importance of saline flush between chemo drugs

[GColdtimer]

I wonder if any doctors, nurses, researchers could help me? My MIL is on her 3rd round of carboplatin/taxol. Her first round was fine, her second round was so dreadful she was in bed for 14 days and could barely breath at one point. the oncologist thought the dose must be too high so they lowered her dose for the third round and she was again fine. It has now transpired that the nurse who administered the second round of drugs failed to perform a saline flush between drugs. She only thought this was a problem when the nurse who administered the third round was shocked and concerned about the failure to perform the flush. I have read somewhere that failure to flush could cause a reaction between drugs.

I feel my MIL should tell he oncologist about this when she sees her tomorrow but my MIL doesn't want to cause any trouble and says its all the in the past. She is worried that it will just be seen as nitpicking and out to cause trouble. I think they should know in case the lack of a saline flush caused the extreme side effects. If that is the case then the dose probably didn't need to be reduced.

Can anyway with knowledge of oncology shed any light on this?

Thanks

macmillan I would maybe give Macmillan a ring as it is quite a specific query.

I have no specialist oncology knowledge, but generally by a reaction to having the drugs mix we would tend to be looking out for the drugs becoming cloudy/sediment from getting mixed together when they shouldn't. Overall, I suspect it is more likely that she had the usual side effects from the drugs, rather than symptoms because they were given a bit too close together without a flush, as they are routinely given on one day AFAIK.

However, it is good practice to always give a flush, as it makes sure all the active meds have gone into the patient and not sitting in the tubing.

There may be a pH issue between the different drugs. Some chemo is also pretty nasty stuff if it gets out of the vein, so the flush is a bit of a check that it's still ok (as tends to be given a bit faster than the other drugs)

Speak to her team (whether the MacMillan, her specialist nurse or consultant)

Thank you. I have persuaded her to mention it to her oncologist tomorrow. She feels nervous of talking to her Macmillan nurse because she was told by her oncologist not to bother her with questions about her treatment. . So I can see why she doesn't feel like rocking the boat.

I'm a Nurse; It will be in the hospital's intravenous drug administration policy that a saline flush should be given between 2 drugs. This is to make sure there is no drug left in the tubing and so the full dose has been received and prevent a reaction between 2 drugs occuring.

This is a clear example of a nurse being too lazy to do this and needs reporting. Being busy / tired are not accepatable excuses.

No idea if the lack of a saline flush in this instance caused the effects you describe though.

Thanks purple. That was what I thought. Glad she us going to mention it.

Purple Wednesday - why does it gave to be caused by laziness?

In my experience the vast majority of errors are caused by stress/workload issues or lack of training/ supervision. I have investigated many 'incidents' and have yet to come across laziness as a cause.
Nurses are just people, and people make mistakes.
Please tell your MIL to tell her Oncologist or the manager of the Oncology team as it is bad practice and COULD potentially cause problems.

i suspect people don't admit to simply being lazy. But you are right daintynuts there are likely to be other factors involved. Training should ensure that certain aspects of practice are second nature even when busy.

This is why I'm not a nurse manager - I can't abide the fuckwitted behaviour that occurs!