CN23 Increased patient and occupational safety for home infusion of cytotoxic and other hazardous drugs

Abstract

There is an increasing demand for intravenous (IV) oncology therapy in a homecare setting. From a healthcare system point of view, up to 90% of the costs could be cut comparing IV therapy given at home to the same care conducted in a hospital setting. From the patient perspective, several studies have shown that the overall experience of treatment is much improved in a homecare setting without a lesser clinical outcome. Side effects such as nausea and vomiting are decreased by the reduced physical and psychological stress and the risk for hospital-acquired infections is reduced. Homecare pose a lesser invasion of the patient’s life. This is especially true for children with cancer where families testify to not feeling as affected by the illness and children describes how they felt less ill and more normal when being treated in their own home, leading to an increase in their quality of life. Shifting IV therapy from the hospital to the home will pose a challenge with regards to risk management. A literature study has been performed to investigate which risks has been documented so far and if they affect patients, caregivers and/or the home infusion nurses. Two of the most important safety issues are identified to be the risk of vascular air embolism and IV-line dislodgement. A proof-of-concept device to address these specific risks has been developed. The disposable closed system device consists of an automatic vent to remove air combined with a weak link connector that disconnects when the IV line is forcefully pulled. The vent eliminates the need for manual removal of air bubbles, thus reducing drug exposure and disruption to flow rates. The connector has valves that seal the system on both sides to retain all liquids in the event of a pulled IV line, reducing injury from dislodgement and drug exposure. Feasibility testing of the device has shown a 99.97% success at air removal compared to standard IV delivery methods and reduction in dislodgment frequency of 92%. A novel device for reducing risks for air embolism and IV-line dislodgement can strongly increase the safety for patients and nurses during IV chemotherapy therapy at home.