All ONS Member Community

Expand all | Collapse all

Vincristine

  • 1.  Vincristine

    Posted 05-09-2019 22:41
    I am wondering how nurses are hanging vincristine? I work in a medium sized infusion center and it has come up that because it is a vesicant you don’t want it to keep infusing if there has been an infiltrated IV and hence and extravasation, but hanging it to gravity seems risky too because you can’t control the drip rate as tightly. Thanks in advance for your responses! Happy Nurses Week!

    Rachel Miles RN OCN

    Sent from my iPad


  • 2.  RE: Vincristine

    Posted 05-10-2019 07:21
    I have worked in Oncology since 95 and have always pushed vincristine.  That is our practice, this way you can check for a blood return.

    ------------------------------
    Tricia Linzenmeyer RN
    Nurse Clinician
    Peoria IL
    ------------------------------



  • 3.  RE: Vincristine

    Posted 05-11-2019 06:18

    Hello,
    The below link may be a helpful reference. The 2016 ASCO ONS Chemotherapy Administration Safety Standards (standard 3.15 addresses the administration of vinca alkaloids).

    https://onf.ons.org/onf/44/1/2016-updated-american-society-clinical-oncologyoncology-nursing-society-chemotherapy



    ------------------------------
    Ronda M. Bowman, MHA, RN, OCN
    Associate Director, Quality Programs
    American Society of Clinical Oncology
    Alexandria, Virgina
    513-218-0668
    ------------------------------



  • 4.  RE: Vincristine

    Posted 05-13-2019 08:03
    ​Hi, Tricia

    There is an FDA Black Box warning on vincristine re: inadvertent IT administration. The national guidelines recommend that vincristine be administered via a mini-bag/IVPB to reduce this risk. Some great sources include: Joint Commission 2005, World Health Organization 2007. There was also a nice article by L.H. Smith in CJON 2009 - Preventing Intrathecal Chemotherapy Errors.

    ------------------------------
    Rae Norrod, MS, RN, AOCN, CNS
    Manager, Cancer Support Services
    Kettering Health Network
    Kettering, OH
    Rae.Norrod@ketteringhealth.org
    ------------------------------



  • 5.  RE: Vincristine

    Posted 05-10-2019 07:24
    ​Vincristine is administered at our institution by hanging a piggyback and infusing by gravity.  The secondary IV set gets primed first and all of the fluids are compatible so the rate will stay to your adjustments.  I think the patients are helpful when know what time the treatment is going to happen.  The bag is flushed with the compatible fluid and administration set is primed.  In the hospital I attach the IVPB and use the prescribed rate, checking for blood return, flushing, and disposing of the IVPB properly when finished.

    ------------------------------
    Cris Watkins
    RN, CPO
    Louisville KY
    ------------------------------



  • 6.  RE: Vincristine

    Posted 05-12-2019 11:38
    I am a new oncology nurse and wanted to know how are you checking for blood return when infusing vincristine? This is in regard to the CSTD or is just an empty 10 mL syringe directly to the port access closes to the pt.

    ------------------------------
    Digna Vargas
    RN
    UMH
    Miami FL
    ------------------------------



  • 7.  RE: Vincristine

    Posted 05-13-2019 13:16
    ​We hang it to gravity in a small bag on a secondary line.  We don't utilize the pump as they can continue pumping even if it has infiltrated.  The nurse checks for blood return at a port site close to the IV insertion site every 2-3 minutes with an empty syringe and is constantly observing the site during infusion.

    ------------------------------
    B. Marie Mackey RN, BSN, OCN
    Orlando FL
    ------------------------------



  • 8.  RE: Vincristine

    Posted 05-10-2019 09:01
    We hang ours IVPB over 10 minutes. You're still able to hook up a flush to the line and check for blood return during the infusion. I was confused because when I started administering it at my current center this way because I was always taught IVP and had always given it that way at my previous job. They said it was a policy change to decrease the risk of it being administered intrathecal.

