Removing Chemotherapy Bags From IV Spikes Is Unsafe

BOSTON—In a Quality Indicator (QI) project, oncology nurses at M.D. Anderson Cancer Center showed that changing intravenous (IV) bags of hazardous drugs (such as chemotherapy agents) is an unsafe procedure with nearly universal contamination of the nurses' gloves, gowns, and drapes. Further, the nurses found that hydrophobic IV tube caps meant to reduce accidental drug exposure actually increase it. Rosanne Arlington, RN, MSN, CNS, OCN, ONC, and her colleagues reported the findings at the Oncology Nursing Society 31st Annual Congress last year (abstract 23).

The studies, which used a fluorescent dye to track leakage, also showed little risk of environmental contamination with either conventional spiking and priming techniques or the PhaSeal closed system (Carmel Pharma, G??teborg, Sweden), although the PhaSeal system may provide some protection against accidentally spiking through a bag.

UV Light Shows Contamination

Five experienced oncology nurses participated in the QI project; each nurse primed IV tubings with normal saline, then spiked 20 conventional 250 mL IV bags containing normal saline and a fluorescein dye (10 with PhaSeal ports and 10 without). Tubing, IV bags, gloves, gowns, and drapes were inspected with UV light before and after spiking, as well as during the spiking, priming, and initial opening of the roller clamps, to simulate chemotherapy administration, Ms. Arlington said.

No contamination was observed with either approach during priming and spiking, but changing bags was another story. "With each removal of an IV bag from the IV tubing device, there was splattering and environmental contamination," Ms. Arlington said. "Our findings indicate that removal of an IV bag containing hazardous drug from an IV spike is inherently unsafe and should be avoided." All such bags should be removed with the tubing intact.

She noted that this has posed a dilemma at M.D. Anderson Cancer Center for some study protocols calling for intra-arterial chemotherapy. The solution, Dr. Arlington said, has been custom-made IV tubing sets.

Hydrophobic Filters a Problem

The team also looked at the safety of methods used to prime tubing when chemotherapy dosing is based on pharmacokinetics. A nurse and a pharmacist primed 50 IV tubings with fluorescein solution to within ° to Ω inch of the end of the tubing, then capped 25 of the tubings with hydrophobic filters and 25 with standard IV caps. In 22 of the 25 tubings with hydrophobic caps, solution was drawn to the end of the tubing when the caps were removed to attach tubing to IV ports. The solution then hung as a droplet from the tubing tip and smeared onto gloves, drapes, and connection ports. Only 3 tubings closed with conventional IV caps had similar contamination.