Download NICaN Nurses Guide Infusor System FINAL

A nurse’s guide
to the care of
an Infusor System
Infusional Services / BCH / 2016
What is an Infusor System?
An Infusor System is a small, lightweight, disposable, non-electronic portable device. It contains an
elastomeric balloon pre-filled with a chemotherapy drug that is encased inside a plastic bottle. This
method of delivery is a convenient way of administering chemotherapy to avoid long stays in
hospital and to keep life as normal as possible for the patient. Delivering treatment in this way is
called ‘ambulatory chemotherapy’. The patient must have a Central Venous Access Device
(CVAD) in place in order to receive chemotherapy via an Infusor System.
A CVAD is a thin, soft, flexible tube, made of silicone or polyurethane; the tip of which resides
within the lower third of the superior vena cava or near its junction with the right atrium. The
CVADS used to administer ambulatory chemotherapy are a Peripheral Inserted Central Catheter
(PICC) which is inserted in a peripheral vein above the antecubital fossa of the arm, or a tunnelled
catheter which is inserted into the chest wall. An implantable port, though rarely used because of
the increased risk of extravasation, can be sited in either the chest wall or upper arm. Placement of
a CVAD will be arranged prior to the patient commencing treatment.
An Infusor System is a ‘user-friendly’ system, requiring minimal input from the patient and can be
carried conveniently in a pouch to keep it safe. There are certain precautions that the patient must
be aware of when receiving ambulatory chemotherapy.

For safety reasons the patient should be advised to keep the Infusor System out of the
reach of vulnerable persons

It is important to ensure that the delivery tubing is secure to avoid pulling on the CVAD

The Infusor System must not come into contact with direct heat sources such as radiators,
open fires and direct sunlight

Care should be taken when bathing or showering. The Infusor System must be kept dry and
must not be submerged in water.
Infusional Services / BCH / 2016
What does the Infusor System look like?
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Diagram 1.
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Winged Luer Cap protects the opening and stops the flow of medication
Luer Lock Connector at end of the delivery tubing. Attaches Infusor System directly to the central catheter
Flow Restrictor controls how fast the medication is infused
Delivery Tubing carries the ‘fluid medication’
Balloon holds the ‘fluid medication’
Progression Lines shows how much medication has been infused
Fill Port Protector Cap protects where the medication was filled
Plastic Housing
Infusional Services / BCH / 2016
How does the Infusor System Work?
The plastic bottle, with the named drug inside, will be attached to the end of the CVAD by the
delivery tubing. When the balloon is filled with the drug, it creates hydrostatic pressure inside the
balloon to empower the infusion. The balloon inside the bottle moves the medication into the
tubing and through the CVAD on removal of the luer cap. The small white connection or flow
restrictor controls how fast the medication flows and must lie next to the skin as the heat of the
body regulates the flow of infusion. For this reason, gauze must not be placed beneath the flow
restrictor. Different sizes of flow restrictors provide different amounts of medication. The hospital
has chosen the medication and speed of flow that is appropriate for the patient. The medication
will run continuously for a period of days depending on the regimen, until it is completed or
requires changing.
Checking the progress of the Infusor System
The Infusor System will deflate very slowly over a period of days. The patient should examine the
Infusor System daily to check that the balloon is deflating and the drug is being delivered. They will
know that the Infusor System is delivered when the balloon is fully deflated. Diagram 1, point 6
shows progression lines of the balloon as it deflates over time.
How to disconnect an Infusor System from a CVAD
Equipment for a PICC / tunnelled catheter:
Personal Protective Equipment (1 x pair nitrile non sterile gloves, apron, armlets, eye protection)
1 x Green clinell wipe
1 x Luer cap for completed Infusor System
Gauze
Cytotoxic burn bin
1 x 10mL prefilled syringe or alternatively 1 x 10mL sodium chloride 0.9% for injection amp /
1 x 18G filter needle / 1 x 10mL luer-lok syringe / 1 x luer cap
Additional equipment for a tunnelled catheter:
Heparin sodium 5mL (50 units in 5mL), 1 x 10mL luer-lok syringe, 1 x filter needle, 1 x luer cap
Implantable Ports
When flushing implantable ports it is important to verify if heparinisation is required. This will depend on
the manufacturer. These details will be provided by the patient’s treating unit.
Infusional Services / BCH / 2016
Procedure
1. Adhere to Hand Hygiene and Aseptic Non-Touch technique (ANTT) Policies
2. Prepare flushes
3. Don personal protective equipment
4. Place gauze underneath luer connector and disconnect the Infusor System
5. Attach a luer cap over the end of the connector of the Infusor System and dispose of in the
cytotoxic burn bin
6. Wipe the end of the needleless connector with a green clinell wipe for 20 seconds and allow to
dry for 30 seconds
7. Attach 10mL syringe of sodium chloride 0.9% for injection to the needleless connector and
flush the catheter using a pulsatile (push-pause) method, completing procedure using a
positive pressure technique. This will create a turbulent flow within the catheter and prevent
occlusion
8. To maintain positive pressure on completion of flush, push gently on the plunger of the syringe
while instilling the last 1mL of flushing solution, disconnecting the syringe or clamping the
catheter simultaneously
9. If the patient has a tunnelled catheter, follow the sodium chloride 0.9% for injection with
heparin sodium 5mL (50units) and repeat as before
10. If the patient has an implantable port check with the patient’s treating unit as to the correct
flushing agent and volumes
11. Dispose of gauze, clinell wipe, syringe, the Infusor System and personal protective equipment
in the cytotoxic burn bin
12. If Infusor System is removed in community, advise the patient to store it safely and return to
treating unit at next visit.
What problems can occur with an Infusor System?
The following problems may occur with the Infusor System that you need to be aware of:-
The medication may not infuse

