Accidental intrathecal administration of vincristine

Abstract

Vincristine is a chemotherapeutic agent used in the treatment of various neoplastic diseases. Its neurotoxicity after therapeutic and pharmacologic doses has been well documented. We report a case of accidental intrathecal administration of vincristine in order to describe the complications seen, discuss possible means of therapeutic intervention, and serve as a reminder that preventive measures are mandatory to avoid such accidents in the future.

Errors involving pediatric patients receiving chemotherapy: A literature review

“…In one case [37], when drug removal was begun 30 minutes after the incident, only 23% of the dose was recovered. In the case in which a more aggressive method of drug removal (ventriculolumbar "washout") was used [36], the attempt at recovery did not begin until 4.5 hours after the error, and that child, like the others, died.…”

“…The amount of drug removed was reported for one case: 23% of a 1.2 mg dose was recovered, 30 minutes after injection, by CSF removal [37].…”

“…Hydrocortisone was given by this route following the intrathecal injection of both vincristine and daunorubicin [18,31,37], and all of these cases were fatalities.…”

“…Drug removal was attempted in four cases: CSF exchange with normal saline at 13 mL/kg stat via lumbar puncture [34]; CSF removal at 1 mL/kg via lumbar puncture, once 30 minutes after injection and once 24 hours later [37]; CSF removal at 1.7 mL/kg stat via lumbar puncture [35]; and ventriculolumbar "washout" with normal saline, to a total of 645 mL, beginning 4.5 hours after injection and continuing until 12.5 hours later (with what appeared to be a 2.5 hour interruption) 1361. The amount of drug removed was reported for one case: 23% of a 1.2 mg dose was recovered, 30 minutes after injection, by CSF removal [37].…”

Impact of the timing of triple intrathecal therapy on remission induction in childhood acute lymphoblastic leukemia: A pediatric oncology group study

“…In one patient described elsewhere [5] major protocol violation was the administration of intrathecal vincristine together with triple IT therapy resulting in the death of the child. For the induction portion of this study, 379 patients were evaluated.…”