Inadvertent vincristine administration into the cerebral spinal fluid often is a fatal medication error. Several safety organizations, including the NCCN, recommend vincristine administration via minibag infusion to eliminate the potential for vincristine in a syringe to be inadvertently administered into the central nervous system. However, oncology nurses have expressed concern that placing vincristine in minibags may result in an increase in extravasations of vincristine.
At the 2017 ONS Congress, staff at the Johns Hopkins Sidney Kimmel Cancer Center reported on their study of vincristine infused via minibag infusions and the incidence of extravasation. Beginning in September 2013, all adult pharmacy and nursing staff at the hospital were educated of the practice change with vincristine administration via the minibag, free-flow (IV side-arm technique). A 5-minute administration video was developed for nursing staff, and staff received didactic education regarding the importance of the planned change.
The hospital’s technique includes nurses staying with the patient while the vincristine infuses via gravity. No vincristine extravasations occurred, and the researchers concluded that vincristine administration via minibag infusion is the safest approach to administering this drug.