Real-Life Test of a Secure Device for the Preparation and Administration of Anticancer Drugs: Chemolock^® (ICU Medical)

Context
Our unit prepares over 40,000 injectable anticancer drug preparations annually. Currently, the bags are presented with a short Luer-Lock^® connector at the distal end, with or without a filter. Due to several issues encountered with this system, we decided to test the feasibility of deploying a new secure device for the preparation and administration of anticancer drugs.

Materials and Methods
The Chemolock^® devices (ICU Medical) were used for two weeks in January 2023 to prepare and administer bags of injectable anticancer drugs intended for the oncology day care unit. The tested devices included spikes with Y-valves, simple spikes, Chemolock^® adapters for infusion tubing, and 0.22µm filters. A qualitative evaluation questionnaire was submitted to pharmacy practitioners (Q-PPH) and nurses (Q-IDE) who used the device to compare it with our current setup. The Q-PPH assessed the device’s ergonomics, preparation speed, ease of injection and homogenization, and safety of use. The Q-IDE assessed ergonomics, ease of connection/disconnection, material quality, filter purging, handling time, and safety of use. Each item was rated as very good/good/average/poor. The evaluator then had to assess the overall superiority or inferiority of the setup. The questionnaires were submitted after one week of use to mitigate the bias related to the learning curve.

Results
We received 6 Q-IDE responses: 100% rated all items as very good, except for filter purging, which was rated as good or average in 50% of cases. The purging of the filter was performed by pharmacy practitioners in the old setup and by nurses in the new setup, explaining the expressed reservations. 100% of Q-IDE respondents considered the new setup superior, particularly in terms of connection safety and reduction of the risk of musculoskeletal disorders. Among the 4 Q-PPH responses received, ergonomics, speed, and safety of use were rated as very good in 75% of cases and good in 25%. The injection of the active ingredient and homogenization were rated as average or poor in 75%. The setup was considered superior in 75% of Q-PPH responses and equivalent in 25%. The time saved was the main positive aspect, and the resistance of the injection valve was the main negative point.

Discussion
The new setup was well received by nurses. A discussion is underway with the supplier regarding the injection valve issue raised by pharmacy practitioners. The results of this trial are consistent with routine use of this device, provided that the additional cost (+123%) is accepted.

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