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Evaluation of a pediatric pre-chemotherapy rapid hydration protocol: A quality assurance project
Krista McKinnon1, Tracey Tran, Victor Lewis2
1Pharmacy Services, 9978Alberta Children's Hospital, Calgary, AB, Canada.
Insights
Rapid hydration protocols significantly reduce the time pediatric oncology patients meet urine parameters for chemotherapy. This approach supports timely treatment initiation and completion, improving patient care.
Area of Science:
- Oncology
- Pharmacology
- Nephrology
Background:
- Intravenous hydration is crucial for preventing nephrotoxicity and enhancing drug elimination in high-dose chemotherapy.
- Prolonged hydration can delay chemotherapy initiation and extend hospital stays.
- Rapid hydration protocols aim to expedite patient readiness for chemotherapy.
Purpose of the Study:
- To evaluate the effectiveness of a rapid hydration protocol at Alberta Children's Hospital (ACH).
- To assess the impact of rapid hydration on chemotherapy administration timelines.
Main Methods:
- Prospective data collection from January to May 2018 for pediatric oncology patients receiving specific chemotherapies (methotrexate, cisplatin, cyclophosphamide, ifosfamide).
- Primary outcome: time to achieve pre-chemotherapy urine parameters.
- Secondary outcomes: proportion of cycles meeting parameters and hydration step efficacy.
Main Results:
- Median time to meet urine parameters was 120 minutes (range 30-600 minutes) across 22 cycles (13 MTX, 9 non-MTX).
- Two MTX cycles (15%) failed rapid hydration; no non-MTX cycles required further hydration.
- No significant adverse events related to hydration were reported.
Conclusions:
- The ACH rapid hydration protocol successfully reduced the time to meet target urine parameters.
- The findings support the continued implementation of rapid hydration before chemotherapy administration.
- This quality assurance review indicates the protocol's benefit in pediatric oncology care.
Introduction:
Intravenous hydration may be utilized to prevent nephrotoxicity and facilitate drug elimination in patients receiving high-dose chemotherapy. Prolonged hydration protocols may lead to delayed initiation and completion of therapy, lengthening hospital admissions. Rapid hydration protocols have been implemented to reduce the time required for patients to meet parameters for chemotherapy administration. This study aims to evaluate a rapid hydration protocol implemented at the Alberta Children's Hospital (ACH).
Methods:
Starting January 2018 through May 2018, data was prospectively collected for pediatric oncology acute care and ambulatory patients at ACH receiving methotrexate (MTX), cisplatin, cyclophosphamide, or ifosfamide. The primary outcome was the time to achieve pre-determined urine parameters prior to chemotherapy administration. Secondary outcomes included the proportion of cycles that achieved urine parameters and the efficacy of each rapid hydration step.
Results:
A total of 22 cycles were included, 13 for MTX and 9 for non-MTX chemotherapy. Median time to meet all urine parameters was 120 min (range 30-600 min). Two cycles (15%) failed rapid hydration in the MTX group, while no cycles required further hydration in the non-MTX group. Adverse events potentially attributable to hydration were mild and did not require intervention.
Conclusion:
The ACH rapid hydration protocol resulted in reduced time to meet target urine parameters. The results of this quality assurance review support the continued use of rapid hydration prior to chemotherapy administration.
