Reply To: Infusion of Stem Cells

  • Deleted User

    December 2, 2021 at 3:39 pm

    Hi Carie,

    We have been infusing via Alaris Pump for several years (between a couple staff members and I we think it dates back to at least 2006). I was not in my current position when we transitioned, so I don’t have the information we used to support the change (sorry!), however our engraftment outcomes demonstrate that this process has been safe and effective. It appears the recent articles would support your proposal as well. 

    Please let me know if you have any other questions related to our procedures!

    Elizabeth Sheldon, CPHON,CPNP-PC,PCNS
    San Diego, CA
    United States
    Original Message:
    Sent: 12-01-2021 07:19 AM
    From: Carie Murphy
    Subject: Infusion of Stem Cells

    I found two recent articles on infusing stem cells via pump v. gravity.  We infuse our cells via gravity and we attach a stop-cock with syringe between IV tubing and patients CVL to “pull and slowly push” any remainder cells from the infusion tube.  The tubing we use is the Y-Type Blood/Solution Set with Standard Blood Filter 170 to 260 Micron and a CLEARLINK Luer Activated Valve, Male Luer Lock Adapter, Approximately 10 drops per mL. Approximate Length 103″ (2.6 m). Contains DEHP. Fluid path is sterile from Baxter.

    When looking at previous discussion threads, I found one from 2015 asking how institutions infuse cells, it is a mix.  The articles I have that support the use of a pump are:

    Kissoon, T., Godder, K., & Fort, J. (2020). Infusion of hematopoietic stem cell products using pump mechanism: An approach worth consideration? Journal of Pediatric Hematology/Oncology, 42(3).

    Reich-Slotky, R., Cushing, M. M., Hsu, Y.-M. S., Ancharski, M., Rojas, J. M., Scrimenti, L. M., Robilio, S., Assalone, D., Roselli, T., Guarneri, D., Vasovic, L. V., Goel, R., Shore, T., & van Besien, K. (2017). Validating and implementing the use of an infusion pump for the administration of thawed hematopoietic progenitor cells-a single-institution experience. Transfusion, 58(2), 339–344.

     I am just wondering what others are doing now and if you have any other current articles in support of or against use of a pump to infuse stem cells.  I am wanting to propose a practice change for our institution to our transplant coordinator and physician.  We have recently began CAR-T cell infusion as well, and I know we free drip these, as well, but those seem to go much quicker and do not require so much tedious “counting” at the bedside for a prolonged period of time.

    Thank you in advance for any comments.

    Carie Murphy, MSN, RN, CPON
    ANM, Weaver 4
    Peds Hem/Onc/BMT Educator
    Wolfson Children’s Hospital
    800 Prudential Drive
    Jacksonville, FL 32207