In a clinic setting, is it within the RN scope of practice to administer bortezomib (Velcade) using Palindrome dialysis catheter access in a multiple myeloma patient? — Suzanne K. Utoh

The Palindrome dialysis catheter is a central venous access catheter that delivers high flow rates. It is a type of catheter that is used by peripheral blood stem cell transplant teams for apheresis to obtain peripheral blood stem cells from patients before their autologous transplants. Standard central venous access ports and catheters should not be used for apheresis since they cannot withstand the process of apheresis. That being said, the catheters used for apheresis are capable of performing chemotherapy infusions.

Therefore, the guidelines for administration of IV fluids, blood, and chemotherapy are similar to other central venous access devices except for the amount of heparin needed to flush the dialysis catheters. Policies in many institutions require that the catheter not be utilized for general use until the transplant team deems that it is no longer needed for apheresis. Once it is no longer needed, there is no clinical reason the catheter should not be used. However, many practitioners prefer to switch to a standard catheter if the dialysis catheter is no longer needed for apheresis because standard catheters are easier and more comfortable for the patient. Check with the transplant team in your institution to find out their policy. As far as credentialing, the credentialing process for the large bore dialysis catheter and other catheters should be the same, but that is another institution-based policy. — Barbara Rogers CRNP, MN, AOCN, ANP-BC

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