Pump vs. Gravity

silverstarRN15 · Jan 12, 2014

Hi!

I work in a hem/oncology unit. Leukemia unit to be specific and we run all our chemotherapies through pump only. Never heard of chemo being given through a gravity drip. We give a lot of Rituxan which we need to keep titrating the rate upwards after 30 min to reach a specific level. I could never imagine giving that drug through gravity. Doxorubicin is a drug we also give a lot which needs to be run for 24 hours straight at a specific level so running through a pump would make more sense than a gravity drip. Plus all our chemo orders state to give though pump. Are the chemos being given at your workplace take short while for infusion like vincristine, idarubicin (typically 30 min infusion)? Or are these chemos 2-3 hours long or longer?

SoldierNurse22, BSN, RN · Jan 12, 2014

This sounds like a familiar question...but I'll bite anyway.

Pump only. Chemo/biotherapies are too sensitive to run by gravity.

nurmac · Jan 12, 2014

This sounds like a familiar question...but I'll bite anyway.
Pump only. Chemo/biotherapies are too sensitive to run by gravity.

I know soldiernurse but you were the only one that responded. I couldn't believe it myself that the place I worked had no pumps.

AdventureRN..."Are the chemos being given at your workplace take short while for infusion like vincristine, idarubicin (typically 30 min infusion)? Or are these chemos 2-3 hours long or longer?"

We give everything without a pump...8 hour chemos (folfox, folfiri, ac, chop, carbo, vp16, rituxan, everything gravity. Couldn't believe it myself when I started there.

nurmac · Jan 12, 2014

AdventureRN..."Are the chemos being given at your workplace take short while for infusion like vincristine, idarubicin (typically 30 min infusion)? Or are these chemos 2-3 hours long or longer?"

We give everything without a pump...8 hour chemos (folfox, folfiri, ac, chop, carbo, vp16, rituxan, everything gravity. Couldn't believe it myself when I started there.

OCRN3 · Jan 13, 2014

I actually worked in an office for awhile that gave chemo by gravity only, I was really new at it so not sure if this was the norm. I'm in Southern California.

Sent from my iPhone using allnurses.com

mluvsgnc · Jan 13, 2014

I'm not in oncology, but am curious about the rationale for gravity vs. pump... is it because of the high toxicity of the meds being given, and a pump miscalculation would be lethal? Thanks in advance.

nurmac · Jan 13, 2014

I'm not in oncology, but am curious about the rationale for gravity vs. pump... is it because of the high toxicity of the meds being given, and a pump miscalculation would be lethal? Thanks in advance.

I would think running via gravity would have way more miscalculations than using a pump. I think they are just too cheap to buy and maintain pumps

nurseprnRN, BSN, RN · Jan 13, 2014

I'd rather rely on another RN double- or triple-checking a pump setting than the chance that something running by gravity has no reliable rate control and could be run in its entirety in a heartbeat.

mluvsgnc · Jan 13, 2014

Ok, so still waiting for the rationale.....

Those who are in this situation- have you asked why?

applewhitern, BSN, RN · Jan 13, 2014

Wow. If given a choice, I would not want to receive chemotherapy at a facility that didn't use pumps!

iluvivt, BSN, RN · Jan 14, 2014

It is the setting that you are in that makes this practice allowable and understandable.. There is no current standard that states that you must use a pump to deliver chemotherapy unless you are giving a continuous chemotherapy. So if the patient is receiving 5FU over a week(s) they need to be using an ambulatory pump. If it is continuous vesicant chemotherapy...this must be give though a central line.

I think that they probably are trying to save money as the pump will cost as well as the tubing is a bit more expensive than gravity tubing. This puts the safe administration all on the nurse with little or no protections in place. I am personally fond of the protections but make no mistake either way the responsibility is all yours for the safe administration of the chemotherapy and you will have to keep close tabs on the rate and site. What I see as a more important safety feature that may save you from a medication error or even a fatal error is the use of medication libraries in smart pumps. This allows you set up libraries in clinical areas with soft and hard limits for drugs and drips so if you input a dose that is incorrect that could harm the patient it will alert you to the input error. Does the facility have access to smart pumps because you can advocate for their use with some really good arguments !

In the meantime you need to be hypervigilant with setting the rate and monitoring it and make sure you poles are set at least 3 feet above venipuncture sites and not much more unless you need that (decide this case by case) . You will get more consistent rates this way.

Ask for dial-a flow type tubing if you are not already using these.