This guidance alerts NHS healthcare staff to the risks of administering vinca alkaloids intended for intravenous administration by the intrathecal (spinal) route in error.
Serious incidents of this type have been reported in hospitals outside the UK and include cases where vincristine doses had been diluted to 10ml and 20ml in syringes. Previous guidance was to dilute doses to 10ml or greater in a syringe, to reduce the risk of wrong route errors.
This guidance applies to all staff who prescribe, dispense or administer intravenous vinca alkaloid chemotherapy (vincristine, vinblastine, vindesine and vinorelbine) in adult and / or teenage patients. It also applies to all healthcare organisations irrespective of whether they also administer intrathecal chemotherapy.
This guidance applies to adult and/or teenage patients being treated in adult and adolescent units. It does not apply to children and teenagers being treated in a paediatric unit where minibags are not being recommended to administer vinca alkaloids.
Actions should be co-ordinated by the chief pharmacist and supported by senior management.
A summary of recommended forms of treating patients with intravenous vinca alkaloids is included.
This document is accompanied by supporting information which includes a review of evidence of harm, evidence of effectiveness and practice, summary, and conclusion.