Residual volume of anticancer drugs when administering a preparation with filter tubing: What solution?

Context
Within our oncology department, anti-cancer drugs are administered using infusion pumps. Some of these treatments require the use of a tube fitted with a 0.2µm filter. During the administration of anticancer drugs, Nurses reported the presence of residual volume in the infusion bags equipped with filter tubing. In 2017, Codan has introduced a shorter tubing system which reduce the angle formed by the tubing when connected to the infusion shaft. The efficiency was not sufficient.

Objective
Assessing the residual volume from the initial administered method and evaluation of the new infusion Bag Hanger^® from Codan.

Material and method
During two weeks, visual estimation of the residual volume from all the administered infusion bag equipped with tubing filter was recorded by the same person.
The infusion pumps were programmed in flow rate mode in order to overcome the standard overfilling of the bags.
Same process was repeated with the use of the Infusion Bag Hanger^® which increase the verticality of the tubing. The number of bags involved and the volumes found in the two cases were compared respectively with the Chi-square and Wilcoxon-Mann Whitney tests.

Results
During the study, Eleven molecules have been found such as : l’aflibercept, l’atezolizumab, le daratumumab, le durvalumab, l’ipilimumab, l’isatuximab, le nivolumab, le paclitaxel, le panitumumab, le pembrolizumab et le trastuzumab emtansine.
Out of the 98 preparation administrated using tubing filter, 20 of them have presented residuals volume.
This result was high for nivolumab with 10 out of 12 preparations and for daratumumab with 5 out of 9. Their average residual volume was estimated at 14.5ml [5ml to 40ml]. It could represent up to 26% of the initial volume of the preparation. In the comparative study, the average residual volume was estimated to be 10ml [5ml to 20ml] with 23 of the 100 administered preparations involved.
No association between the use of Infusion bag Hanger^® and the absence of residual volume was statistically demonstrated (p < 0.731). The observed volumes were not significantly lower in the comparative study (p < 0.918).

Conclusion
This problem is restrictive for the nurses who have to apply pressure on the bag to administer the entire preparation to the patient. The solution considered is not relevant. The study could however gain in reliability with a more precise measurement method.

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