Vincristine NPSA alert

August 13, 2008

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The NPSA in the UK have reported on “…reports of serious incidents in hospitals outside of the UK in which doses of vinca alkaloids intended for intravenous administration have been administered by the intrathecal (spinal) route in error, updated advice has been issued to the NHS. The incidents include three cases where doses of vincristine had been diluted to 10ml and 20ml in syringes”.

IVTEAM has reported on one of these cases here.

The NPSA continue with “Previous guidance to the NHS in England and Wales was to dilute doses of vinca alkaloids to 10ml or greater in a syringe in order to reduce the risk of wrong route errors. This guidance needs to be updated following the learning from these incidents in other countries.

When vinca alkaloids are prescribed, dispensed or administered in adult and adolescent units:

• Doses in syringes should no longer be used.

• The prescribed dose should be supplied from the hospital pharmacy ready to administer in a 50ml minibag of sodium chloride 0.9% (for some brands of vinorelbine glucose 5% solution for injection may be used instead of sodium chloride 0.9%).

• The following warning should be prominently displayed on the label of ALL vinca alkaloid doses ‘For Intravenous Use Only – Fatal If Administered by Other Routes’.

• There should be judicious use of colour and design on the label, outer packaging and delivery bags to further differentiate minibags containing vinca alkaloids from other minibag infusions.

• The vinca minibag should be infused intravenously over 5 - 10 minutes and the patient closely monitored for signs of extravasation. Incidents of extravasation should be reported and shared via the National Extravasation Information Service (www.extravasation.org.uk).

• Chemotherapy policies and procedures should be amended to reflect these requirements.

• Staff should be alerted and trained to follow the new practice.

• Practice should be audited to ensure compliance with the revised safety procedure”.

Click here for the NPSA page on this topic.