Evaluation of the performance of elastomeric pumps in practice: are we under-delivering on chemotherapy treatments?

Salman, Dahlia; Biliune, Jurga; Kayyali, Reem; Ashton, Jane; Brown, Peter de Nully; Mccarthy, T. P.; Vikman, Elin; Barton, S.K.; Swinden, Julian; Nabhani‐Gebara, Shereen

doi:10.1080/03007995.2017.1374936

Cited by 14 publications

(12 citation statements)

References 22 publications

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“…16 An evaluation of the performance of elastomeric pumps in practice demonstrated that a proportion of patients were not receiving their planned doses mainly resulting from unfinished infusors being discarded. 24 Therefore, education is essential not only regarding adverse events that may result from the chemotherapeutic agents but also to teach appropriate use of the infusors including what to do if the infusions finish early, or late. There are also possible malfunctions for which protocols must be established, including in the unlikely event of leaks or the development of occlusions.…”

Section: Discussionmentioning

confidence: 99%

Stability of vincristine sulfate, doxorubicin hydrochloride and etoposide phosphate admixtures in polyisoprene elastomeric pump supporting transition of the EPOCH regimen to outpatient care

Svirskis

Behera

Naidoo

et al. 2018

J Oncol Pharm Pract

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Background The EPOCH regimen, consisting of vincristine sulfate, doxorubicin hydrochloride, and etoposide phosphate, is typically administered by continuous infusion over four days to oncology inpatients. If the EPOCH regimen was available to be administered through portable elastomeric pumps, chemotherapy could be transitioned to an outpatient setting, reducing inpatient bed days and overall healthcare costs. However, a lack of stability data for the admixtures in the elastomeric infusion devices currently prevents the transition of the regime to an outpatient setting. The purpose of this study is to determine the physical and chemical stability of the admixture in polyisoprene elastomeric pumps under different storage conditions to support the transition of the EPOCH regime to an outpatient setting. Methods The physico-chemical stability of three admixtures at a range of clinically relevant concentrations compounded in polyisoprene elastomeric infusors was determined when refrigerated at 2-6℃ over a 14-day period followed by 35℃ up to 7 days in the dark, and under standardized fluorescent light to simulate scenarios in clinical practice. Results All tested admixtures were compatible and the drugs were stable in the elastomeric infusors for up to 14 days when stored at 2-6℃ followed by 7 days at 35℃ in the dark, with nominal losses of <5%. The major degradant of etoposide phosphate was its active form etoposide. There was no degradation (<1% loss) found when the admixture was exposed to a standardized fluorescent light dose of 80 klux-h (25℃) for 10 h. The temperature and light conditions the infusors were exposed to during the stability study were more severe than the conditions determine during clinical administration. Conclusion The extended stability of the three infusional admixtures compounded in elastomeric infusion pumps demonstrated herein permits advance preparation and storage of these drugs, reducing pharmacy compounding resources. The demonstrated stability at 35℃ and under light exposure, conditions more severe than those experienced during clinical practice, support continuous infusions for up to seven days from the elastomeric infusors without a loss of potency. The proven stability of the EPOCH regimens in the tested elastomeric infusion device supports the transition of treatment to an outpatient setting which will reduce inpatient bed days and overall healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Stability of vincristine sulfate, doxorubicin hydrochloride and etoposide phosphate admixtures in polyisoprene elastomeric pump supporting transition of the EPOCH regimen to outpatient care

Svirskis

Behera

Naidoo

et al. 2018

J Oncol Pharm Pract

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“…Consequently, we conducted a two-phase study (Salman et al 2017) to observe and evaluat patients receiving home chemotherapy via elastomeric pumps (5FU infused via a 48 hour elastomeric pump) at three gastrointestinal medical day units (MDU).…”

Section: Delivering Chemotherapy At Home: How Much Do We Know?mentioning

confidence: 99%

Delivering chemotherapy at home: how much do we know?

