Department of Pharmacy, Institut Universitaire du Cancer (IUCT) Oncopole, Institut Claudius Regaud, Toulouse, France.
Department of Pharmacy, Institut Universitaire du Cancer (IUCT) Oncopole, CHU de Toulouse, Toulouse, France.
Am J Health Syst Pharm. 2020 Oct 30;77(22):1866-1873. doi: 10.1093/ajhp/zxaa357.
Infusion of cytotoxic drugs carries the risk of occupational exposure of healthcare workers. Since disconnecting an infusion line is a source of contamination, flushing of tubing after infusion of cytotoxic agents is recommended, but the optimal volume of rinsing solution is unknown. The objective of this study was to assess whether postinfusion line flushing completely eliminates cytotoxics.
Infusions were simulated with 3 cytotoxics (gemcitabine, cytarabine, and paclitaxel) diluted in 5% dextrose injection or 0.9% sodium chloride injection in 250-mL infusion bags. Infusion lines were flushed using 5% dextrose injection or 0.9% sodium chloride solution at 2 different flow rates. The remaining concentration of cytotoxics in the infusion line was measured by a validated high-performance liquid chromatography (HPLC) method after passage of every 10 mL of flushing volume until a total of 100 mL had been flushed through.
All cytotoxics remained detectable even after line flushing with 80 mL of flushing solution (a volume 3-fold greater than the dead space volume within the infusion set). Gemcitabine and cytarabine were still quantifiable via HPLC even after flushing with 100 mL of solution. Efficacy of flushing was influenced by the lipophilicity of drugs but not by either the flushing solvent used or the flushing flow rate. After 2-fold dead space volume flushing, the estimated amount of drug remaining in the infusion set was within 0.19% to 0.56% of the prescribed dose for all 3 cytotoxics evaluated.
Complete elimination of cytotoxics from an infusion line is an unrealistic objective. Two-fold dead space volume flushing could be considered optimal in terms of administered dose but not from an environmental contamination point of view. Even when flushed, the infusion set should still be considered a source of cytotoxic contamination.
输注细胞毒性药物存在医护人员职业暴露的风险。由于断开输液管路是污染的来源，建议在输注细胞毒性药物后冲洗输液管，但最佳冲洗溶液量尚不清楚。本研究旨在评估输注后冲洗管路是否能完全清除细胞毒性药物。
在 250 毫升输液袋中，用 5%葡萄糖注射液或 0.9%氯化钠注射液稀释 3 种细胞毒性药物（吉西他滨、阿糖胞苷和紫杉醇），模拟输注。以两种不同的流速，用 5%葡萄糖注射液或 0.9%氯化钠溶液冲洗输液管路。用经过验证的高效液相色谱（HPLC）方法测量冲洗通过每 10 毫升冲洗体积后，输液管路中残留的细胞毒性药物浓度，直至总共冲洗 100 毫升。
即使使用 80 毫升冲洗溶液（体积是输液套装内死腔体积的 3 倍）冲洗管路，所有细胞毒性药物仍可检测到。即使使用 100 毫升冲洗溶液冲洗，吉西他滨和阿糖胞苷仍可通过 HPLC 定量。冲洗效果受药物脂溶性的影响，但不受冲洗溶剂或冲洗流速的影响。冲洗 2 倍死腔体积后，在所评估的 3 种细胞毒性药物中，估计剩余的药物量在给药剂量的 0.19%至 0.56%之间。
从输液管路中完全清除细胞毒性药物是不现实的目标。从给药剂量的角度来看，冲洗 2 倍死腔体积可能是最佳选择，但从环境污染的角度来看并非如此。即使冲洗后，输液套装仍应被视为细胞毒性污染的来源。
