I am trying to convince my oncology RNs and RPhs that we do not need to pump exact diluent volumes into an empty bag for most chemotherapy. Our practice has been to pump exact volumes for chemo that is infused over several hours, all peds chemo, and IVPBs with large med volumes. Their rationale was that the unknown amount of overfill in the bag could cause the infusion to last an extra hour or 2, which turns into many hours for a 5 day chemo regimen. I consulted Dennis Tribble's blog post on ASHP titled "The Illusion of Accuracy". He points out the accuracy limitations of syringes (+/-5%), commercial medication vials (+/- 10%), and IVPBs (+3 to 15%). Our Alaris infusion pumps have a rate accuracy of -/+ 5%. So, even if we dispensed an IVPB that contained EXACTLY 500 mL, the inaccuracy of the pump could cause the bag to finish 1 hour early or 1 hour late on a 24 hr infusion. We are striving for a level of perfection that is not possible, and it costs more money ($10 for an empty bag), opportunity for infection and error from the additional manipulations, and time.

1. Does anyone else pump exact volumes for medications? If so, which ones?
2. If you don't pump exact volumes, do you have something in policy that allows RNs to adjust infusion rates by +/- 10% so the infusion ends on time?
3. Any other wise words I can use to convince my staff this is the wrong approach?

I am considering allowing exact volumes in these 2 scenarios: pediatric chemo (I don't think it is necessary, but I'm willing to compromise) and IVPB chemo where the drug volume is > 20% of the diluent amount (70 mL of carboplatin in a 250mL diluent bag).

thanks!