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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.
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.
Why: A fatal overdose happened when nurses had to calculate the rate from the dose themselves and made an error.
“Include critical information required for medication administration as part of standardized order sets in manual and electronic medication orders.”
Why: If the rate cannot be programmed wrongly at the bedside, the error that killed a patient in 2006 cannot happen.
Common practice: ISMP Canada recommends pumps with safeguards such as pharmacy-controlled rate delivery (elastomeric pumps) or preset maximum rates, but its recommendation tables are set in columns that the extracted text interleaves, so the sentence cannot be quoted verbatim.
Why: A truly independent check, done without being told the answer, catches calculation and programming slips.
“Infusion pump (if applicable) settings, including rate”
Why: A person who knows the pump should run for about two days will notice if it empties in hours.
“Before initiation of antineoplastic therapy, personnel approved by the health care organization who is administering the antineoplastic(s) confirms the therapy with the patient, including, at a minimum, the name of the drug, the infusion time, route of infusion, symptoms to report, for example: hypersensitivity symptoms or pain at infusion”
Why: Pumps can leak, and fluorouracil residue has been found around the connection.
“Procedures for safe handling medications in the home, including disposal of waste, handling body secretions, storage, safe handling, and management of unused medication, and clean-up of drug spills”
Why: Leaks and flow problems are the commonest pump failures.
“The main technical failures were: chemotherapy product leakage (44%), flow rate anomalies (30%) and injection difficulties (20%).”
Journal of Oncology Pharmacy Practice (Chefchaouni et al.) 2023
Why: Drug residue on the pump and connection can expose nurses, patients and family.
“The detection of 5-FU residues highlights the critical need for safe handling practices and the consistent use of personal protective equipment (PPE) to protect healthcare workers, especially nursing staff involved in the removal of the infusion pumps, after treatment.”
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
No graded guideline on home chemotherapy pumps could be read. The strongest open source is ISMP Canada's root cause analysis (2007): critical administration details in the standard order, standardised volumes or concentrations, rates in mL per hour only, pumps with rate safeguards, and truly independent double checks. ASCO-ONS (2024) adds verification of pump settings and rate before administration, confirmation with the patient of the infusion time, and home safe-handling education. Disconnection with a closed-system device and patient self-disconnection are promising but rest on small studies.
Institute for Safe Medication Practices Canada 2007 · ASCO and ONS (JCO Oncology Practice) 2024
Where it differs: Connects the pump line to the port needle through a closed-system device instead of a standard Luer lock or needle-free connector.
Evidence: In a laboratory study of 30 elastomeric pumps, overall 5-FU contamination at disconnection was significantly lower with the closed device (Qimono) than with Luer lock or a needle-free connector; wipes showed 43 to 61% less contamination.
Where it differs: Trains selected patients to disconnect their own pump and do basic line care instead of a nurse visit.
Evidence: A six-month pilot of nine patients reported time savings of 102 minutes per cycle for patients and 64 for home care nurses, with stable satisfaction. Too small to judge safety.
Annales Pharmaceutiques Françaises (Al Fartousi et al.) 2026
Shares Safe handling of hazardous anticancer drugs where they are given: protective equipment, closed systems, spills, waste and body fluids, Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield).
Shares Safe handling of hazardous anticancer drugs where they are given: protective equipment, closed systems, spills, waste and body fluids, Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield).
Shares Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports).
Shares Ambulatory and elastomeric pumps for home chemotherapy (CADD-Solis, Curlin, Sapphire, Avoset, SMARTeZ), Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield).
Shares Ambulatory and elastomeric pumps for home chemotherapy (CADD-Solis, Curlin, Sapphire, Avoset, SMARTeZ), Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield).
Shares Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports).
Shares Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports).
Shares Peripherally inserted central catheters (PICC lines), Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports).