Research Article|Articles in Press, 102322

Chemotherapy induced phlebitis experienced by women with breast cancer following administration of epirubicin using a volumetric infusion pump; an observational study

Published:March 11, 2023DOI:


      • Peripheral administration of epirubicin can cause phlebitis.
      • Limited evidence exists for epirubicin administration methods to reduce phlebitis.
      • Infusion pump administration of epirubicin increased patient-reported phlebitis.
      • No significant difference in phlebitis severity on clinical assessment.
      • A transient increase in phlebitis severity compared to manual injection method.



      To establish the incidence and severity of chemotherapy-induced phlebitis (CIP) following administration of epirubicin chemotherapy using a volumetric infusion pump (Hospira Plum 360), compared to a previous study of manual injection of epirubicin. Secondly to gain insight into staff perceptions of ease of use and safety of infusion pump administration.


      An observational study of women with breast cancer (n = 47) receiving epirubicin via volumetric infusion pump. Phlebitis was reported through a participant self-assessment questionnaire and graded by clinical assessment three weeks after each chemotherapy cycle. Staff perceptions were explored using questionnaires.


      Infusion pump administration delivered a significantly higher concentration of epirubicin (p < 0.001), a significantly higher rate of grade 3 and 4 participant reported CIP between cycles (p = 0.003) but demonstrated no significant difference in grade 3 and 4 CIP when assessed clinically three weeks after treatment (p = 0.157).


      Peripheral epirubicin administration will result in severe CIP being experienced by a proportion of patients irrespective of whether infusion pump or manual injection method is used. Those at high risk of severe CIP should be informed of the risk and offered a central line. For those with a lower risk of severe phlebitis use of the infusion pump appears to be a safe option.


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