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  • 1.  CSTD

    Posted 07-31-2019 16:52

    Our facility currently uses a closed system transfer device adaptor at the end of our primary tubing when hooking chemotherapy up to a patient.
    This workflow is part of our facility's policy.
    We are currently looking into different cstds and the reps are saying that their product is not used this way at other facilities. And that the line is flushed whenever the line needs disconnected from a patient so that there is no reason to put a cstd at the end of the primary line.
    My thoughts are- even if the line is flushed, there can still be trace amounts of chemo.
    Also, if a patient is experiencing a reaction and needs disconnected- the line is not being flushed before getting disconnected. That closed system device at the end of the primary line serves as another safety shield for the patient and nurse if an emergency disconnect is necessary.

    I just wanted to see others thoughts on putting a cstd at the end of the primary line and if you do which cstd do you use.
    A lot of the pieces we've demoed are very bulking and awkward for this. We are moving away from the spiros/chemo clave system.

    Any information is much appreciated!

    Alexandrea Nikollaj, BSN, RN, OCN
    Med/Surg Oncology Clinician

    "The bigger the dream, the more important the team."

  • 2.  RE: CSTD

    Posted 07-31-2019 19:10
    I have heard this "argument" before from some device manufacturers and disagree 100%. If we were convinced that flushing with saline removed all HD residue, why do we insist on wearing PPE to disconnect? Right.

    I have had several conversations with some of these manufacturers and their point of view is framed on cost. If they agreed that it needed to be at the end of the primary tubing, then it would greatly increase the cost of their product, making them less competitive in the marketplace.

    I applaud your efforts and your arguments!

    For more information on this topic, click HERE.


    Seth Eisenberg RN ASN OCN BMTCN
    Seattle Cancer Care Alliance
    Federal Way WA

  • 3.  RE: CSTD

    Posted 08-01-2019 10:26

    I will add that even with the use of a closed system device some systems require flushing to prevent exposure. We are currently converting from Spiros to PhaSeal and during training learned before disconnection the closed system PhaSeal device must flushed to clear the connection of hazardous drug.  This caused us to rethink and retrain several processes in our nursing staff; something that was not considered by pharmacy when they decided to make the change in products.



    Michelle Payne MSN, RN, OCN, BMTCN
    Nurse Educator

    Wake Forest Baptist Health

    7CC West BMT and 7CC East Hem/Onc
    Medical Center Boulevard  \  Winston-Salem, NC 27157
    p 336.713.7694 \  f 336.716.5399/ pager 6815  \



  • 4.  RE: CSTD

    Posted 08-01-2019 08:47

    We place a CTSD at the end of all of our lines.  We use Equashield and love the product.  The pharmacy attaches the female adapter to the end of all of the chemotherapy primed lines.  The oncology nursing staff attach the male adapter to the peripheral J loop and Huber needle adapters.  It is standard to flush with normal saline 10mL pre-filled syringe after each drug is administered to prevent mixing of medications, a normal saline bolus from the IV bag does not offer enough pressure (even at 999mL/hr) to get the medication out of the luer activated valves in the primary tubing.  I hope this helps.


    Best Regards,

    Laura Muller BSN, RN, CPUI, OCN

    Director of Oncology & 1 South Clinics

    615 Fulton Street

    Port Clinton, OH 43452

    T- 419-734-3131 ext. 3344

    T-Direct Line 419-301-4352



    Magruder Hospital
    HealthCare's Most Wired Winner, 2017

    CONFIDENTIALITY STATEMENT: This electronic message contains information from Magruder Hospital and may be protected health information or other confidential and privileged information under law. The information is intended to be for the use of the individual or entity named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this message is prohibited. If you have received this electronic message in error, please notify the sender immediately by reply e-mail or telephone at 419-734-3131.

  • 5.  RE: CSTD

    Posted 08-01-2019 16:48
    "normal saline bolus from the IV bag does not offer enough pressure (even at 999mL/hr) to get the medication out of the luer activated valves in the primary tubing. "
    This is very very interesting! I've seen this when I've administered colored medications or blood. Just curious do you happen to have any literature that includes this info?

    Alexandrea Nikollaj, BSN, RN, OCN
    Med/Surg Oncology Clinician

    "The bigger the dream, the more important the team."

  • 6.  RE: CSTD

    Posted 08-01-2019 11:08
    We went from ​PhaSeal to Equashield about a year ago.  Equashield has many more pieces than PhaSeal so it's more complicated for pharmacy to keep all those pieces in stock.  However, Equashield's self contained syringe is fantastic and so safe to use it's worth it.  I also think from the nursing side the male and female adapters of Equashield are easier to put together than PhaSeal.  Depending on the IV pump you use though PhaSeal might be better.  With plum pumps the Equashield is a little harder to put the two pieces together from a secondary onto the primary.  With Alaris either works well. For patients going home with a 5FU pump there are issues with a CSTD being a bulky item.  We couldn't put one on with the PhaSeal.  With Equashield we did come up with a solution, however it's weird and awkward and can still be problematic.

    In terms of putting on a CSTD on the end of the primary line, it's what I recommend.  My rationale for why to put one on the end is exactly as you describe....emergency scenarios.

    Good luck!

    Meredith Maheu RN BSN ONC CMSRN OCN
    Professional Development Specialist Cancer Center
    Northwestern Medicine Kishwaukee Hospital Cancer Center
    DeKalb Illinois
    [] [815-756-1521x154059]

  • 7.  RE: CSTD

    Posted 08-01-2019 11:25

    We use CSTD at the end of the primary line. For the reasons you stated above and the unpredictability of kids and their curious fingers. Most recently I have used the Phaseal devices, and even though it is big and bulky, we don't tend to have any problems. And surprisingly, most kids leave them alone. (There is a cover that can be put over the device to help secure it from being pulled apart, but we rarely have to use that.)

    Amanda Lulloff PhD RN PCNS CPHON
    Clinical Nurse Specialist
    Blank Chidlren's Hospital

  • 8.  RE: CSTD

    Posted 08-01-2019 16:49
    Thank you everyone for all of your input!​

    Alexandrea Nikollaj, BSN, RN, OCN
    Med/Surg Oncology Clinician

    "The bigger the dream, the more important the team."