We are re-evaluating our chemotherapy and non-chemotherapy extravasation policies to look for optimizations in the process and antidote management.

Would any institutions be willing to share their policies here?

Thank you in advance!

In our infusion area we have heard complaints from patients about IV push diphenhydramine and/or dexamethasone being pushed too fast. After evaluation, the nurses are appropriately pushing over appropriate durations per the literature, but this often still feels too fast to the patient. Patients report drowsiness, lightheadedness, and restless leg when drugs are being administered. Some patients receive diphenhydramine as an IV piggyback which seems to help, but this is the exception not the rule.

Are you aware of a single-dose, or a one-day regimen for dexrazoxane used for the treatment of anthracycline extravasation? If so, could you please share your regimen/reference?

FDA-approved dosing is for a three-day regimen (1000 mg/m2 on days 1 and 2 infused over 1-2 hours, and 500 mg/m2 on day 3).

Thank you.

If administering vinca alkaloids as an IVPB, does pharmacy dispense with primary or secondary tubing?

On a related note, if using secondary tubing, what is the nursing procedure in case of an infusion reaction?

Thank you,
Daniel

If administering vinca alkaloids via IV bag, is your practice to administer the medication via gravity infusion without a pump, or do you use an infusion pump and program as rapid infusion (e.g. 10 mins)?

Have you had any issues or seen disadvantages with administering as a gravity infusion without pumps?

Thank you,
Daniel

We are in the process of implementing interoperability between smart pumps and EMR. During this process we have identified that our EMR is setup to have a dual verification for chemotherapy rate changes. This is not something that was forced before but when completing the pump rate verify it ask for each rate change to be dual verified.

The standards from ONS suggest a dual verification for initial pump programming but do not go into detail regarding rate changes. APON suggest a dual verification for initial pump programming and rate changes of chemotherapy.