The National Comprehensive Cancer Network’s (NCCNs’) Best Practice Committee has recently issued guidelines that advise healthcare providers to dilute vinca alkaloids in a mini-IV drip bag, rather than preparing and providing the agent in a syringe. Similarly, the forthcoming American Society of Clinical Oncology/ONS Chemotherapy Administration Safety Standards have recently been updated and include this provision as well. To create a safer practice, providers preparing vinca alkaloids for administration should always bag the agent to avoid a potentially fatal accidental intrathecal injection.

This guideline led the NCCN to announced a new campaign to ensure the safe delivery and administration of vincristine to patients with cancer. The NCCN’s Just Bag It campaign encourages the use of drip bags instead of syringes for the preparation and delivery of vinca alkaloids, aiming to eliminate the chance that this powerful chemotherapy would be mistakenly administered intrathecally. 

Vesicant Administration

Refer to the ONS Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (4th ed.) “Special considerations for vesicant administration” on pg. 128 for additional information on infusing vincristine via central or peripheral IVs.

Vincristine—mainly used to treat patients with leukemia and lymphoma—is always delivered by IV and prevents the spread of cancer by disabling the cell’s ability to divide. However, the agent is fatal if accidently introduced to the spinal fluid through intrathecal injection. Because many patients with leukemia and lymphoma receive treatment via both IV and intrathecal routes, the possibility for accidental administration is very high. By preparing the agents in a drip bag, the possibility that it would be administered through an intrathecal push is reduced immensely. 

According to the NCCN’s vincristine fact sheet, “This precaution renders it impossible to accidentally administer the medication into the spinal fluid and greatly decreases the chances of improper dosage.” Along with ONS’s support, the NCCN’s Just Bag It campaign has also received endorsements from the Institute for Safe Medication Practices, the Joint Commission, and the World Health Organization. 

In addition to national and international medical organizational support, all 27 NCCN member institutions throughout the United States have implemented policies to reduce the risk of accidental administration through new bagging procedures. The NCCN is encouraging all providers to add their institution’s name to the list of growing cancer centers and hospitals from around the country. Visit the NCCN’s Just Bag It website for more information.