Does anyone have specific protocols for the administration of vesicant chemotherapy. I am keen that all breast patients receive vesicants cytotoxics via central lines where possible,to reduce the risk of extravasation, but I'm receiving some resistance from consultants.

By affles on Tuesday, January 27, 2004 - 05:41 pm:

Dear Elaine,
Due to the increased use of Epirubicin in Breast patients we are meeting with the same problems.We are observing increased incidence of phlebitis.
We have recently introduced a new patient clinic where the patients are assessed before commencing treatment, during and after, with a view to producing the evidence for the use of Picc and Tunnelled central lines.

By M aria Boland on Thursday, September 08, 2005 - 04:37 am:

Could I please have some response in relation to how vincristine is administered in your clinical practice. I am currently involved in a steering committee in relation to a national alert and recommendations of how to administer vincristine. There are several members of the steering committee that are involved only in the reconstitution of vesicants, they are NOT INVOLVED in the administration of vincristine in the clinical area. This national alert has been requested by a government organisation resulting in recommendations for administration of this vesicant. One of the very strong recommendations from this group is that vincristine is prepared in a low volume infusion bag to be administered as a slow infusion. I have great difficulties with this recommendation due to the impact on our clinical practices. Currently we are administering our vincristine via a push dose reconstituted in a 30ml syringe, so it is a slow push dose enabling the clinician administering the drug to participate in safe recommended best practices by the governing bodies. It is proposed by this group the vincristine will be reconstituted in a low volume infusion bag enabling the clinicians administering this vesicant to sit by the patient for the duration of the administration and partake in recommended safe/best practice. I work in a very busy unit and foresee considerable issues in relation to this actually happening. I personally have observed the low dose infusions of vincristine in a minibag been delivered by a peripheral vein via a pump. This is the type of practice that this situation creates. Another practice I have witnessed is other vesicants of vincristine and doxorubicin in a low volume infusion bag been delivered via a peripheral vein via a pump!!! Could I have some comment on your thoughts in relation to the impact/responsibility of the individual clinician in the clinical area. We are the bunnies that will be left with the issue impacting on our clinical safe practice. Obviously this has come about due to the inadvertant administration of vincristine intrathecally. The end result of this is catastrophic resulting in death. I am aware practices have to change but in changing them I have great difficulty in watching other safe practice been eroded.Maria Boland.