What is the recommended best practice for preventing accidental exposure/leaks when administering chemotherapy drugs that are incompatible or have unknown compatibility with the closed system device (CSD) utilized by the facility (eg, bendamustine is incompatible with most CSDs)? —Name withheld on request

The recommended best practices are to use compatible systems. National Institute for Occupational Safety and Health (NIOSH) recommends using CSDs when transferring hazardous drugs from primary packing such as vials to dosing equipment (ie. Infusion bags, bottles or pumps). The NIOSH proposed Vapor Containment Performance Protocol for closed-transfer devices is a useful assessment tool or guideline to evaluate containment efficacy of CSDs without creating potential exposures to hazardous drugs. Any specific system is subject to institutional and organizational guidelines and preference.

Agents must be primed separately via a separate line with normal saline under an approved chemotherapy hood, and infused separately via free flowing line. Alternative compatible syringes, vials and devices that have been tested and approved must be substituted.

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The stability and half-life of the medications should be taken into consideration when dealing with infusion times and methods. Specific guidelines vary by institutions, and no general guidelines relative to the type of replacement devices have been established. —Jiajoyce Conway, DNP, FNP-C, AOCNP, NP-C

Revised on Feb. 2, 2016.