Mini-IV Drip Bag Delivery of Vincristine Avoids Risk of Deadly Errors

Delivering vincristine via mini-IV drip bags instead of pushing it with a syringe might avoid injection into spinal fluid, which is uniformly fatal.

Simply diluting and delivering vinca alkaloids like vincristine via mini-IV drip bags instead of pushing these chemotherapy agents with a syringe might avoid accidental injection into spinal fluid, researchers reported in a poster session at the Oncology Nursing Society (ONS) 42nd Annual Congress, held May 4–7 in Denver.

“This was a big change in practice for bedside nurses at Johns Hopkins Hospital who had, to this point, always administered vesicants-other than continuous infused vesicants-as an intravenous push through the side port of a free-flowing line,” reported MiKaela Olsen, MS, APRN-CNS, AOCNS, of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, in a statement.

The researchers found that delivering these agents via mini-IV drip is safe in an analysis of patient data that spanned 12 months of clinical experience at Johns Hopkins Hospital. The team found that after more than 1,300 mini-bag vincristine administrations, no cases of extravasation occurred.

The change to a mini-IV drip bag was first adopted for pediatric oncology and involved careful planning by nursing and pharmacy staff, Olsen noted.

Nurses were trained using a video tutorial on the safe mini-bag administration of vincristine to avoid extravasation, before using the new procedure with patients. The video teaches nurses to remain by the patient’s side during the 5-minute vincristine administration procedure, checking blood returns. “This approach was key to our success,” Olsen emphasized.

Not all nurses understood that accidentally administering vincristine to spinal fluid is uniformly fatal for patients, the researchers found. Vincristine should be labeled with a warning reading “For intravenous use only-fatal if given other routes.”

Last year, the National Comprehensive Cancer Network (NCCN) initiated a “Just Bag It!” campaign to promote new guidelines urging the safe dilution and drip administration of vincristine in order to avoid the risk of preventable, fatal clinical errors associated with syringe delivery. It is impossible to accidentally deliver vincristine into spinal fluid if it is delivered by mini-IV drip. Drip delivery also reduces the risk of dosing error, Olsen and her colleagues noted.

NCCN Chief Executive Officer Robert W. Carlson, MD, said that the researchers’ findings were welcome news that he hoped would encourage others to change from syringe to mini-IV drip delivery of vincristine.

“Our staff feel confident that this new procedure is safe and that it is absolutely the right thing to do to prevent patient harm,” Olsen said. “Once we made the change, we did not look back.”