Dear Colleagues:

As you know ISMP has long promoted that intravenous vincristine should only be given after dilution in a minibag and never by syringe. We recently called upon FDA to eliminate syringe administration in product labeling. Syringe administration remains in certain protocols around the world. In particular, syringes are used in infants and children in some locations, which continues to put patients at risk of injection into spinal fluid when mixed up with a drug intended for administration by that route. We are aware of 4 child deaths outside the US since January.

One of the challenges is availability of information that spells out how dilution is accomplished when used for kids. For those of you who work with infants and small children receiving IV vincristine by dilution, would you have a protocol or other information that you could share with us that (post or send to mcohen@ismp.org). In particular, we are interested in learning more about what dilutions are being used (amount of drug and volume)and the process used for flushing after administration (taking into account amount remaining in tubing).

Thanks!

Mike Cohen