Safe Vincristine Handling: Just Bag It
At NCCN, our mission to improve the lives of patients with cancer is at the core of everything we do and ensuring patient safety is of utmost importance.
That's why we launched the NCCN Just Bag It Campaign in 2016 for the safe handling of vincristine, calling for healthcare professionals to always dilute vincristine in a 50ml mini-IV drip bag and never in a syringe.
Why Bag It?
Vincristine is an important chemotherapeutic agent properly administrated intravenously in the treatment of many patients with leukemia or lymphoma. However, improper administration of vincristine is fatal. When it enters the blood, it is highly effective at blocking the growth of cancer by preventing cells from separating. However, vincristine is a neurotoxin that causes peripheral neuropathy when given intravenously and causes profound neurotoxicity if given into the spinal fluid, which flows around the spinal cord and brain.
Many patients who receive vincristine have a treatment regimen that includes other chemotherapy drugs that are administered intrathecally, or injected into the spinal fluid with a syringe. If vincristine is mistakenly administered into the spine, it is uniformly fatal, causing ascending paralysis, neurological defects, and eventually death.
NCCN’s Member Institutions create the cancer treatment guidelines (NCCN Guidelines®) that set the standard for care in the US and around the world. NCCN’s Best Practices Committee, which is dedicated to improving cancer treatment protocols, issued guidelines advising healthcare providers to always dilute and administer vincristine in a mini IV-drip bag and never use a syringe to administer the medication. This precaution renders it impossible to accidentally administer the medication into the spinal fluid and greatly decreases the chances of improper dosage. Today, all NCCN Member Institutions have adopted the safety practice.
.png?sfvrsn=2929e71c_1 "Vincristine Prepared in IV Drip Bag (RECOMMENDED)")
.png?sfvrsn=91ef761_1 "Vincristine Prepared in Syringe (NOT RECOMMENDED)")
NCCN Templates
In 2008, the Best Practices Committee led the charge to publish the NCCN Chemotherapy Order Templates (NCCN Templates®). Today, there are more than 2,300 NCCN Templates®, which detail the most common regimens for many cancers and highlight safety parameters and special instructions. For more information about NCCN Templates, visit NCCN.org/templates.
Making a Difference
In 2020, in response to the NCCN Just Bag It campaign, as well as the advocacy of other organizations, the U.S. Food and Drug Administration (FDA) requested Pfizer remove syringe administration from the labeling for vincristine to prevent the fatal error of incorrect route of administration. This labeling change is a significant accomplishment that will save lives! We would like to thank the Institute for Safe Medication Practices (ISMP) for their tireless efforts to promote awareness and advocate for vincristine safety. Read their June 2020 press release here. Other organizations that have helped promote the practice of dispensing vincristine via minibag include The Joint Commission (TJC), Oncology Nursing Society (ONS), American Society of Clinical Oncology (ASCO), and the World Health Organization (WHO). Of course, we would also like to commend all of the cancer centers that adopted this approach to ensure that vincristine is always administered properly.
Christopher's Story
Christopher Robin Wibeto, the third of four children, a lover of movies, computer games and progressive rock music, passed away August 29, 2005 in Stanford, California at the age of 21 following a tragic medical error involving the mishandling of the chemotherapy agent, vincristine. Christopher had been hospitalized for about a month with Non-Hodgkins Lymphoma, but was making progress as the treatments went on. He and his mother had discussed traveling to Florida and Georgia to visit his siblings when he felt better. He was also considering going back to school. But one day, Christopher mistakenly received an injection of the chemotherapy agent vincristine into his spinal fluid. Medical oncologist Robert W. Carlson, MD cared for Christopher at another hospital following the mistake and watched, distraught, as Christopher’s condition deteriorated and nothing could be done to reverse it. He died within four days. When Dr. Carlson served as CEO of NCCN from 2013-2023, he worked to prevent future errors.
On November 10, 2016, Christopher’s parents, Robin and Debra Wibeto, joined NCCN to launch a national campaign: Just Bag It: The NCCN Campaign for Safe Vincristine Handling. The effort calls for all cancer treatment providers in the US and abroad to adopt the NCCN recommended guidelines to eliminate the possibility of this tragic medical error once and for all. "We are proud and honored to be part of this campaign," Debra Wibeto said. "If it saves even one life, Christopher’s death will have made a difference."