No solid research exists regarding IV chemotherapy administration setups, because they can vary greatly based on the regimen, equipment availability, and patient status. Of the utmost importance is that the administration setup ensures chemotherapy is given safely and allows for prompt nursing intervention in the event of an adverse reaction or infiltration.
Depending on treatment complexity, ONS’s Chemotherapy and Biotherapy Guidelines and Recommendations for Practice state that chemotherapy agents being administered by infusion “may be connected directly to the IV catheter or to a line of compatible maintenance solution.” Therefore, critical and collaborative consideration of the components of each regimen and the clinical presentation of the patient should be part of the treatment planning process.
Primary and Secondary Infusions
Nurses play an integral role in determining whether an infusion is appropriate for primary or secondary infusion.
- For primary infusions, the agents should be administered by direct connection to the access site using primary tubing, a Luer lock connection should be used, and a compatible IV flush solution should be readily available for emergent administration issues and to clear the line after completion.
- Secondary infusions are safest administered with the use of secondary tubing attached with a Luer lock connector to the primary line containing a compatible IV solution. The flush line can be used before, during, and after the infusion to verify line patency and blood return for a flush solution if the chemotherapy must be stopped because of an adverse reaction.
Multiagent regimens add another level of complexity, and nurses must not only ensure patient safety but maintain safe handling principles and confirm agent compatibility. In some regimens, enough data support sequencing of agents, but in others, data are lacking. Two important safety features are important here.
- According to the ONS and American Society of Clinical Oncology standards, sequencing of chemotherapy agents must be included in the chemotherapy order set.
- If not clearly defined in the literature, practitioners should follow the sequence of administration published in the regimen’s original study.
Tubing features can present another challenge when considering how to best administer chemotherapy agents. Some agents require non-leaching, DEHP-free tubing; others require an inline filter, while others specifically state not to use this tubing. Table 7 in Chemotherapy and Biotherapy Guidelines and Recommendations for Practice discusses special features required for administration, but package inserts should be referred to for the most up-to-date information. The text also contains guidelines for administration via peripheral or central access and provides vesicant administration considerations.
When administering chemotherapy, nurses should always be able to say that safe handling has been considered and opportunity for exposure has been limited, but also that clinical staff have accounted for ensuring the dose is received in its entirety and they can rapidly intervene should an adverse event or complication occur.