Reply To: Blinatumomab ( blyncito)

  • Jennifer Nordin

    Member
    May 6, 2020 at 8:09 am

    ​We recently created a policy and training to start these patients on the home CADD pump. Nursing was trained and our inpatient unit purchased their own pumps so we could avoid issues with billing for the home care pump. They transition inpatient to outpatient CADD with readmission, but we don’t have to worry about different pharmacy procedures and waste of the back up bag inpatient. Our current issue is that our first patient at home did a 7 day bag, and it did not go well. The pump alarmed often and our thoughts are that the rate is just too low to maintain pressure with a port a cath, but wondering if other facilities have had success with 7 day bags and what line are they using.

    Also, does anyone have a process in place for communication if a family continues to have problems with the pump but can’t get a hold of home care, or their issue isn’t resolved?

    ——————————
    Jennifer Nordin, RN
    Leawood, KS
    United States
    ——————————
    ——————————————-
    Original Message:
    Sent: 05-06-2020 07:45 AM
    From: Terese Weart
    Subject: Blinatumomab ( blyncito)

    We are using our Alaris infusion pumps while the patient is inpatient for start of therapy and they switching them over to the MOOG Medical Curlin home infusion pump.  We are using a portacath or single lumen PICC for the infusion.  The pharmacy is purging the blina bag of air to prevent air in line at home.  We run 24hr bags inpatient and up to 96hr bags outpatient with few reported issues (running all at 5ml/hr).  The patients come to clinic Mon/Thurs or Tues/Fri for bag/tubing change and port reaccess weekly.  We do not flush the line or check blood return for bag changes.  For reaccess, the nurse performs peripheral lab collection, pharmacy preps drug, all independent double checks occur, and then the nurse deaccesses the port (without flushing), applies cold spray, reaccesses, and does a very small blood return check and small flush before connecting new tubing.  ​Our Curlin pumps are owned by the department, so we also have a policy written and legal approval to maintain the patient on that “home” pump if they are readmitted during the 28-day course and stable.

    ——————————
    Terese Weart, CPHON,CPNP,MSN,RN
    Clinical Educator
    Cumming, GA
    United States
    ——————————

    Original Message:
    Sent: 11-15-2019 01:04 AM
    From: Sarah Hakim
    Subject: Blinatumomab ( blyncito)

    Hello,

    Appreciate providing me with answers on below inquiries regarding the home infusion of blinatumomab through the CADD pump.
    Noting that during hospitalization the drug is infused in BBraun pumps and when the patient needs to be discharged the drug will be shifted by the nurses in our hospital to the CADD pump, we are in the process of teaching the nurses on the administration of the blinatumomab through CADD pumps.

    – Who does the priming of the drug before discharge or when a bag needs to be changed the nurse or the pharmacist knowing that the priming must be done when the drug is attached to the CADD pump.

    – How is the priming done, do you put a Spiro connector to prevent leakage or spill of the drug during disconnection.

    – What do you do in case of air bubbles in the IV tubing knowing that we can not flush blinatumomab

    – During hospitalization do you administer blinatumomab through a peripheral or a central line? noting that we have single lumen ports that we also use for blood withdrawal, so we put blinatumomab in peripheral line to prevent flushing of the drug during blood withdrawal and to avoid running other medication with blinatumomab because we know that it should run alone. In that case when the patient will be discharged home on the blinatumomab , we need to disconnect it from the peripheral line and put it in the ports through a CADD pump.(opening the closed system)

    Thank you in advance for all you responses,

    ——————————
    Sarah Hakim, MSN,RN
    Clinical Educator
    Lebanon
    ——————————