Equipment issues and countermeasures during blinatumomab administration using a continuous ambulatory delivery device

Abstract

Blinatumomab treatment typically commences in an inpatient setting, transitioning home-based therapy to regular outpatient visits. We introduced a continuous ambulatory delivery device (CADD) to enhance outpatient care. This study aimed to identify equipment-related issues associated with blinatumomab administration via CADD to optimize clinical practice. We retrospectively reviewed the medical records of 21 children who received blinatumomab via CADD between December 2019 and April 2025 (46 cycles) at our institution to identify equipment issues and corresponding preventive actions. The median age was 8.4 years (range; 0.9–15.8), with a median of two blinatumomab administration cycles per patient (range; 1–6). Equipment-related problems included line disconnection (11 cycles), blood backup into the line (11 cycles), battery failure (six cycles), filter leakage (two cycles), and air in the line (two cycles). After introducing an instruction manual for checking the infusion line connections, the frequency of line disconnections decreased from nine out of 29 cycles (31%) to two out of 17 cycles (12%). Backing of blood into the infusion line was resolved by adjusting the position of the line. Our identification of equipment issues and the implementation of appropriate preventive measures resulted in safer blinatumomab administration.