Reply To: Methotrexate infusion

  • Kelly Horn

    February 7, 2020 at 3:08 pm

    We are actually doing sort of a trial on this right now because we have had some issues with running over the 26 hour maximum time frame.  Our pharmacists are sending on primary tubing primed with drug and we bifuse with the bicarb. They remove all the overfill and leave the exact amount of drug to run at the calculated rate.  When we set up the infusion we subtract 20 ml from the volume to be infused so that the pump will go off when the bag is nearly empty or is empty.  Sometimes it’s perfect and sometimes there’s still a little left (probably due to Alaris accuracy).  When the bag is dry and the drug is only in the chamber, we add in our 30 ml flush and continue with the same rate. 


    We are tracking this with our bedside sheet that has a spot for 4, 8, 12, 16, hour checks for VTBI.  It also has a space to write in when flush was added, when the infusion completed, and if there were any reasons the infusion was ever paused. This was pharmacy’s request.


    So far, MOST of our infusions have completed within the 24 to 24.5 hour mark which we are thrilled with and we’ve gotten used to the subtracting at the beginning and adding in 30 at the end.  That took a little bit of getting used to programming that way.  It may sound weird, but it’s definitely working well.


    Kelly Horn MSN, RN, CPON

    Nursing Professional Development Specialist

    Clinical Nurse Supervisor
    4W/5W Medical Surgical Unit

    McLane Children’s Medical Center

    Baylor Scott & White Health
    1901 SW HK Dodgen Loop | Temple, TX 76502

    254-935-4416 Office | 254-718-7722 Cell


    The information contained in this e-mail may be privileged and/or confidential, and protected from disclosure, and no waiver of any attorney-client, work product, or other privilege is intended. If you are the intended recipient, further disclosures are prohibited without proper authorization. If you are not the intended recipient (or have received this e-mail in error) please notify the sender immediately and destroy this e-mail. Any unauthorized copying, disclosure or distribution of the material in this e-mail is strictly forbidden and possibly a violation of federal or state law and regulations. The sender and Baylor Scott & White Health, and its affiliated entities, hereby expressly reserve all privileges and confidentiality that might otherwise be waived as a result of an erroneous or misdirected e-mail transmission. No employee or agent is authorized to conclude any binding agreement on behalf of Baylor Scott & White Health, or any affiliated entity, by e-mail without express written confirmation by the CEO, the Senior Vice President of Supply Chain Services or other duly authorized representative of Baylor Scott & White Health.

    ——Original Message——

      This has been an issue at every hospital I have worked at and I have worked at 7 different large pediatric oncology units. What is working for us is increasing the rate starting at 3 hours before the end. This has been an issue for the past 20 plus years due to the large volume and pumps. So much they change the protocols to allow the MTX to end in 26 hours vs 24. Pumps are more sensitive now also so there is a delay. We run til dry because our RX takes pictures of hand injecting drug. Alaris pumps has an average 8% inaccuracy rate. 

    Search MTX or Methotrexate and I am sure you will see several threads 🙂 Good luck!

    Cara Johnson RNIII, BSN, CPON®
    Clinical Manager
    Hematology/Oncology Inpatient
    Cincinnati Childrens Hospital
    Work: (513)803-0306
    Cell: (513) 490-9253