Reply To: Chemo bag overfill

  • Sheila Tobin

    August 15, 2014 at 7:31 pm

    We had similar issues in the last few years, and had pharmacy perform studies on the fill volumes of chemotherapy bags. We discovered it wasn’t overfill in chemotherapy bags, it was the variability of the infusion pump rate.  Our hospital uses Alaris pumps, and we met with our local rep and learned that all infusion pumps can have a 2-5% variabliity on the actual amount of fluids infused, when looking at the pump alone.  The height of the bag’s drip chamber above the infusion pump affects the accuracy of the infusion as well.  We were having delays in completion times of 24 hour infusions of chemotherapy.  After review and approval from our pharmacy quality group and physician group, we changed the policy to allow the RN to increase the rate by a specific amount only once at the beginning of the 24 hour chemotherapy infusion to allow for timely completion and to compensate for the potential delay that cannot be avoided by our infusion pumps.  This has decreased our infusion delays on 24 hour chemotherapy infusions.

    For all chemotherapies that are infused from a bag, our policy and procedure includes a 15 mL “rapid prime.”  The chemotherapy tubing is a closed “secondary bag” (chemo bag attached to short secondary set with SPIROS connector).  This is attached by the 2 chemo RNs to a closed NS chemotherapy line (with SPIROS  connector at end of tubing, connecting to patient’s central line).  After all safety checks are performed, prior to starting the chemo, 2 chemo RNs are at bedside during a rapid infusion of the NS in the chemotherapy tubing (15 mL).  This primes the line with chemotherapy, and then the rate of infusion is set as ordered (500 mL over 2 hours= 250 mL/hour).  When the chemotherapy reaches “air in line”, the nurse removes the closed chemotherapy tubing and SPIROS connector and discards, and then infuses 20 mL (at the same ordered infusion rate) from the original NS line to flush the remaining chemotherapy that is in the lower portion of the tubing, ensuring the patient receives the full dose.

    This rapid prime method for infusions of bagged chemotherapies has allowed for our infusion durations to be as close to ordered infusion times as possible, without varying the infusion rate.  It is important to mention that our institution does not use buretrols.

    Thank you

    Sheila Tobin
    Inpatient Nurse Educator
    Rady Children’s Hospital
    San Diego, CA
    United States

    Original Message:
    Sent: 08-11-2014 02:14 PM
    From: Traci Marsh
    Subject: Chemo bag overfill

    Hello all,

    We are currently having some issues with the amount of overfill noted in our chemotherapy bags, more commonly Ifosphamide and Etoposide. I was just curious to see if anyone else has issues with overfill in the bags and if so what do you do to correct or help with that issue. We have already spoken to pharmacy and they state they do everything correctly on their end. I wasn’t sure if anyone weighed the bags to do calculations or not? If so, how does that seem to work for your institution? Any advice, research, direction would be greatly appreciated.


    Traci Marsh
    Guyton, GA
    United States