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Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

  • 1.  Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 08-21-2018 15:22
      |   view attached
    Howdy,
         This is a really great game-changer, evidence-based practice clinical research study showing a novel way to reduce hypersensitivity reactions with First-dose rituximab. It was done meticulously as a great team effort at Sloan Kettering Cancer Center to include Dr. Margaret Barton-Burke, RN, PhD, FAAN as Sloan Kettering's Director of Nursing Research. She is also a former Nat'l ONS President.
          Here below are some snippets from the study, but I'd encourage you to really read the whole great article in the current issue of Clinical Journal of Oncology Nursing (CJON). There are 0.5 ILNA points also available.
        

    1. Background: Strategies to reduce hypersensitivity reaction (HSR) incidence with rituximab include premedications and slow titration. Literature is lacking on the priming method used when preparing rituximab IV lines and the potential impact on HSR incidence.

    2. Objectives: The primary objective is to evaluate HSR incidence in titrated first-dose rituximab infusions when priming IV lines with rituximab, as compared to priming with diluent.

    3. Methods: A retrospective, comparative, descriptive study with two arms (rituximab- versus diluent-primed) was conducted. Variables were HSR incidence in relation to priming method, age, sex, diagnosis, and premedications. For patients with HSR, severity, time to onset, and infusion rate were examined.

    4. Findings: HSR incidence was significantly higher in the diluent- versus the drug-primed arm. Other significant findings included higher HSR incidence in women and lower HSR incidence in patients premedicated with dexamethasone.
         WEBLINK:
    https://cjon.ons.org/cjon/22/4/hypersensitivity-reactions-priming-practice-change-reduce-incidence-first-dose-rituximab



    ------------------------------
    Donna Clark, BSN, RN, OCN
    Oncology Clinic Nurse
    USA Mitchell Cancer Institute Kilborn Clinic
    Fairhope, Alabama
    850-261-9236
    ------------------------------


  • 2.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 08-22-2018 08:53
    Hi Donna,
    This is great information.  Thank you for sharing.
    Tina

    ------------------------------
    Christina Klein MSN, RN, OCN, CRNI
    Oncology Educator
    Cancer Treatment Centers of America
    Philadelphia PA
    215-537-5586
    ------------------------------



  • 3.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 08-24-2018 12:11
    ​for those of you already practicing this, is the tubing being primed while mixing or is the nurse priming the tubing prior to infusion?

    ------------------------------
    Jennifer Anderson
    RN, BSN, OCN
    Clinical Lead
    Seby B. Jones Cancer Center
    Boone, North Carolina
    828-262-4332
    janderson@apprhs.org
    ------------------------------



  • 4.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 08-28-2018 08:25
    At my institution, the tubing is primed while mixing by the pharmacist. But this is something I could discuss with my pharmacist. Thanks

    ------------------------------
    Michelle Watson BSN-RN
    Asst. Nurse Manager
    Washington Adventist Hospital
    Takoma Park MD
    ------------------------------



  • 5.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 08-29-2018 09:36
    I would like to know also if this is done in pharmacy under the hood. My resolve from the IV pharmacist was that they had concerns based on safety of the staff making the chemo because of the amount that would be spilled on the bottom of the hood. They suggested the nurse administering draw 10 to 20 mls of solution out of the bottom port of the tubing and push that into the patient to clear the line of NS. What are other places doing for this priming issue?

    Sent from my iPhone




  • 6.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 08-22-2018 09:35
    ​We started priming the tubing with drug a couple of years ago so that we could be consistent and ensure that the titration was accurate.

    ------------------------------
    B. Marie Mackey RN OCN®
    UF Health Cancer Center at Orlando Health
    Orlando FL
    ------------------------------



  • 7.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 08-22-2018 10:32

    It is important to prime not only Rituximab,but all chemos and Monoclonal Antibotics before administering and also to hydrate the patients with NS prior to chemo to avoid sudden reactions to the agents.

    ------------------------------
    Wanda Maria
    Oncology/IV Pharmacy Tech.
    James J Peters Medical Center , Bronx VA Hospital
    Bronx NY
    718-584-9000
    ------------------------------



  • 8.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 10-22-2018 12:57
    ​In your practice, do you only prime the tubing of Rituxan or all the MABs?

