Pump vs Gravity for vesicants

All chemo, vesicant or otherwise, passes by pump where I work.

Our protocole is to check the reflux and permeability with a saline flush immediately before all chemo in both peripheral and central access.  And we pass all chemo by pump.

If you get an extravasation your pump will hopefully alarm pretty quickly. If your vesicant is running by gravity you may have a larger volume that's infiltrated before you or the patient notices. Then there's the issue of timing and products not running in too fast. 

I've seen an extravasation with Cisplatin, and it's not nice! I've also seen a faulty port-a-cath leak Ifosamide all over a patient, and while Ifo isn't a vesicant and the patient was OK, it still panicked the hell out of the poor lady.

My current setting, we run everything by gravity, hence why I have refused to run the chemo myself. The one infusion nurse may leave and I may get pressurized to help out. I spoke with head of operations for the company that serves as the umbrella for some practices in the area including ours, she was nonchalant about it. She told me their Maryland offices run it by gravity too. I was surprised about this as it doesn't seem like standard of practice. My prior office ran fluids and vesicants by pump.