Providing a closed-system transfer and administration device for chemoembolisation ensure safe use?

Introduction
The performance of hepatic chemoembolisation using a mixture of Idarubicin and Lipiodol in the operating room is an occasional procedure in our healthcare institution which may be a potential source of exposure to an anticancer agent for medical staff in both the pharmacy and the operating room.

Objective
In collaboration with the occupational health department, we wished to assess the exposure of medical staff to anticancer drugs during hepatic chemoembolisation (one administration per month) and the use of the mixing and administration kit for the medical device dedicated to this use, the Vectorio^® kit marketed by the Guerbet laboratory.

Materials and methods
Assessment of professional practices in the use of the device in 2 steps. Within the pharmacy, an evaluation grid was used to assess the preparation staff’s handling of the device and their preparation of the syringes. Within the operating room, assessment during a procedure of the handling of the device by the nurses as well as the radio-interventional doctor.

Results
* At the pharmacy: In total, only half (3 out of 6) of the pharmacy technician had sufficient knowledge of the medical device, its indication and handling.
* In the operating room: The audit revealed misuse of the device, with the syringe being disconnected from the tap providing the closed system and exposing the operating room staff directly to the cytotoxic agent.

Discussion / Conclusion
The evaluation of the chemoembolisation circuit, from preparation to administration, led to the implementation of several actions: the creation of a video showing the syringe preparation towards the pharmacy staff, the implementation of chemoawareness for operating room nurses, and training in handling the device for radiointerventional doctors.

This study highlights the importance of the pharmacist’s educational role in supporting the use of specific medical devices and in preventing the risk of exposure to high-risk drugs such as cytotoxic agents, both within the pharmacy and in the various hospital departments.

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