Dilution of 5-Fluorouracil in Baxter Ambulatory Infusion Pumps
5-Fluorouracil (5-FU) for continuous infusion in Baxter ambulatory pumps should be diluted to concentrations between 1-16 mg/mL using either 0.9% sodium chloride or 5% dextrose, and is stable for at least 7 days when stored at 4°C with light protection in PVC bags 1.
Preparation and Storage Guidelines
Concentration Range
- Recommended dilution range: 1-16 mg/mL in PVC bags
- Most commonly used concentrations in clinical practice range from 1.8 mg/mL to higher concentrations depending on the specific regimen 1
- The solution maintains stability across this entire concentration range
Compatible Diluents
Both of the following are appropriate:
- 0.9% sodium chloride injection
- 5% dextrose injection
Both diluents demonstrate equivalent stability profiles with no significant drug degradation 1, 2.
Storage Conditions
- Temperature: Store at 4°C (refrigerated) with protection from light
- Stability duration: At least 7 days (up to 14 days demonstrated in some studies) 1, 2
- Room temperature stability: If stored at 21°C, 5-FU remains stable for 14 days, though refrigeration is preferred 2
Container-Specific Considerations
PVC Bags (Standard Baxter Infusion Bags)
- Highly compatible with 5-FU at all tested concentrations
- No significant drug loss during simulated 24-hour infusions 1
- Stable for 14 days at both 4°C and 21°C 2
- No adsorption issues with PVC material
Ambulatory Pump Reservoirs
For continuous home infusion using portable pumps 2, 3:
- PVC reservoirs: Stable for >14 days at 33°C (body temperature during infusion)
- Caution at 4°C in PVC reservoirs: Precipitation may occur after 5 days of refrigeration
- EVA (ethylene-vinyl acetate) reservoirs: Stable for 2 weeks at 33°C, but only 3 days at 4°C before precipitation
Clinical Dosing Context
When preparing 5-FU for continuous infusion regimens 4:
Common Continuous Infusion Protocols
- FOLFOX/FOLFIRI regimens: 1200 mg/m²/day × 2 days (total 2400 mg/m² over 46-48 hours)
- Important safety note: NCCN recommends ordering chemotherapy in 24-hour units (i.e., 1200 mg/m²/day NOT 2400 mg/m² over 46 hours) to minimize medication errors 4
Typical Preparation Example
For a patient with BSA of 1.8 m² receiving FOLFIRI:
- Daily dose: 1200 mg/m² × 1.8 m² = 2160 mg
- If diluted in 250 mL bag: concentration = 8.64 mg/mL (well within stable range)
Critical Safety Considerations
Evaporative Water Loss
- Substantial water loss can occur from pump reservoirs at 33°C over 14 days, leading to falsely elevated drug concentrations 2
- This is primarily a concern for extended home infusions lasting >7 days
- Less problematic with standard 46-48 hour infusions
Precipitation Risk
- Avoid refrigerating filled pump reservoirs if treatment will extend beyond 3-5 days
- Prepare fresh solutions or use room temperature storage for pump reservoirs
- PVC bags for hospital use can be safely refrigerated
Administration Set Compatibility
- No significant drug loss occurs with PVC administration sets during 24-hour infusions 1
- Standard IV tubing is appropriate
Practical Preparation Algorithm
- Calculate total 5-FU dose based on patient BSA and regimen
- Select diluent: Either 0.9% NaCl or D5W (institutional preference)
- Determine final volume to achieve concentration of 1-16 mg/mL (typically 5-10 mg/mL for convenience)
- For hospital-based infusion: Prepare in PVC bag, store at 4°C with light protection, stable for 7 days
- For ambulatory pump:
- Use PVC reservoir if available
- Prepare at room temperature or refrigerate only if infusion will begin within 3 days
- For body-worn pumps, solution stable at body temperature for full treatment duration
This preparation method ensures optimal stability while maintaining the efficacy and safety profile established in clinical trials for 5-FU continuous infusion regimens.