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Discussion

Protocol for checking continous infusion chemo-- what do you do?

Quick question--

If you have someone on a continuous infusion of chemo-- for example, a Baxter Intermate ("baby bottle") pump infusing 5-FU over 40+ hours-- what is the policy at your hospitals for checking blood return through the line that it's infusing? (In the situation I ran into, the pump was running through one lumen of a PICC.) Normally, where chemo is running through a PICC, there's a leuer lock area where I can hook up a syringe to check for blood return without disconnecting the chemo at all. I could NOT do this with the "baby bottle" chemo, as I didn't see place to leuer lock a syringe into the line.

I asked at work about how to care for this device (and the patient!), and was told that yes, of course, we need to check for blood return every shift-- so I was told to disconnect the "baby bottle" pump and check for blood return. The reason I'm asking is because the pump was set to deliver a continuous infusion of 5-FU at 5 ml/hr. I wasn't sure if disconnecting the pump would cause the 5-FU to spill out at all (but it's going at such a slow rate, so I wasn't sure if that was why I was allowed to do it.) Being a new nurse, and working at nights, I also didn't want to "mess up" the tubing in any way, since resources at nights are limited....

For those unfamiliar with the Baxter Intermate pumps (as I was)-- they look like baby bottles with balloons inside-- the balloons are filled with chemo which slowly infuses into the patient. They are not hooked up the IV pumps-- there is a line running from the "baby bottle" directly into the patient's venous access.

I checked on the Baxter site, and did a few general searches on the web, but just wanted to know if any of you had run into this, or knew of protocols that I could read up on just to educate myself a little more. For example, it may be that when the "baby bottle" is unhooked from a patient, the pressure changes cause the chemo to stop running until it's hooked back up-- I have no idea-- I've only seen one of these, and my nurse manager wasn't too familiar with these either....

Thanks in advance for any info or advice!

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We use elastometric infusers which sound similar to what you are describing - they do not look like baby bottles, but are continuous infsion "balls" which are gravity-fed (either 2ml/hr or 5ml/hr) continuous infusion devices which we send pts home with from out outpt chemotherapy unit. We check for blood return prior to starting the infusion, and when they return for disconnect. But because they go home with the infusion running, there is no check (nor need there be) while the infusion is running.

The chemo stops running when the line is clamped, and starts up again when the clamps are open. It is fine to check for blood return during the infusion by clamping the tubing, disconnecting the "bottle", checking for blood return, reconnecting, and re-opening the clamps. On the other hand, it is obviosuly fine not to disrupt this system, since we send people home with these devices all the time and there are no checks for blood return until they return for disconnect (of course in a hospital, protocols are all together different).

Lastly, your pharmacist who makes up the pumps can always help you out when no one seems to know how they work. Or, you can hook up with the outpt chemotherapy unit connected with the hospital, where these devices are really common.

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