Ensuring intravenous use of vinca alkaloids
Vinca alkaloids (vincristine, vinblastine, vindesine and vinorelbine) are for intravenous use only.
Incorrect administration via the intrathecal route can cause paralysis followed by death.
All NHS Trusts must comply with the minimum requirements for the preparation, labelling, packaging and administration of vinca alkaloids. These are designed to prevent vinca alkaloids being mistaken for an intrathecal injection and administered by the intrathecal route in error.
The National Patient Safety Agency (NPSA) published guidance on using vinca alkaloids in 2008. This has now been archived but is still available as a best practice guide for reference. The archived national guidance can be found in the National archive – Vinca alkaloid minibags (adult/adolescent units).
The minimum requirements are summarised below, refer to the national guidance for full details.
Product presentation
Ready to administer preparations
All vinca alkaloids must be supplied ready to administer from pharmacy so no further dilution by nursing staff is required.
Bag and syringe size
Adults and adolescents
Vinca alkaloids for adults and adolescents are prescribed, prepared, dispensed and administered in a 50mL minibag of sodium chloride 0.9% or glucose 5% according to stability.
Children
Vinca alkaloids for children are prescribed, prepared, dispensed and administered in a 10mL or greater syringe size.
Labelling and packaging
All vinca alkaloid labels should use positive messaging in the largest practical font size for the route of administration. For example, ‘For intravenous use only – fatal if administered by other routes’.
There should be sensible use of colour and design on the label, outer packaging and delivery bags to further differentiate vinca alkaloid minibags from other minibag infusions.
Administration
Vinca alkaloid minibags should be infused intravenously over 5 to 10 minutes and the patient closely monitored for signs of extravasation.
Governance
Local protocols
The Trust must have a current and approved local chemotherapy protocol(s) which covers the requirements for vinca alkaloids, from preparation through to administration.
Staff training in local chemotherapy protocols should explain the patient risks if intravenous vinca alkaloids are accidentally administered intrathecally.
Regular audit
The Trust must have processes in place to regularly self-audit practice and act on the results to ensure it is compliant with the national guidance.
Trusts providing both intrathecal chemotherapy and vinca alkaloid chemotherapy must ensure that there are processes in place to comply with both the national guidance on vinca alkaloids (NHS national archives) and the national guidance on safe intrathecal administration (Department of Health national archives) to prevent wrong-route administration. The SPS article on managing an intrathecal chemotherapy service provides more information.
Reporting arrangements
All near misses or incidents relating to vinca alkaloid chemotherapy should be reported and managed as per the Trust’s incident reporting process.
Reporting arrangements for escalation of any incidents, issues or non-compliances identified via self or external audit should be defined, for example chemotherapy working group or committee.