We undertook an analysis of fluorouracil elastomeric infusion devices to quantify the proportion of devices failing to infuse the correct volume in the specified time. From this evaluation we were able to quantify the problem, postulate a cause and implement a new method of infusional fluorouracil administration in this patient group.

It had been noted that patients treated with infusional 5FU sometimes presented for disconnection with a substantial proportion of their treatment un-infused. Over two and a half months we undertook a survey and evaluation of 120 returned elastomeric infusion devices to determine the extent of the problem, and if possible identify a cause and implement a correction.

We found that there were few issues with 2 day infusors but that 20% of 7 day, 69% of 4 day and 100% of 5 day infusors under-infused by an average of 24%. An examination of the method of administration determined that (as per institutional policy) 2 day infusion patients typically utilize port-a-caths, while other patients on longer infusions utilize PICC lines.

It was suspected that the resistance to flow in the PICC line is, in some circumstances, too great for the elastomeric infusor to overcome which results in a positionally dependent pulsatile flow, where depending on the activity or position of the patient the line is occluded only part of the time.

To overcome this problem, we evaluated the use of ambulatory pumps in this patient group. All test patients with previously problematic PICC lines and subsequently transitioned to ambulatory pumps demonstrated 100% infusion in the required time. We are now in the process of rolling out ambulatory pumps to the entire patient group and will complete a follow up survey and evaluation of this administration method by October 2015.