How a Nurse's Question Changed Stem Cell Infusion Practice at UC Davis

When nurses at UC Davis Medical Center asked why stem cells were infused by gravity rather than by pump with filtered tubing, Jessica Miles, MS, RN, CNS, AOCNS, TCTCN, had no evidence-based answer. Her search for one became a nurse-driven quality improvement (QI) project, published in the Clinical Journal of Oncology Nursing, which found that peristaltic pumps and non–leukocyte-reducing filters did not compromise stem cell infusion safety.¹

In part 1 of a 2-part “Onc Nurse On Call” episode, Miles, a clinical nurse specialist in oncology and blood and marrow transplant, told Oncology Nursing News co–editors in chief Patricia Jakel, RN, MN, AOCN, and Stephanie Desrosiers, DNP, MSN, RN, AOCNS, TCTCN, how the project moved from bedside question to publication.

What prompted the question about stem cell infusion?

New nurses and nurses from other centers kept raising the same issue. "They would ask, 'Why do we, you know, do these cells by gravity? Why do we use this tubing versus that tubing?' And I couldn't give a great answer," she said.

Stem cell infusion practices vary widely and are often set by institutional policy because supporting clinical data are limited.¹ Other blood products, by contrast, typically run through a non–leukocyte-reducing filter on a pump. "Why do we administer stem cells differently than we administer the rest of our blood products, right?" Miles said.

How did the team test pumps and filters?

With buy-in from the stem cell laboratory's medical director, Miles and laboratory scientist Lindsay Hoffman, CLS, simulated infusions of thawed cells by 3 methods: gravity with unfiltered tubing, gravity with filtered tubing, and pump with filtered tubing, sampling cells before and after each infusion.

Postinfusion CD34+ cell recovery and time to engraftment did not differ among the 3 groups, according to the published report.¹ Miles said the bench data showed "there was not a significant effect on the viability of the cells after being infused via a non-leukocyte-reducing filter and a pump." A later review of patient outcomes before and after the practice change likewise "did not see…a significant difference between our pre pump use and post pump use," she said.

What changed for nurses at the bedside?

Cryopreserved cells can now be given by gravity or pump. When a line runs slowly, nurses can switch to the pump rather than pushing cells by syringe, which adds connections and manipulates the cells. For longer infusions of fresh cells, the pump replaces hand-calculated drip rates. Because cell infusions are not a daily task, Miles noted, "it was hard if it's something they haven't done in a couple months to re-remember how to calculate a drip count."

Why did Miles decide to publish?

Peer centers already infused cells by pump but had not published their experience. "I wish they would publish because then I would be able to add to my list," Miles recalled thinking. Tia T. Wheatley, DNP, RN, AOCNS, AGACNP-BC, the journal's quality and safety associate editor, encouraged her to submit and guided the manuscript. "I don't know if I would have known where to start without her guidance," Miles said.

The hardest part, she added, was "just the sitting down and writing it, and getting what's in your head onto paper." An earlier Onc Nurse On Call episode explored how a UCSF clinical nurse specialist improved difficult IV access care for patients with cancer.²

What are the key takeaways for oncology nurses?

• Treat "we've always done it this way" as a prompt to look for evidence, not as the evidence itself.
• Partner with laboratory colleagues to generate data before proposing a practice change.
• Measure clinical outcomes after the change.
• Publish QI results so other programs need not repeat the work.

References

1. Miles J, Hoffman L. Implementation of infusion pumps and filtered administration sets for stem cell transplantation. Clin J Oncol Nurs. 2024;28(2):209-213. doi:10.1188/24.CJON.209-213

2. DIVAs in oncology: improving IV access procedures for patients with cancer. Oncology Nursing News. February 18, 2026. Accessed November 5, 2026. https://www.oncnursingnews.com/view/divas-in-oncology-improving-iv-access-procedures-for-patients-with-cancer