Remember that the Infusor System flows very slowly, so make sure that you have waited
the prescribed time before disconnecting
Infusional Services / BCH / 2016

To infuse effectively, the ‘Flow Restrictor’ must be in contact with the patient’s skin. Gauze
must not be placed beneath the small white connector or flow restrictor as this will affect the
rate of flow

If the patient has a CVAD with clamps, ensure they are unclamped

If the medication is still not flowing/totally infused, contact the treating unit
A spillage may occur
Although rare, a spillage or a leak can occur from either the Infusor System or the CVAD. In the
case of such an event and as a precaution, on discharge the patient will be provided with
equipment to deal with a spillage. If a spillage occurs, the volume of fluid will be minimal as the
flow rate is a maximum of 2mL per hour. This may be seen as a clear fluid or a “white powdery”
substance when dry. It can appear underneath the dressing, down the arm or on the chest wall
depending on the central catheter in place. The spillage can occur for several reasons, as listed
below:
A fault in the fill port protector cap (7)

A fault or a hole in the delivery tubing (4)

A fault or loose connection at the luer connector (2) of the Infusor System

A loose connection at the needleless connector at the end of the CVAD

A fracture in the CVAD

Disconnection of gripper needle form implantable port
If a spillage does occur please follow the points overleaf and then contact the patient’s treating unit
as soon as possible for advice. Documentation of incident is required in written and/or electronic
form depending on local policy.
Infusional Services / BCH / 2016
Key points to handling a spillage
If a spillage occurs it is important to take prompt action.
1. Please contact the treating unit as soon as possible to inform them of the spillage and gain
advice on subsequent action and follow the points below
2. Open the equipment provided to deal with the spillage and don personal protective equipment
3. Place gauze under luer connector and disconnect the Infusor System from the CVAD by
turning the connector in an anti-clockwise direction and attach the luer cap provided to cover
the end of the Infusor System tubing. Place the Infusor System into the burn bin provided
4. Absorb any spillage immediately using the plastic backed pads
5. Place all equipment used into the cytotoxic burn bin and seal the lid
6. If the fluid from the Infusor System comes into contact with the patient’s skin, wash the area
immediately with plenty of tap water. This should then be repeated using warm soapy water, and
the area gently dried. Do not apply any moisturising cream or hand cream on the affected area.
Advise patient if redness or irritation lasts for longer than a few hours to contact their GP or
ward/clinic/patient helpline
7. If the chemotherapy drug comes into contact with the patient’s clothes, advise them to remove
these wearing the gloves provided and wash affected clothes separately through two cycles of
a normal wash
8. If a carer is handling the clothes, advise them that they should wear gloves
9. Return the sealed, signed cytotoxic burn bin to the treating unit as soon as possible.
Infusional Services / BCH / 2016
Bibliography:
Allwood, M. et al (2003) The Cytotoxics Handbook. 4th Ed. Radcliff Medical Press. UK.
Belfast Health and Social Care Trust (2014) Aseptic Non Touch Technique (ANTT) policy.
Belfast Health and Social Care Trust (2015) Control of Substances Hazardous to Health (COSHH)
policy
Dougherty, L. and Lamb, J. (1999) Intravenous Therapy in Nursing Practice. London: Churchill
Livingstone.
Epic3.(2014) The Journal of Hospital Infusion. National evidence-Based Guidelines for Preventing
Healthcare-Associated Infections in NHS Hospitals in England. (Volume 86) Supplement.
Northern Ireland Cancer Network, (2016) Guidelines for the safe prescribing, handling and
administration of hazardous drugs.
Royal College of Nursing, (2010) Standards for infusion therapy. London: 3rd Edition.
Infusional Services / BCH / 2016