# Intrathecal chemotherapy safety and vinca alkaloids given only by minibag

Source: https://onco.cc/protocols/intrathecal-chemotherapy-and-vinca-alkaloid-safety/  
OnCo record `intrathecal-chemotherapy-and-vinca-alkaloid-safety` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some treatments are injected into the fluid around the spine (intrathecal chemotherapy). Vincristine and related drugs, given into a vein, are fatal if injected there by mistake. Hospitals prevent this by keeping spinal chemotherapy separate in time and place, using only trained and registered staff, double checking with you, and giving vincristine from a small drip bag rather than a syringe.

## Summary

Vinca alkaloids (vincristine, vinblastine, vindesine, vinorelbine) cause paralysis and almost always death if injected intrathecally; HSC 2008/001 cites 55 such incidents worldwide. The safeguards are of two kinds. First, intrathecal chemotherapy is separated: ASCO-ONS (2024, standard 3.13) requires it to be prepared separately, uniquely labelled, stored and delivered apart from other chemotherapy, and given immediately after a time out with a two-practitioner double check. England's HSC 2008/001 goes further: a register of trained and authorised staff for every task (prescribing, dispensing, issuing, checking, administering), issue only after written confirmation that the day's intravenous chemotherapy has been given (paediatric exceptions), a separate room with walls and a door used for nothing else in that session, a check by a second registered person and the patient if they wish, and normal working hours.

Second, intravenous vinca alkaloids are given only by infusion from a minibag, never a syringe. ISMP Best Practice 1 applies this in every setting, and ISMP does not accept large-volume syringes as an alternative; ASCO-ONS requires it where intrathecal chemotherapy is given; the NPSA alert of 2008 applied it to adult and adolescent units and not to paediatric units. Extravasation was similarly rare with syringes and minibags (0.03% and 0.04% in an Australian study cited by ISMP).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: intrathecal chemotherapy safety; ITC register; vincristine minibag; wrong-route vincristine; never event vincristine; spinal chemotherapy checks; HSC 2008/001; NPSA RRR004; ISMP best practice 1

## 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/), [Anticancer treatment prescribing and pharmacy verification before each cycle](https://onco.cc/protocols/sact-prescribing-and-pharmacy-verification/)
- drugs: [Cytarabine](https://onco.cc/drugs/cytarabine/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Vinblastine](https://onco.cc/drugs/vinblastine/), [Vincristine](https://onco.cc/drugs/vincristine/), [Vindesine](https://onco.cc/drugs/vindesine/), [Vinorelbine](https://onco.cc/drugs/vinorelbine/)
- terms: [Intrathecal therapy (lumbar puncture, Ommaya reservoir)](https://onco.cc/terms/intrathecal-therapy/)

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