# Ambulatory chemotherapy pumps at home: set-up, checks, spills and disconnection

Source: https://onco.cc/protocols/ambulatory-chemotherapy-pumps-at-home/  
OnCo record `ambulatory-chemotherapy-pumps-at-home` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some chemotherapy, such as fluorouracil for bowel cancer, runs for about two days from a small pump you carry home, connected to your port or PICC. The rate is set in the pharmacy or checked by two nurses before you leave. You will be told how to carry it, what to do if it leaks or the line comes apart, and who to call day or night.

## Summary

Home infusion pumps carry a particular hazard: a programming or calculation error delivers days of chemotherapy in hours. ISMP Canada's root cause analysis of a 2006 death, in which fluorouracil intended to run over 4 days ran over 4 hours, found that the order lacked the volume and rate to programme, the rate had to be calculated through several steps, the label carried a confusing 'mL/24 h' figure, the pump gave little feedback, and checks were not truly independent. Its recommendations: put the critical administration details (total volume, rate) in standard order sets; standardise volumes or concentrations so the calculation is built into the order; express rates only in mL per hour; use pumps with safeguards such as pharmacy-controlled rates (elastomeric pumps) or preset maximum rates; and embed independent double checks with documented calculations.

ASCO-ONS (2024) requires a second verification at preparation and a final check before administration that includes pump settings and rate, confirmation with the patient of the drug, infusion time and symptoms to report, and education on home handling: storage, waste, body fluids and spill clean-up. Elastomeric pumps fail too: in 205 incident reports from one pharmacy, 44% were leaks, 30% flow anomalies and 20% injection difficulties, and fluorouracil residue has been found around the catheter connection. A closed-system device reduced contamination at disconnection in a laboratory study, and a small pilot found patients could be trained to disconnect their own pump.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: chemo pump at home; 5-FU pump; fluorouracil infusor; elastomeric pump; balloon pump; 46-hour infusion; baby bottle pump; CADD pump; pump disconnection; infusor

## Connected records

- protocols: [Anticancer treatment administration checks at the chair: assessment, independent double checks and line tracing](https://onco.cc/protocols/sact-administration-checks-at-the-chair/), [Oral anticancer medicines at home: prescribing, teaching, adherence, storage, handling and disposal](https://onco.cc/protocols/oral-anticancer-medicines-at-home/), [Safe handling of hazardous anticancer drugs where they are given: protective equipment, closed systems, spills, waste and body fluids](https://onco.cc/protocols/hazardous-drug-handling-in-clinical-areas/)
- technologies: [Ambulatory and elastomeric pumps for home chemotherapy (CADD-Solis, Curlin, Sapphire, Avoset, SMARTeZ)](https://onco.cc/technologies/ambulatory-chemotherapy-pumps/), [Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield)](https://onco.cc/technologies/closed-system-transfer-devices/), [Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)](https://onco.cc/technologies/implanted-ports/), [Peripherally inserted central catheters (PICC lines)](https://onco.cc/technologies/picc-lines/)
- drugs: [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/)
- terms: [Living with FOLFIRINOX, NALIRIFOX and gemcitabine with nab-paclitaxel](https://onco.cc/terms/chemotherapy-side-effects-pancreatic/)

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