Reply To: Busulfan in SCT

  • Nancy Noonan

    Member
    July 1, 2022 at 11:56 am

    MaryLynn:

     

    Since all our transplant recipients have dual lumen catheters/lines we have not encountered this and draw from the non-infusion lumen.

     

    I do recall once instance in which that detail was missed by the bedside caregiver and it was discovered post sample processing that the samples were drawn from the infusion lumen.  No toxicity and appropriate engraftment were noted – a fortunate outcome for all.

     

    I am interested to see if this is a common issue for others.

     

    Nancy A Noonan MS, RN, PCNS-BC, BMTCN

    BMT Clinical Nurse Specialist

    Blood & Marrow Transplant Program

     

    A Clinical Nurse Specialist (CNS) is a masters or doctoral prepared Advance Practice Registered Nurse (APRN), who is certified, and whose function is to improve outcomes in patient care.
    The CNS is an expert in clinical practice, patient education, research and consultation and influences the three spheres of practice: patient care, nursing and systems.

     

    UCSF Benioff Children’s Hospital Oakland

    747 52nd Street – Oakland, CA  94609

    Ph: 510.428.3885 ext 2835 / Pager 510.801.5708 / Fax 510.597.7169

    Email: nancy.noonan@ucsf.edu

     

    http://www.childrenshospitaloakland.org

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    ——————————————-
    Original Message:
    Sent: 7/1/2022 9:09:00 AM
    From: Mary Lynn Rae
    Subject: Busulfan in SCT

    Hello All:

    For SCT/BMT: We almost always infuse busulfan in one lumen and draw from another.  We have run into a few situations in which we only have one lumen though (i.e. other lumen not working or they just have a port).

    We send our PK samples to Seattle and this is what they said (see below in bold). 
    So my question is if you do use the same lumen to infuse and draw PK samples how much do you flush with for the first PK sample and waste? and then subsequent PK samples?

    Seattle Lab

    Our standard recommended procedure is, when drawing PK samples to follow your standard procedures for blood draws. Disconnect the tubing where busulfan was infusing and flush the line. Make sure to draw blood for busulfan PK from a different lumen (usually red) other than the lumen that busulfan was infusing. From the lumen intended for busulfan PK sampling, inject 10 mL of 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP, withdraw the same amount of blood and discard. Then draw blood for busulfan PK sampling.

    If it is not possible to draw busulfan PK from a different lumen, peripheral blood draws can be utilized. Drawing from the same lumen as infusion is not preferred, but can be used provided the line is completely flushed with adequate waste. Please note this on the patient requisition accompanying the samples.

    ——————————
    Mary Lynn Rae, MSN, RN, NPD-BC, CPHON, BMTCN
    NPD Practitioner/Clinical Educator Hem/Onc/SCT
    Ann & Robert H. Lurie Children’s Hospital of Chicago
    312-227-4224
    mlrae@luriechildrens.org
    225 East Chicago Avenue,
    Chicago, Illinois 60611-2991
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