Peds onc chemo administration question

[smiles and medicine]

This might be a silly question but I figure I’ll ask it anyways. Some chemos can cause serious transfusion reactions, for example etoposide (VP16) can cause a low bp when administering, I haven’t worked on an onc floor in a minute, my question is about the setup for administration. If you are giving VP16, and the patient has a single port, would you use a pigtail on the end of the port and have an open NS line during etop administration in case bp drops and you have to bolus/ just a line to give meds in if something goes wrong, given these meds are compatible with etop and the infusion is still going?— would you have NS maintenance still going if it was ordered or would you pause until infusion is completed? Thank you in advance 

[DavidFR, BSN, MSN, RN]

I would imagine local protocols vary. 

I have personally never had a problem with VP16 in 13 years of oncology and we give it alone.

Most of our patients have port-a-caths or single lumen central lines. The rare occasions we may have to give something at the same time we will pose a peripeheral line aswell. If you have to give something in an emergency you've usually stopped the chemo anyway so you flush and use the same line.

Some protocols have fluids running  alongside the chemo (some but not all of our protocols involving Cisplatin) and some protocols have Mannitol or Bicarb running alongside the chemo with no problem. This might most usually be with Cisplatin or Ifosamide. I've never had a problem running these products together. Sometimes we have Aracytine running over 24 hours via syringe pump and never had a compatibility issue with regular mediactions. Our phramacy tells us it's OK.

5FU is the difficult one. It runs over several days by Baxter infusor or by syringe pump, and in this case we only ever run it alone. 

[smiles and medicine]

Thank you for the insight & thorough answer, you’re right, if rescue meds are being given, the chemo is stopped & that line can be used, I think I’m just overthinking things, will definitely be reviewing all the protocols when I start. Thanks again! Yea