    Thank you

    ------------------------------
    Florence Buenconsejo APRN, MSN, OCN
    Director Nursing / Social Work
    Mount Sinai Comprehensive Cancer Center
    Miami Beach, FL
    ------------------------------



  • 9.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 29 days ago
    In our facility our pharmacy primes all drugs that are titrated with drug (rituximab, infliximab,  IVIG). All other drugs that have a single rate are  primed with saline/D5 to reduce potential exposure when nursing is hooking up the line.

    ------------------------------
    Kate Huot RN BSN
    RN
    Sanford Health System
    Leonard MN
    ------------------------------



  • 10.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 28 days ago
    We are trying to move toward this practice but we are not getting Pharmacy on board to change practice. Please provide research articles to help support this if you can. Thanks

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    Jennifer Scott RN
    Georgetown KY
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  • 11.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 22 days ago
    Kate.

    In our institution we have switched for the tubing on the Rituxan, Remicade and Inflectra to be pre-primed with the actual drug.  The pharmacy does the priming of the tubing. We hang these drugs as the primary infusion not as an IVPB. We have definitely seen a decrease in reactions with this process.

    ​https://cjon.ons.org/cjon/22/4/hypersensitivity-reactions-priming-practice-change-reduce-incidence-first-dose-rituximab

    ------------------------------
    [Charlotte] [Pyles] [RN, OCN]
    [Manager Infusion Center and Specialty Clinic]
    [Saint Francis Medical Center]
    [Cape Girarardeau] [MO]
    [573-331-5156]
    [cpyles@sfmc.net]
    ------------------------------



  • 12.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 18 days ago
    Hi Jennifer
    Perhaps it's better to ask pharmacy for THEIR research. There is nothing in NIOSH or ONS or USP that dictates priming of rituximab in the pharmacy by pharmacists or technicians. It is not on the hazardous drug list (for good reason) [go here for a more in-depth discussion as to why]. The pharmacy needs to separate this drug (and several other mAbs from chemotherapy.

    Yes, we prime our tubing with rituximab at the bedside and pharmacy is delighted in not having to worry about it.

    Seth

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------



  • 13.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 13 days ago
    We also prime rituximab at the bedside an have for 4-5 years now.

    ------------------------------
    Brenda Wolles, MS, RN, CNL, OCN
    Clinical Nurse Leader, Oncology
    Sanford Health System
    1305 W 18th St
    PO Box 5039
    Sioux Falls, SD 57117
    Phone: office - 605-312-0044, cell - 605-940-9221
    ------------------------------



  • 14.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 08-19-2019 02:34
    Great article Donna,
    thanks for sharing
    Qasem​

    ------------------------------
    Qasem Alnasr RN BSN MSN
    Education Coordinator
    King Faisal Specialist Hospital & Research Centre
    RIYADH
    ------------------------------



  • 15.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 16 days ago
    Hi Donna,

    Thanks for sharing this article, we are planning to change our practice to (drug primed versus diluent), I  would like to ask if this practice mentioned in drug monograph or it's mentioned in other references. It's looks simple intervention with great impact on patient and workflow.

    Thanks

    ------------------------------
    Zaid AL-Soud
    Clinical Resource Nurse
    King Hussien Cancer Center
    Amman
    ------------------------------



  • 16.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 14 days ago
    Why does priming tubing with Rituxan help reduce incidence of HSR in first dose Rituxan.

    ------------------------------
    Judith Zarzynski RN
    Rn
    Enloe Medical Center
    Chico CA
    ------------------------------



  • 17.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 13 days ago
    Priming with Rituxan helps reduce reactions because as soon as pump starts infusing, patient will be receiving Rituxan. If line is primed with saline, patient is receiving saline during first step of the ramped infusion. Then when next step goes faster, the patient is receiving the drug for the first time at a faster rate than intended for initial infusion.

    ------------------------------
    Heidi Bartolotta RN OCN
    Clinton CT
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  • 18.  RE: Hypersensitivity Reactions: Priming Practice Change To Reduce incidence in 1ST-dose Rituximab

    Posted 12 days ago
    Thank you Heidi. I was guessing that  this was the case,but appreciate your responding to my inquiry.

    ------------------------------
    Judith Zarzynski RN
    Rn
    Enloe Medical Center
    Chico CA
    ------------------------------