you as far as evidenced based practice goes. At my hospital everyone seems to do it differently. I hang chemo as primary with NSS on stand by (hanging but not connected). When we have ill effects whether it be a reaction or something like an infiltrate we don't flush with NSS...we withdrawl from the catheter.

Good luck on your search and if you do find anything please let us know.

At my hospital we attach a 20ml syringe to the port for the secondary line to flush chemo through when complete but we do not have any set routine for setting up Nss for any reaction or problems. NSS is a good idea though. I would prefer to have it instead of the syringe.

[lish_99]

At the clinic where I work, we use NS/D5 as the primary. The chemo is hung as a secondary, except the ones the pharmacy sends up on its own primary tubing (taxol) then like barb said the ns is still the "main" primary but the taxol is luer locked to the most distal site... If the pt had a rxn the whole tubing wouldn't be taxol. I don't know if it is hosp. protocol or if that's just how they do it but I will find out.

[julieK]

We hang chemo the way you're describing: A bag of NS as the mainline and connecting the chemo through the pump at the most proximal port to the patient. We clamp off the NS right at the port, so in the even of a reaction, it's maybe a few inches of chemo going into the patient before the NS hits.

-Julie in NYC

[heamoRN]

on our ward we use a y-set blood line, on one end have normal saline/5%dex, on the other one the chemo.

prime the line with NS/5%dex then clamp run chemo. when chemo finsh clamp chemo side and flush the set with the flash bag.