Tevadaptor^® closed-system novel design: flow separation, homogenization and ergonomic assessments on the new Chemfort^TM transfer device

Introduction
In case of an urgent chemotherapy request during a shift in our hospital, the pharmacy intern reconstitutes the drug at the Cytotoxic Preparation Unit, on the bench, using a closed-system transfer device. Until now, the transfer device of the Tevadaptor^® range used in our unit had a clamp to avoid the drug diffusion towards the tube during its injection into the infusion bag. At the launch of the new Chemfort^TM system, permanently replacing the Tevadaptor^® range, the transfer device has been shortened and the clamp has been removed. The clamp has been replaced by two internal channels allowing the flow separation.

Objectives
To test the independence of the flows during the use of the new Chemfort^TM design and consequently the non-diffusion of cytotoxic products into the tube, despite the absence of a clamp. To observe that the infusion bag is properly homogenized before the administration. To assess the ergonomic improvements brought by the new system, in order to decide whether it should be used in our center.

Material and method
Comparison between the old Tevadaptor^® system and the new one Chemfort^TM: simulation of the drug dissolution with a colored marker (eosin). Observation of colored liquid flows during the injection between the syringe and the infusion bag, and then after homogenization. Assessment of the ergonomic progress of the new range.

Results
No diffusion of the colored marker towards the tube was observed during injection into the infusion bag via the closed-system transfer device, whether using the old Tevadaptor^® range correctly clamped or the new ChemfortTM design. Suppressing the clamping step with the Chemfort^TM design allows a convenient handling and reduces preparation time. After homogenization, the colored marker does not diffuse into the tube.

Discussion – Conclusion
The absence of a clamp on the new Chemfort^TM design is not an issue for the drug diffusion out of the infusion bag during the preparation, confirming the flow separation. Forgetting to clamp the tube before the product injection with the old Tevadaptor^® model was a risk for the patient to be exposed to a bolus effect, and for the nurse to a cytotoxic drug exposure. The new Chemfort^TM model avoids this hazardous step. It also ensures the correct homogenization of the drug in the infusion bag. Easy to use and more ergonomic than the Tevadaptor^®, it was decided to list it in our center, following a review of our internal procedures.

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