Congress Abstracts 2006

23

CHEMOTHERAPY SPIKING/TUBING PREPARATION PROCEDURES: WHAT'S SAFE/WHAT'S NOT. Rosanne Arlington, RN, MSN, CNS, OCN^®, ONC, Susan Spivey, Lucy Moyer, BS, RPh, and Mildred Toth, RN, MS, OCN^®, AOCN^®, CLNC, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Significance and Background: Concern for nurses' and other healthcare professionals' safety, and the need to administer some chemotherapeutic agents based on pharmacokinetics led to review of processes used to prime IV tubing to assure safe, effective, and economically efficient techniques.

Purposes of this project included to determine if the conventional spiking and priming technique potentially allow drugs escape into the environment; evaluate if a closed system, PhaSeal, prevented release of hazardous drugs into the environment; and determine the safest method of priming tubing when dosing is based on pharmacokinetics.

A 0.05% solution of Fluorescein was prepared in 250 ml bag of normal saline. UV light was used to visualize fluorescein leaks and spills.

Five oncology nurses each primed IV tubings with normal saline and then spiked 10 bags having a PhaSeal port and 10 bags without the PhaSeal port (a total of 50 bags with PhaSeal port and 50 bags without PhaSeal port were spiked.)

To determine the safest method to prime tubing for pharmacokinetic administration, a nurse and pharmacist primed 50 IV tubings to within ¼ inch of the end of the tubing. Twenty-five tubings were capped with hydrophobic filters and 25 with standard IV caps. Then filters/caps were removed, and tubings were attached to our usual IV port and inspected.

Swipe tests of the chemo preparation and administration areas were completed on multiple units.

Following standard spiking of 50 bags with a PhaSeal port and 50 bags without a PhaSeal port with tubing primed with normal saline, no external contamination with fluorescein was identified.

Following priming of tubing for pharmacokinetic administration, the tubings primed using a hydrophobic filter, had fluid into the very end and contaminated gloves/prep pad/IV ports. Tubings primed using a cap did not contaminate the environment.

We are awaiting results from swipe tests of our current environment.

Information gained from this project, can help oncology nurses maintain a safe, effective, efficient environment for chemotherapy administration (including pharmacokinetic administration), provide information to industry to improve safeguards, and serve as a stimulus for nursing research.