Opinion poll about IV practices in chemotherapy

queenjean · Feb 14, 2008

If you mean "chemotherapy" in general terms of medications used to treat disease, and not agents specific to cancer treatment, I'll respond.

We never hang by gravity. The exception to this would be if there were a shortage of pumps. Our official hospital protocol is that everything is run through a pump. Unofficially, though, I have hung bags by gravity when it is something I feel comfortable doing (as in, an antibiotic, not a cardiac drip) and there weren't any pumps readily available.

I have no idea how many pumps our hospital has. Our floor is a 40 bed medical floor with an average census of 28; on our floor we have 20 pumps at any given time, but we share throughout the hospital.

We use Baxter pumps. Why? Because that is what the hospital has purchased. I have never used any other pumps, so I can't really give an informed critique of them.

How many different sets? We have primary lines ( they are longer and are used for the primary solution, such as normal saline and have several ports in them for giving IV push meds), piggyback lines for intermittent infusions (these are much shorter and hook into a port high up on the primary line, before the tubing is hooked into the pump), blood sets, nitrotubing, vented tubing for meds that come in glass, and microtubing for PCA meds. I just realized I have no clue what brand our PCA pumps are, though. Since we are a general medical floor, these are really all the types of tubing we are going to be using. An ICU would probably have more, I suppose.

I'm from the US. Hope that helps.

albilore · Feb 14, 2008

Thank you very much queenjean ! Anyway, I indeed forgot to tell that I cared more about chemotherapy in cancer treatments. But your answer is going to be useful for my study and I will use it as a good beginning.

Does everyone know a British forum, similar to this one?

See you later, and thank you again!

Keep answering please... :bow:

A.L

caroladybelle, BSN, RN · Feb 14, 2008

I will make my contibution.

As a travel Oncology nurse, I have given chemo for about the last 12 years, on hemotology, oncology and bone marrow transplant units, in 7 states and one district of the USA. I have worked in community hospitals and major teaching facilities. I have given chemo in small community hospitals, in office and in facilities including the National Institutes of Health, and Johns Hopkins.

In most teaching hospitals, chemo is almost always on a pump unless it is IV push. In community hospitals, it is still usually on a pump. While in office, chemo may be hung by gravity unless the chemo is one with a high rate of dangerous reactions, then it frequently place on a pump.

Chemo meds with critical timing factors (advanced meds for leukemia/BMT) should always be on a pump, especially the Induction regimens (7 days of 24 hour around the clock infusions with some pushes involved.

I have no clue as to the number of pumps in most hospitals.....on most units that I work, there are usually at least 1-2 per patient. In offices, the number is limited.

Pump brands vary, and there may be several different types in one hospital. At JHUH, I was on a speciality leukemia floor, and we used a highly technical Omniflow pump, plus some Alaris pumps. in other places, Bard, Gemini, and Plum cares, plus others. Quite frankly, once I figure how to use it, I really don't take note of the Brand.

The Omniflow was a critical care pump....as the unit was a critical care unit, capable of timing several meds, programming several separate flushes, and simultaneously running several compatible drips that are compatible. They are not used on "standard" oncology units and required some getting used to.

Most USA pumps come preset as far as pressure permitted in the line before it alarms for obstruction. Since some forms of chemo can do serious damage if the IV line comes loose or infiltrates, we may set ours to alarm at the least obstruction if we are running those drugs. However, the majority of US patients getting lots of chemo or harsher drugs usually have a port/PICC/central IV access, and may actually need higher pressure.

The pumps are often no different than those on other compatible unit. If there is a difference, it is in regard to level of care. If the oncology nurse is giving a more "critical" drug, one with higher rates of detrimental effects, those units usually use pumps similar to those in the ICU units. Less critical drugs on a M/S onco floor will be handled by a simpler pump.

You will find that BMT, high dose biologic patients and those with "liquid tumors" (leukemias, lymphomas, myelomas) are generally more "critical" during chemo, than "solid" tumors.

Tubings though are often different. Chemos may need to be filtered specially, or may need tubing resistant to certain chemicals....Taxol requires special tubing, though uses the regular pump. Some chemos have to be in glass bottles not bags. These issues might factor in pump pressures, as the tubing has to specially vented.

albilore · Feb 15, 2008

Did I close the opinion poll?? Oups...

Could you still answer please??

Thank you, have a good week end!

A.L