To Push or Not to Push: The Benefit of Administering Anti-Emetics By Intravenous Push

Background

Prevention of chemotherapy-induced nausea and vomiting is crucial for maintaining the quality of life of cancer patients. Granisetron and dexamethasone are commonly used medications prior to chemotherapy to minimize these adverse effects. There are no well-defined guidelines on the route of administration of medications that are administered prior to chemotherapy. With the ever increasing cost of cancer care, innovative methods need to be employed to maximize utilization of resources.

Methods

A retrospective chart review was performed to identify patients who received granisetron and dexamethasone prior to emetogenic chemotherapy. The primary study site was the cancer center of a tertiary care community hospital. Over a two month period there were 1552 instances when patients received dexamethasone or granisetron prior to emetogenic chemotherapy. Patients either received medications by intravenous piggyback (IVPB) or intravenous push (IVP). The time spent on delivering medication by the two routes and the rate of occurrence of nausea and vomiting requiring the administration of rescue medications were compared.

Results

Patients who received granisetron and dexamethasone by IVPB had a 2.8% rate of adverse effect rate requiring rescue medications (n=806) and patients who received the medication by IVP had a 2.9% rate of adverse effects requiring rescue medications (n=746). There was no statistical significance in the occurrence of nausea and vomiting requiring rescue medications between the two groups (p>0.80). The total average duration for administration of granisetron and dexamethasone by IVPB was 30 minutes and two minutes by IVP. The average cost of an IVP is $57 as compared to $161 for IVPB based on national average costs.

Conclusions

An average of 28 minutes of chemotherapy chair time is saved on each patient for each session of chemotherapy by administering granisetron and dexamethasone by IVP. Approximately $167,000 would have been saved if the above IVPB group received medications by IVP. This sum excludes nursing costs, chemotherapy chair costs and other disposable charges. The route of administration of the medications did not affect the rate of occurrence of adverse effects requiring rescue medications. The utilization of the intravenous push route will save the patient time and reduce nursing hours without compromising on the effectiveness of the drugs while adding to sizeable cost savings.