Reply To: HD MTX infusion

  • Cara Johnson

    Member
    April 10, 2015 at 6:42 pm

    I love to respond to this because I feel we have “cracked the code” lol. I have worked at 7 different institutions and MTX never finished on time. There are many variables and this is why the protocol changed to allow us to go to 26 hours 🙂 However our Type A MDs would like to continue with the 24 hour expectation lol. So here are the reasons it finishes late:

    ->/<10% realted to diluent in the bag

    -2-4% error on the pump

    -Pauses in the pump related to shifting of patient “checking line”

    -Meds, lab draws

    Etc

    All these build up in 24 hours and you can see it happening on wonderful Carefusion reports!

    Soooooooo how can you help this you ask?? Well here is what we do and it has worked since last November. 

    We look at the infusion 3 hours before it is supposed to complete. We guestimate when it will be done and call the provider for a rate change. Then we look at 1 hour before and do another rate change if necessary. This has greatly helped our infusions and staff are getting really good at estimating. Hope this helps. Email me if you want tracking papers or some data 🙂

    Cara Johnson RNIII, BSN, CPON®

    Clinical Manager

    Hematology/Oncology Inpatient

    Cincinnati Childrens Hospital

    cara.johnson@cchmc.org

    Work: (513)803-0306

    Cell: (513) 490-9253

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    Original Message:
    Sent: 11-28-2014 07:23 PM
    From: Gwen Faschoway
    Subject: HD MTX infusion

    Thanks for your response.  It is good know there are others with this issue as well.  We are trying to figure out why this happens.
    Thanks 🙂

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    Gwen Faschoway
    Surrey, BC
    Canada
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    Original Message:
    Sent: 11-28-2014 03:11 PM
    From: Kelly Horn
    Subject: HD MTX infusion

    We had this battle for several years with the Alaris pump.  We tried several things to help us with this.  We make sure that there is the 11-12 inches between the bottom of the bag and the pump, so it will pull right and we make a “bra” for the extra large bags so the weight is more evenly distributed.  It helps, but it wasn’t enough, so our doctors now write an order that we may adjust the rate up or down by 20% to ensure the bag finishes on time.  We monitor for the adjustment every 4 hours. 
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    Kelly Horn
    McLane Children’s Baylor Scott & White
    Temple, TX
    United States
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    Original Message:
    Sent: 11-28-2014 01:48 PM
    From: Patricia Conlon
    Subject: HD MTX infusion

    The buretrol helps us know what is left to infuse and we recalculate the rate as needed.
    It has been a challenge so we use the buretrol for large volume chemo only for just this reason.

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    Patricia Conlon
    Mayo Clinic
    Rochester, MN
    United States
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