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

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.

Tubing Requirements

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.


Posted by Tracy Nun (not verified) 1 month ago

What a wonderful reference for a nursing student interested in oncology. Thank you.

Posted by Robin (not verified) 3 weeks 4 days ago

What is the best method for ensuring the total volume of a drug has infused in small-volume therapies, i.e., Abraxane? It is administered as a secondary infusion. We currently connect the Abraxane bag to the primary line via secondary, run the Abraxane down the primary to the patient, then load the tubing into the infusion pump and begin the infusion. We can do this because Abraxane is colored and we can "see" when it's reached the patient. We set the pump to deliver 70mL (typical volume in the bag) but for some reason, not all of the Abraxane is infused when the pump alarms. We've considered the accuracy of the noted volume on the Abraxane bag, and we have new infusion pumps. Ideas?

Posted by PR (not verified) 3 weeks 2 days ago

Our chemo bags are primed with primary tubing. The 1st 22 mls is the saline. Then chemo infuses and we at 22 mls thru secondary tubing to flush rest of chemo thru tubing

Posted by Deb (not verified) 2 weeks 1 day ago

Our pharmacy mixes Abraxane in a 60mL syringe. We use equashield closed system devices for mixing and administering. So we attach the syringe as a secondary using the equashield devices and that empties nicely.

Posted by Kathleen Wiley (not verified) 4 days 3 hours ago

Hello All, and thank you for your comments. ONS doesn’t have one specific standard for how to infuse the smaller-volume infusions. As someone else has noted, a syringe is an option (however, safety standards have moved away from using syringes to infuse vinca alklaloids to avoid inadvertent intrathecal administration).
Whatever method you take, you would want to avoid allowing for hazardous drugs to free-flow down the tubing line to avoid inadvertent spillage and exposure. Some connect the medication to a primary line filled with saline to the patient and allow the first 18-22ml (whatever the volume of the infusion tubing) to infuse in order to fill the tubing with drug. Adding additional volume at the end of the infusion, or changing to a flush bag once the medication is emptied are options to ensure the patients receives the entire ordered dose. You might consider posting on the chemotherapy community discussion board to see how other nurses are handling this procedure.

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