    ------------------------------
    Jonathan Morgan, RN
    Registered Nurse, Med/Onc, Infusion Services
    Egg Harbor Township, NJ
    ------------------------------



  • 9.  RE: Vincristine

    Posted 05-10-2019 09:32
    https://voice.ons.org/news-and-views/whats-the-preferred-method-for-vincristine-administration-when-treating-a-patient

    ------------------------------
    Well, after looking it up ONS suggests IV bag per gravity.
    https://voice.ons.org/news-and-views/whats-the-preferred-method-for-vincristine-administration-when-treating-a-patient
    Tricia Linzenmeyer RN
    Nurse Clinician
    Peoria IL
    ------------------------------



  • 10.  RE: Vincristine

    Posted 28 days ago
    The ONS is stating in the above link...to hang by gravity for peripheral infusions.  However, ONS supports infusions of mini bag Vinca Alkaloids via pump with Central line catheters.  However, I prefer to do both peripheral and Central line per gravity so it makes me stay with the patient ultimately preventing the patient from inadvertently impacting the port needle placement/integrity (i.e. getting up to use the bathroom).

    ------------------------------
    Ali Jackson RN BSN OCN
    ------------------------------



  • 11.  RE: Vincristine

    Posted 05-10-2019 09:37
    https://voice.ons.org/news-and-views/whats-the-preferred-method-for-vincristine-administration-when-treating-a-patient

    ------------------------------
    Tricia Linzenmeyer RN
    Nurse Clinician
    Peoria IL
    ------------------------------



  • 12.  RE: Vincristine

    Posted 05-10-2019 10:30
    But the value of not using a pump is knowing that it isn't being "forced" into the vein.

    I know it seems weird, but drip rate is less crucial than extravisation. After all, when we side-push drugs, it's not exact either. I was just laughing about the 'old days' in nursing when we had to manually calculate drip rates and there were two sizes of tubing you would use for better control. Talk about ballparking the numbers!  Here's a copy of a 2004 nursing article on how to do drip rates. When I went to school in 2001, we actually had a brief math class on this kind of stuff. https://journals.lww.com/nursingmadeincrediblyeasy/Citation/2004/07000/How_fast_should_the_drops_drip_.12.aspx

    ------------------------------
    Carol Siewert RN
    Madison WI
    ------------------------------



  • 13.  RE: Vincristine

    Posted 05-10-2019 12:46
    Hi. We give our VCR by gravity ​piggybacked on a 0.9NS line. Check blood return before and after. It is to gravity so you can assess if the drip stops dripping that may signal a problem with the IV. We used to push VCR but our institution switched to all VCR in piggybacks as a safety precaution because somewhere in the country someone had given it IT instead and patient had died.

    ------------------------------
    Emma Bushon RN
    Adult Oncology Infusion
    Michigan Medicine
    Ann Arbor, MI
    ------------------------------



  • 14.  RE: Vincristine

    Posted 05-10-2019 16:56
    ​We infuse both Vincristine and Vinblastine as a secondary to gravity over about 10 minutes. We check for blood return before and after, and sometimes about halfway through or if the drug stops dripping. I was also given the explanation that it is no longer given IVP d/t possibility of mistakenly administering it IT.

    ------------------------------
    Sara Brush OCN
    RN
    Kootenai Clinic Cancer Services
    Athol ID
    ------------------------------



  • 15.  RE: Vincristine

    Posted 05-10-2019 20:05
    Edited by Rachel Miles 05-10-2019 20:05
    Thanks to everyone for the great response. I learned a lot and really appreciate the input!

    ------------------------------
    Rachel Miles
    BSN, OCN
    Essentia Health
    Duluth MN
    ------------------------------



  • 16.  RE: Vincristine

    Posted 05-11-2019 06:23
    Hello,
    The below link may be a helpful reference. The 2016 ASCO ONS Chemotherapy Administration Safety Standards (standard 3.15 addresses vinca alkaloid administration). https://onf.ons.org/onf/44/1/2016-updated-american-society-clinical-oncologyoncology-nursing-society-chemotherapy

    ------------------------------
    Ronda M. Bowman, MHA, RN, OCN
    Associate Director, Quality Programs
    American Society of Clinical Oncology
    Alexandria, Virgina
    513-218-0668
    ------------------------------



  • 17.  RE: Vincristine

    Posted 05-13-2019 15:11
    Pushing vincristine with a syringe puts the vein at risk since you are applying pressure.

    Hanging it with saline by gravity allows it to flow so that it is not forced into the vein.  you can change the fluid intermittently with the saline to slow it down and drop both bags below the vein to check for blood return.

    ------------------------------
    Summer Vanslager RN
    Santa Cruz CA
    ------------------------------