Pharmacokinetics: Unique Challenges in Blood Monitoring for Oncology Nurses

Jitesh D. Kawedia

Nilesh Kalariya

Alison M. Gulbis

Borje S. Andersson

Alan L. Myers

stem cell transplantation, busulfan, pharmacokinetics, blood sampling
CJON 2019, 23(2), 191-196. DOI: 10.1188/19.CJON.191-196

Background: Pharmacokinetics (PK) is the study of the absorption, distribution, metabolism, and excretion of drugs. Many chemotherapeutic agents have a sensitive PK index, in which a small margin in blood concentrations is the difference between nontherapeutic, therapeutic, and adverse outcomes.

Objectives: This article will provide an overview of evidence-based approaches to the collection of PK samples, monitoring of PK levels, and the resulting management of patients undergoing PK testing.

Methods: A case study involving busulfan, an alkylating agent used in the pre–stem cell transplantation setting, will highlight the cross-contamination of samples while a drug is being infused through a central venous catheter with PK sample collection from a proximal peripherally inserted central catheter. The influence of false elevations in drug concentrations on PK-guided dose adjustments will also be emphasized.

Findings: Imprecise blood collections or cross-contamination of samples may lead to inaccurate drug concentration results and, subsequently, undesired low or high drug dosage calculations.

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