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Closed-loop systems

Improving the administration of hazardous infusions

The implementation of new systems and technologies from CareFusion has improved safety for patients and operators in the Civitanova Marche Hospital (ASUR Area Vasta 3)

Maria Giacinta Manfroni Coordinator Operative Unit, Medicine/ Haematology Day Hospital Caterina Ferranti Massimo Sabbatini Professional Nurse Operative Unit, Haematology Day Hospital Maria Grazia Macellari Professional Nurse Operative Unit, Medicine/Haematology Day Hospital Civitanova Marche Hospital (ASUR Area Vasta 3), Italy

After years of experience in the administration of cancer therapies, mainly to patients suffering from blood diseases here at the Civitanova Marche Hospital, we would like to share our experiences using an improved safety infusion system – the closed-loop systems. This change in practice takes into account both the latest safety regulations and our participation in different professional development courses. Historical practice has been to use standard personal protective equipment and good sound judgement. In 2008, after several reports of accidental chemotherapy drug leaks and spillage from the usual infusion sets supplied, in collaboration with the Health and Safety Department, we agreed to evaluate the closed-loop systems. This would enable us to conform to local safety and quality standards.

Closed-loop systems are infusion administration sets that provide a closed, contained system that creates a safer system of working with hazardous infusions. They also reduce the number of interventions required when administering antiblastic drugs. The use

of this system reduces the risk of any accidental contact with these drugs, which could be dangerous for the operator and the patient.

In collaboration with the Hospital Pharmacy Service, we contacted the manufacturers, assessed the data sheets and evaluated the products they showed us. We did all this for approximately one year, after which, following careful review of the tests performed, we came to the conclusion that the set proposed by CareFusion met our requirements. The system we use is comprised of two

basic parts: an extension set (secondary set) for drug reconstitution and a multi- way infusion set. The extension set (secondary set) for drug reconstitution is attached to a bag/ bottle in the UMACA (Unità di Manipolazione Chemioterapici Antiblastici — chemotherapy handling unit), and then filled with saline solution; the extension set is then clamped and the bag is reconstituted via the self-sealing needle-free valve, with the undiluted drug taken from the vial.

The multi-way set looks like an 15

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