Shereen

Salman

2019

Br J Community Nurs

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Ambulatory chemotherapy offers many advantages from supporting a closer to home treatment approach to lowering the cost of care. Ambulatory devices such as elastomeric pumps can deliver prolonged infusions of a variety of chemotherapy agents. Elastomeric pumps are preferred by the patients, as they get them connected at the hospital or cancer centres, then go back home where they can have visits from the district nursing team. This minimises disruption to carers and families. Despite all the advantages, experiments carried out by the authors and others in the literature showed that the performance of these pumps varied depending on the temperature and/or viscosity of the diluent. Interestingly, a two-phase study that was carried out to observe and evaluate patients receiving ambulatory chemotherapy concluded that in 50% of the observed cases the infusion pump did not finish on time. This disrupted the patients' treatment schedule and, in some cases, resulted in sub-therapeutic dosing.

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“…Many studies have investigated drug stability in extended infusions in the outpatient parenteral antimicrobial therapy (OPAT) setting to ensure patients receive their intended dose of therapy . However, few studies have investigated the performance of the devices used or specifically any factors that may affect the total dose patients gets in this setting . These other factors may result in larger dose deficits for the patient than drug degradation, and must be understood to ensure best possible patient care.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] However, few studies have investigated the performance of the devices used or specifically any factors that may affect the total dose patients gets in this setting. 6,7 These other factors may result in larger dose deficits for the patient than drug degradation, and must be understood to ensure best possible patient care.…”

Section: Introductionmentioning

confidence: 99%

“…A recent study demonstrated the importance of flow rate with these devices, showing that 40% were not running out to completion within the designated time frame . Of these devices, 35% had volumes remaining that equated to 17% of the daily dose not being administered . This warrants further investigation to ensure a better understanding of the optimal functioning of the devices, and therefore leading to better patient care.…”

Section: Introductionmentioning

confidence: 99%

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Total intended antibiotic delivery related to drug concentration affecting the flow rate of elastomeric devices used in outpatient parenteral antimicrobial therapy (OPAT)

Perks

Pain

Franklin

2019

Pharmacy Practice and Res

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Background Many studies have investigated drug stability in extended home infusion pumps, but little is known of other factors that may affect the total daily dose the patient receives. It has been noted that up to 40% of these infusions are incomplete after the designated run out time. Aim This study investigated whether concentration can affect the flow rate of home infusion pumps, and thus the total dose the patient receives in outpatient parenteral antimicrobial therapy (OPAT). Method The flow rates of 10 different drug and dose formulations (4–18 g in 0.9% sodium chloride) in Baxter LV10 (Old Toongabbie, Australia) infusion pumps were investigated. The pumps were run out at 31°C and weighed at intervals, with flow rate and total volume infused calculated over the 24‐h period. Results Piperacillin/tazobactam 18 g was the only formulation not to meet the minimum standard of 90% of the volume being infused over the 24‐h period. This indicates a failure of intended therapy. Across all infusions, the expected dose delivered (DD) can be calculated as %DD = −1.9x + 122.85, where x is the total drug and excipient weight within the infusor. Conclusion Dose is inversely related to flow rate in the LV10 Baxter infusion pump. Under nominal conditions, any amount greater than 12.02 g in the 240‐mL infusion pump will result in an incomplete run out over the 24‐h period. Clinicians should be aware that prescribing daily doses higher than 17.28 g may result in <90% of the intended dose being received by the patient. Further research should investigate whether this decrease in flow rate results in poor clinical outcomes.

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Evaluation of the performance of elastomeric pumps in practice: are we under-delivering on chemotherapy treatments?

Abstract: The performance of pumps varied, which affected nurse workload and patients' waiting-times. A smart system is an option to monitor the performance of pumps and to predict their accuracy.

Cited by 14 publications

References 22 publications

Stability of vincristine sulfate, doxorubicin hydrochloride and etoposide phosphate admixtures in polyisoprene elastomeric pump supporting transition of the EPOCH regimen to outpatient care

Stability of vincristine sulfate, doxorubicin hydrochloride and etoposide phosphate admixtures in polyisoprene elastomeric pump supporting transition of the EPOCH regimen to outpatient care

Delivering chemotherapy at home: how much do we know?

Total intended antibiotic delivery related to drug concentration affecting the flow rate of elastomeric devices used in outpatient parenteral antimicrobial therapy (OPAT)

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