A guide to the safe set-up and administration of cytarabine CRIs

Cytarabine is a treatment option for meningoencephalitis of unknown origin, an immunemediated neurological disease of dogs. Any veterinary professional setting up and administering a constant-rate infusion (CRI) of cytarabine needs to wear appropriate personal protective equipment (PPE), such as impermeable gowns, long nitrile gloves, eye protection and respiratory protection. PPE must also be readily available in the ward for staff to wear when interacting with the patient. The prescribing veterinary surgeon will evaluate the patient's haematology results before calculating the desired cytarabine dose based on the animal's body surface area. The cytarabine CRI must be prepared using a closed system transfer device, ideally within a laminar flow cabinet to help prevent user exposure. The CRI needs to be protected from light once prepared and while being administered; to achieve this, an opaque bag can be placed over the fluid bag, with UV-light-protected extension sets or syringes being used to connect to the patient. It is important that the intravenous catheter is inserted at the first attempt with no trauma to the vein, to avoid leakage of the medication. The patient must be in an appropriate environment while the CRI is being administered, consisting of a floor-level kennel lined with absorbent sheets and bedding. All cytotoxic waste must be collected separately from other practice waste and disposed of by specialist contractors.